250 Jasmine St RERF20-0033 Shingle rsREROOF SHINGLE PERMIT PERMIT NUMBER
'�
`:< is CITY OF ATLANTIC BEACH RERF20-0033
(---.A.
� 800 SEMINOLE ROAD ISSUED:
'tis` ATLANTIC BEACH. FL 32233 EXPIRES: I
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:
250 JASMINE ST REROOF SHINGLE SHINGLE ROOF $7000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170851 0000 ATLANTIC BEACH SEC H
COMPANY: , ADDRESS: CITY: STATE: I ZIP:
A CROWN ROOFING INC 9791 Old St Augustine Rd JACKSONVILLE FL 32257
OWNER: ADDRESS: CITY: : STATE: ZIP:
ROSARIO EDWIN 600 10TH AVE APT 4FN NEW YORK NY 10036-3023
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date: 1 of 1
Building Permit Application
. ' updated 10/9/18
('t A City of Atlantic Beach Building Department "ALL INFORMATION
.%�
/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us iS REQUIRED.
lob Address: 2,r0 7a5M YIE Sf)A� i� L R F Z 0 -- C'(_;3 J
+r^'t�l� ac+ru r1� �zL3 Permit Number:
Legal Description (g-3N. 1.7-1.S -29E A-�lan�-1c' c eatN Se._ H 1.p} k N//Z9.ui t R`E�' h�u g� l708S1-A ?
Valuation of Work(Replacement Cost)$ 71O§0 Heated/Cooled SF i 056) Non-Heated/Cooled ii i 7
• Class of Work: ONew ❑Addition ❑Alteration XRepair °Move LiDemo OPool OWindow/boor
• Use of existing/proposed structure(s): ❑Commercial t Residential
• If an existing structure,is a fire sprinkler system installed?: flYes IINo
• Will tree(s)be removed in association with proposed pro)ecty_pf/es(must sub it separate Tree em4val rmit) Cif No
Describe In detail the type of work to be performed: ( e- 't 17 C ,L�-e ) //2 k�1 S{ a�j�
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name E SW'VI R050-1;0 a Address (,0110 10th _Ave. API- '(F
City 1 ' . 1 . State NI Zip 10636 Phone 9 17- S36-1171
E-Mail t ,a;Q14nD).31?A. ,110M
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information_
Name Addre of Company A f( QualifyingAgent�V)Aki0-W't RUt►n
s 97?( 0 t� ;r Rd City 3f Ll ftv:tit State 7L zip 3zZrY
Office Phone pr�q.ij9- �7
!" � Job Site Contact Number p{-Z 37 r141-J
State Certification/Registration it Ca.(3 2 952 I E-Mail W Rokn ta iilawn roar
r tj can
Architect Name&Phone# J
Engineer's Name&Phone#
Workers Compensation insurer I '.' . ' _1_ . ,y _,,,,.., OR Exempt o Expiration Date 0(70t/Z 2(
Application is hereby made to obtain a permit to do the work and Installatio 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 regulating
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. 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.
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 FI LACING, CONSULT WITH YOUR LENDER OR AN ATTOR BEFORE
RECORDI R NOTIC COMMENCEMENT.
(Signature of Owner or Agent) /
(Signator:of Contractor)
S" lted and sworn to(or affirmed b fore me this 4Z__.day of Signed a i worn to(or affirmed)before me this day of
1) ,,,A_ry . 2� ,by 1 / iZ1Of� e) '� .r' 4. 202e,by 1.4.)./f,'oevt �4
2 - / /
(Signature of Notary) 7 (SignatureJ
of Notary)
i )Personally Known OR i ersonatiy Known OR
(')Produced identifications, O Produced Identification
Type of identification: Type of Identification
MY COMMISSION#GG 13 9490 ' i ' ' DON MICHAEL—WATERS,JR.
o= EXPIRES:August 3,2023 +; MY COMMISSION 4 GG 319490
°....',7i
' Bonded Tru M.tary Public linden/Mien = o: EXPIRES: .zo23
''',u:iti,�' Bonded Tin Notary Fabric unsenrriism
Doc tt 2020036215, OR BK 19105 Page 1266, Number Pages: 1,
Recorded 02/14/2020 02:28 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
(PREPARE IN Cl1PUCATE)I ry Q
Permit No. Tax Folio No. ` I g (� — 0000
Slate of County of (arkt
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property and in
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 0-) 1 (� 7- 9 C A i l
01\4 r L b u 1
1-1 tok � Z9 .1-;3�7
Address of property being improved: 7..51) 3 65111 i'in . 7T �O n4;L ("36 50,-‘,FL 3 2.z.:3)
General description of improvements: Re'R(Crt
Owner Fdw''\ oscf•c;
Address 660 101% Ave A)'+ �{FN New York,/VY 10036
Owner's interest in site of the improvement 5C'if
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor/?• • jk'i 74( ( I
Address f.:/,' !• S (1 Cc 71(/ I7P / c Tck
Ct0'7
Phone No. .�0 ♦ ✓ Fax No. Q y £ - 6 11&f.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for he construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.06(2)(b),FlOrila Statutes.(Fill in at Owner's option).
(
Name n f`crit L�j
Address 50-01
1' Phone No.
Fax No.
Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a
444 different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
segned , `� •ATE 2/4 'o D
Before me this day of s_�►�3• J -v
. pLpt�a In the CouMy d�SlaleptFty4dgt�aa :... appeered
himself/herself and a1ACaoiar+ilAa4 Ma
ms that at statements and herrn
d
AD
aro true and accurate ;„;i,: DON MICHAEL WATERS.JR.
(/ �i �l� Ali COMMISSIONS GG 319490 4490
I �f ,� % ? �' P' EXPIRES'
J(PIRES Aupuet 3.2Q23
23
a .• �,'• "Oen
Iked-A Thou notary Public tAderrrbra
Notary' buc at Large. late o• �/�,�` .w,ty',f ► i
My corrxniesbne�lres: �'c S: �?7
Personally Knwn or
D� —