84 W 2nd St RERF20-0036 Shingle ,;--:5,...,\,,J--,---;,,, REROOF SHINGLE PERMIT PERMIT NUMBER
,* s' RERF20-0036 1
l." CITY OF ATLANTIC BEACH
�r ISSUED: 2/27/2020 H
800 SEMINOLE ROAD
\`ail `9r v ATLANTIC BEACH, FL 32233 EXPIRES: 8/25/2020
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:
84 W 2ND ST REROOF SHINGLE SHINGLE ROOF $4092.00
TYPE OF i REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP: #
170837 0300 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: IiCITY: STATE: ZIP:
RELIANT ROOFING INC 4230 Pablo Professional Ct#155 Jacksonville FL 32224
OWNER: ADDRESS: CITY: STATE: ZIP:
MANGUM WANDA M 13034 TWIN PINES CIR S JACKSONVILLE FL 32246
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.
1
r+
.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$79.00
Issued Date: 2/27/2020 1 of 1
, , 5 Building Permit App ication Updated l0/9/18
't� City of Atlantic Beach Building Department **ALL INFORMATION
7.',..f-,, � HIGHLIGHTED IN GRAY
,� }�
�Fi, 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us R IS/R�EQUIRED.
lob Address: 84 W.2nd St Permit Number: E.1\P Z v -003(0
Le al Description 18-34 17-2S-29E.06 SEC H ATLANTIC BEACH PT LOT 4 RECD O/R 13708-134 REN 170837-0300
g P
Valuation of Work(Replacement Cost)$4092.00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew DAddition ❑Alteration DRepair DMove DDemo ❑Pool DWindow/Door
• Use of existing/proposed structure(s DCommercial DResidential
• If an existing structure, is a fire sprinkler system installed??( DYes ❑No
• Will tree(s)be removed in association with proposed proiect?❑Yes(rtlust submit separate Tree Removal Permit) flNo
Describe in detail the type of work to be performed: X
reroof townhouse,9 sq, 5/12 pitch,shingles FL10124-R21
Florida Product Approval# for multiple products use product approval form
Property Owner InfojmatiorFL10124-R21
Name David Bolton '/ Address 13034 TWIN PINES CIR S
City JACKSONVILLE State FL Zip 32246 Phone 904-860-4637
E-Mail bolton79@icloud.com
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Reliant Roofing Qualifying Agent Cameron Shouppe
Address 4230 Pablo Professional Ct#155 City Jacksonville State'vi Zip,32224
Office Phone 904-657-0880 Job Site Contact Number 904-712-3111
State Certification/Registration If' CCC1330615 E-Mail amanda@reliantroofino.com
Architect Name&Phone SI
Engineer's Name&Phone#
Workers Compensation Insurer:Po)icyli:1yp_126-A9725 OR Exempt❑ Expiration Date 11/20/2020
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 o tFf. riglµlatir
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WO ,eL WAS)NS F\ I ‘.1,..., 4 1,r b
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition t6 thb itremiks4 nts'of this i y'
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. FEB 2 5 2020
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.
B�lilc!i ( �"nrtment
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMEN ENT MAY' ICS' FL
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 NOTIC OF COMMENCEMENT. f
(Signature of Owner or Agent) (Signa a of . actor)
Signed and sworn to(or affirmed)before me this d6 day of Signed and sworn to(or affirmed)before me this 25day of
FP cS , `ZCILQ,by_DD,. I Cia•kkOY-, ce k3 , 2.0'2.0,by Y`y,-oh 51-,n��P�, °�
g
:.a..::-.ate. -
AN1INa : fgeKSON (Si•n to ►-
`,s 41:' AMANDA JACKSON
..-'0411/w,-.,..state of Florida-Notary Public 4:',11p,,,
k._.,• Commission a GG 205328 Siete of Florida Notary Public
)6 Personally Known O-%;".3.1-,,,,;0,,:-' My Commission Expires (Personally Known OR ;. -... •2 Commission M GG 205328
% " April 09,2022 r•• . 'a8 l ty Commission Expires
Produced Identifica>1 n " "' [ 1 Produced Identification �.;o,,,,d,: 2022
I ] AOril09,
Type of Identification: .y.��a�� `1 ?v•-•S R vv Type of Identification: n --
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL _
1.Siding
2.Soffits
3. EIFS
4.Storefronts
5.Curtain walls
6.Wall louvers
7.Glass block
8. Membrane
9.Greenhouse
10.Synthetic stucco
11. Other
D. ROOFING PRODUCTS
1.Asphalt shingles GAF 3-tab Royal Sovereign FL10124-R21
2. Underlayments GAF Feltbuster FL18686-R1
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16.Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updated 10/17/18
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor Name (Print Name):Cameron Shouppe *Contractor Signature: CiaoVIA,treritt,
*Company Name: Reliant Roofing
*Mailing Address: 4230 Pablo Professional Ct #155
*City: Jacksonville *State: FL *Zip Code: 32224
*Telephone Number: 9046570880 *E mail Address: amanda@reliantroofing.com
Cell Phone Number: 9047123111 Fax Number:
Page 4 of 4 Updated 10/17/18
Doc # 2020035745, OR BK 19104 Page 2326, Number Pages : 1 ,
Recorded 02/14/2020 09:59 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tux Folio No.
State of Florida —^� County of pu
To whom It may concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved' 18-34 17-2S-29E .06
SEC H ATLANTIC BEACH PT LOT 4 RECD
QLCi13708-1345 BLK 82 c —
Address of property being improved: S 1-1. W._ f1 C� S-�'- ,.3oq`1 33
-
General description of improvements' Roof Replacement
Owner David Bolton
Address 13034 TWIN PINES CIR S JACKSONVILLE, FL 32246
Owner's Interest in site of the improvement owner
Fee Simple Titleholder(if other than owner)
Name
Address ------.-__..-_--
Contractor Reliant Roofing —Address 4230 Pablo Professional Ct#155 Jacksonville FL 32224
Phone No.904-657-0880 Fax No.
Surely(if any) _
Address _Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the anprovements.
Name
— -
Address . ..- ---
Phone No. Fax No,
Name of person within the Stale of Florida,other than himself.designated t 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 ccpy 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- ___— Fox No.
Expiration data of Notice of Commencement(the expiration date is one(1)year front the d te of recording unless a
different date Is specified):
THIS SPACE FOR RECORDER'S USE ONLY ,0 elf..- q> 4E'R l
02/05/2020
Signed: �.p C1� DATE
Before me finis _day of �`g)
Cou v Ouvai ate for a b¢d mono's
277' i �p ytNDA JACKSON
tam3�1r/herserfana etnn leaa statementsa 3 tg'fbte of Florida-Notary Public
ore hue t(iu• tote - I+ii. Commission OGG 205328
='' ''3:'''7My Commission Expires
mt ' April 09,2022
Nol roduc-Mit • argo.Sten•• - county Of �,.• llU
My commis .n xpires: — •
Personally (no n - • t, or
Pmd,rcad dans cation---'\ i it�V---.-•_
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