500 Orchid St RERF20-0022 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF20-0022
800 SEMINOLE ROAD ISSUED: 2/5/2020
E)iii" ATLANTIC BEACH. FL 32233 EXPIRES: 8/3/2020
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:
500 ORCHID ST REROOF SHINGLE SHINGLE ROOF $9750.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170906 0000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
SCHULTZ ROOFING JACKSONVILLE
216 N 20TH ST FL 32250
COMPANY INC BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
HADDEN BEVERLY E 500 ORCHID ST ATLANTIC BEACH FL 32233-3442
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
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
j
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $104.00'I
Issued Date: 2/5/2020 1 of 2
(rp.A4 ri REROOF SHINGLE PERMIT PERMIT NUMBER
,`/ * ..t,at
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED:RERF20-0022 2/5/2020
o;: 9'' ATLANTIC BEACH. FL 32233 EXPIRES: 8/3/2020
Issued Date: 2/5/2020 2 of 2
Sy' Building Permit Application
City of Atlantic Beach
\'l
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
) 7
Job Address: SOD Q r-(4 t d 22—t- Permit Number: R1 ZO- 00 Z C
Legal Description ) g -3q /7 -a S "0/1 c=,-- .S EC i1 HTL�j/L66/9c1I RE#
Go -s5; evg li /a -7
Valuation of Work(Replacement Cost)$ 175-0 0 v Heated/Cooled SF 10 y Non-Heated/Cooled / g Y
Is'y
• Class of Work(Circle one): New Addition Alteration Repair Move D.." 'ooI Window/Door Re-200 f-
•
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/
• 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:
Pt,l-f- O c 4-1'1-e h-e Lv , M,'d.Cf44c unde�//ky/4tint FLA/ / 7 ye)/-
Florida Product Approval# G-A RS/-troy/e S -Fut/Q/d t/. / for multiple products use product approval form
Property Owner Information 64 FCOb/G<IR- Ve n14' Fc�#- 6c 47• /
Name: 1 2V 8-c iV ttadde-r Address: 50 0 C9rc—Ls d SI
City 11- ( . 6G{-, State F( Zip 3223 3 Phone o2 to ^ a 3 s7 -2
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information 1 (� / r_ (� ,L
Name of Company: c h UI 4 ? k C--, (�� l� 10`Civali ing Agent: c CC /a_s 4 ch., /1-2
7
Address I (G Z City-lc,X 6Ca-1 Site r Zip 37 2 S
Office Phone 9 C LI - ,;2 4(( -4 ) Job Site/Contact Number 9t ( ) S-,7 po{0 3
State Certification/Registration# C C C -- r] ,r'f Mail .5C—I, r00-7c cad 3 7J Va-A 00 . Gds r -
Architect Name&Phone# /
Engineer's Name&Phone#
Workers Compensation 3 w' S/]Sca.rarc C Solt Ill'onc Z. Lc (AJ . Oaf t-000O( — Of
Exempt/Insurer/Lease Employees/Expiration Date g.-I c• a019 ..q- IC-242D
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 0: FAIN FINANCING, ONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC e 'DING Y•UR N O T E OF COMMENCEMENT.
/ , , 0, / ip„______ -j-.:. .`�/i �U
(Signatur- • Owner or Agent including Contract$r) (Signature of Cot actor) ��yy ,
Signed and swor . (or affirmed)beforemethis. / day of Signed and sworn to(or affirmed)be Ire me thiSO day of
�-..^ gZ0D.(6 , by a'P.V€C t-.( bi -- —``--- ,c' ' ,by � l5ic-S P 5 e-6.c,. (f
,(>134‘..,' _ -A-605 _5-zQ____ 7,,,e2 Z----'LI• 7)2}0"zr)-- --
(Signature of Notary) (Signature of Notary)
II -�t"" ROBIN C.MOORE iiR ! ROBIN C.Ni.'J JRE
., 9585 '•`
Personally Know W COMMISSION GG 35 V]Personally Known OR ' ;a :* MYCOMMISSI:: I<G�_359r�85
-�i EXPIRES:July 28,2023 '?•��—'o; EXPIRES:July 28,::Q23
[ ] Produced Identifi tib °•' Bonded 7Mu Notary pubMcllydennilers [ ]Produced Identification
OF i��e T
Bonded.hru NotEri�Lbii:.:!:e,wdters
Type of Identificatio .J4 �e1 - �� Type of Identification:
Doc#2020027443,OR BK 19093 Page 567,
Number Pages:1
Recorded 02/04/2020 11:51 AM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
Permit Number RECORDING $10.00
Key Number
NOTICE OF COMMENCEMENT
State of Florida
County of Hernando
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.of the
Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property(legal description): .J E=3( I Q.S'a9 SEC tf- . 431r1( c13_(L_ A_
a)Street(job)Address: SbD ,-Ci,,'oI -s--t-. f 4-f p c_li Pi L o s ,57:4 Q J k /2
2.General description of improvements: ?az 3 3
-------- ------------- --- - --------- ------------
3.Owner Information or Lessee information if the Lessee contracts or the improvement:
a)Name and address: -1 44.0(R__
------------- --------------- ----
b)Name and address of fee simple titleho er(if different than Owner listed above)
----- - ----c)Interest inro
P PedY: e
4.Contractor Information
a)Name and address: SG,t,_i i--z_ too A- --__Tri C • a l& ni• --�7`� 5g• J x /3d
b)Telephone No.: (optional) C{ -
y-02.��2 a 3 1 S-------- ---- Fax No.: � 3Po_,P----- -----..
5.Surety(if applicable,a copy of the payment bond is attached)
a)Name and address:
b)Telephone No.:
c)Amount of Bond: $
6.Lender
a)Name and address:
b)Telephone No.:
7.Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.13(1)(a)7.,Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.:(optional)
8.a.ln addition to himself or herself,Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
b)Phone Number of Person or entity designated by Owner:
9.Expiration date of notice of commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be 1 year from the date of recording unless a different date is specified): ,20
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,SECTION 713.13, FLORIDA STATUTES,AND CAN RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON
THE J.B SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATT•'NEY BEFOR COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
1 If / ipvp-----
1'A�._ e_1.
ignature of Ow •r.r Le see,or Owner's or Lessee's(Authorized Officer/Director/Partner/Manager) (Print Name Prbulde Signatory's Title/Office)
The foregoing in• ment was acknowledged before me this o1-$ day of �OkY 1 L.,LS�.,h e ,20 a,,,C�
b y -er -� J a s
(Name of Person) (type of authority,...e.g.officer,trustee,attorney in fact)
for (name of party on behalf of whom instrument was executed).
--- ------
Personally Known Known Produced ID ❑
Type of ID e -4a1///602-____
°i tt ROBIN C.MOORE Print na e
;,,: MY COMMISSION#GG 359585
�,;o`,.� EXPIRES:July 28,2023
„od;g.,• Bonded Thru Notary Public Underwriters