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1107 Cornell Ln RERF20-0001 Shingle %S'r'`''%% REROOF SHINGLE PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RERF20-0001 c3ei � � :- ISSUED: 800 SEMINOLE ROAD 401i19'" ATLANTIC BEACH. FL 32233 EXPIRES: MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 1107 CORNELL LN REROOF SHINGLE SHINGLE ROOF $6626.00 TYPE OF f REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 177387 4020 CORNELL ONE COMPANY: ADDRESS: CITY: STATE: ZIP: PRIME ROOF 13725 BEACH BOULEVARD, #13 JACKSONVILLE FL 32224 CONTRACTING LLC OWNER: ADDRESS: CITY: STATE: ZIP: CORTES RAFAEL ET AL 1107 CORNELL LN ATLANTIC BEACH FL 32233-3484 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. LIST OF CONDITIONS —— 's Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $85.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $89.00 Issued Date: 1 of 2 .,:11-Anti,' REROOF SHINGLE PERMIT PERMIT NUMBER �. CITY OF ATLANTIC BEACH RERF20-0001 ��rj 800 SEMINOLE ROAD ISSUED: \ �'_ ATLANTIC BEACH. FL 32233 EXPIRES: Issued Date: 2 of 2 Building Permit Application o iJ City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 9� Phone: (904) 247-5826 Fax: (904)247-5845 Job Address: 1107 Cornell Ln., Atlantic Beach, FL 32233 Permit Number: R �R,` Z0-000 Legal Description 55-91 38-2S-29E .178 CORNELL 1 LOT 4 RE# Valuation of Work(Replacement Cost)$6,626 Heated/Cooled SF 1246 _Non-Heated/Cooled 70 • Class of Work(Circle one): New Addition 1 eratio>n Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial cesidenti1) • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 40 • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: Replace roof with asphalt shingles Florida Product Approval#FL10674-R12(shingles) FL17420-R2(synthetic) for multiple products use product approval form Property Owner Information Name: Maria Novoa and Rafael Cortes Address: 1107 Cornell Ln. City ATLANTIC BEACH State FL Zip 32233 Phone 904-233-1029 E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) -_ Contractor Information Name of Company: Prime Roof Contracting, LLC Qualifying Agent: Mark Young Address 13725 Beach Blvd Suite 13 city Jacksonville State FL Zip 32224 Office Phone (904) 530-1446 Job Site/Contact Number (904) 860-0230 State Certification/Registration# CCC1329505 E-Mail office@primeroofingfl.com Architect Name&Phone# Engineer's Name&Phone# Workers Compensation FRSA Self Insurers Fund Inc. 01/01/2021 870-040093/3EE6142 Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. -' -A . h 01500-- / .i (Signature of Owner or Agent including Contractor) (Signature Contracts - Signed and sworn to(or affirmed before me this Nday of Signed and sworn to(or affir -d)before ('this ? ay of 2-07,6,by filarI c NOVO° Zozo ,by 4)—Azie -rArjr;a1;-'C–: (Signaturef Notary) (Signature of Notary) 014 ', drew D. Davis vlib Andrew D. Davis COMMISSION#GG241220 ',' =COMMISSION GG241220 I�rsonally Known OR y ' ,; V1 Personally Known OR ( ] ',,; nm„� EXPIRES. Sept. 17, 1021 ( ]Produced Identification ., ,. ,.` EXPIRES: Sept 17, 2022 Produced Identification �� �� � p�,,,�_�mN�� uvi�uou Notary Type of Identification: Rmeted_lbni-Aaron Notary Type of Identification: yp NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of Florida County of Duval To whom it may concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved:55-91 38-2s-29E.178 CORNELL 1 Lora Address of property being improved:1107 Cornell Ln.,Atlantic Beach,FL 32233 General description of improvements:Re-roof Owner Maria Novoa and Rafael Cortes Address 1107 Cornell Ln.,Atlantic Beach,FL 32233 Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name Address Contractor Prime Roof Contracting,LLC Address 13725 Beach Blvd Suite 13,Jacksonville,FL 32224 Phone No.(904)625-1446 Fax No. Surety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name Address Phone No. Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY 'A��� OWNER Signed: —`1 u�`�Cl �O 0 OC - DATE I—r1—20 Before me this IHh day of 2�7(� in the CountufaDuu,al,Staite of Florida,rihas perso ally appeare [%{Rt`"li b �/�/e�►��y�himself/11 herself andaffirmsthat all statements and deal, on,a et d' �• D. Davis� Page 2065, are true and accurate 3 -COMMISSION GG241 Doc#2020004262,OR BK 19060 r SSIOIN 220 Number Pages:1 y. t<,',. EXPIRES:Sept 17, 2022 -, Bonded rnN Arron Recorded 01/0812020 09:20 AM, Notary RONNIE FUSS ELL CLERK CIRCUIT COURT DUVAL Notary ublic at Large,State f Ga 1-L , County of (?tiv 1 T COUNTYMy commission expires: o RECORDING $10.00 Personally Known or Produced Identification