925 Seminole RERF20-0049 Shingle -- 't'-'-/-%.,,,, REROOF SHINGLE PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH RERF20-0049
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800 SEMINOLE ROAD ISSUED: 3/11/2020
\0;iwr ATLANTIC BEACH. FL 32233 EXPIRES: 9/7/2020
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:
925 SEMINOLE RD REROOF SHINGLE SHINGLE ROOF $12200.00
TYPE OF I REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170060 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: I STATE: ZIP:
HAMMER TIME ROOFING 14286 Beach Blvd JACKSONVILLE FL 32250
OWNER: ADDRESS: CITY: STATE: I ZIP:
ROSS XAVIER 925 SEMINOLE RD ATLANTIC BEACH FL 32233-5445
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 $115.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$119.00
Issued Date: 3/11/2020 1 of 1
Tr' y'%, Building Permit Application
n Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
,``; i 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 902 S ,., ;,,,v le 2j Permit Number: RERr Z0 -- 9
Legal Description. -(,c1 1 -aS- 49 C= ,1 ti /}l(tnJ.,c 3v .I L() 1/!.? i31k id_ RE# 1 76(-)6()-- CLIGOO
Valuation of Work(Replacement Cost)$ I ) , ,If jC•, Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ( R/ issidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes G1Fdtr
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) I4¢tT'
Describe in detail the type of work to be performed: I
ke - k2r,f i it,,i1L,
Florida Product Approval# /=[ It 6 7 u(, ',IVO/'"'31c j for multiple products use product approval form
Property Owner Information PC i3 14' -R (U-,c4<-1-7' 4-
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Name )1l /Z_)(?.; % Address c/a.i c e,..-1.--,<)rc i�
City /} 1L,.,i„ n .•c 1 State I_
E-Mail ( Zip 3 L -33 Phone
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company f-(c,,r.,,j..- j;,..-1,� 124..o CI,� „(�,`� //
Address /`t,) f�7 34:-..5_,, I_ /� � '.t�( /�.--I'r.4)b-11._r:L.-.•
l „C1 .fir lei- 3� Qualifying Agent h City 3c:.14. State C Zip ' )a
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Office Phone (1&I 17/ - q/9 qJob Site Contact Number7(}.1 ).
State Certification/Registration# CCC /3 /lei 8 3 E-Mail hr,,,,,,,.... hme f-.0 (e, 5.,,_ e___,‘,1_,
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer l3; thie t Ic' t t;.,,...i 1- OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do the work and'nstallations 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 FINANCING, CONSULT WITH YOUR LENDER 0, N ATTORNE BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent)
(Signature of Contractor)
Signed and sworn to(or affirmed)befor me this fday of S' ned and sworn to(or a irm'•)be •re me this day of
VPb(1 4�� , hoc)U, • - ` 11 �.�5J Qk 202,C) . 4 d /,. `
....,;, ,. ,. _ <_. ' nature of Notary) 0 Signair1r'o N
; ,....a'-• JENNIFER JOHNSTON
* (� ,�, MY COMMISSION#GG 042984
'r : -,.- EXPIRES:October 27,2020 r
[ ]rsorallPattflowaFOIL Underwriters
•�__,_ j.}Personally Known OR
rod ( ]Produced Identification
Type of Identification: C 1,. ` n� 9, S I ' L A S.1L Type of Identification: ;.,,,.Y. , TONI GINDLESPERGER
.: mr 1,-, MY-COMMISSION ft GO 153178
.•o: EXPIRES:October 6,2023
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°,.r:f`�OP' Boded Thru Notary Public Underwriters
NOTICE or commgscrazirr
I
iFF:= .'.E IN DUPLICATE,
Permit No. I 7c6O 0
Stesta of No f'1fCie, Tax yIIC t'1Q� " v{�("}�)
County of , �V,� , " '�./
To whom it may concert;:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Sectio 7.13 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: S- 6i I6 - aes - ca' E < 161
Ancerolle .te In
Loi- W b iii k i 1 ,
Address of property beino improved: 9 a SCI
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614r..a114 .,„i..L. FL 3, a 3"?
General description of improvements: /2 r — u
I
Owner 3; I( Ras S ) t� /�
Address 94o),S- ,c-�;.,u I hL i' .d /Y'Hr.. ,
D;:rers interest in site hi3,-,:c_4. 1`( i�� 3
t_of the impro•!ernent
Fee Simple.Titleholder(If other than owner!
Name
Address
Contractor ilArl"t r ! 'LP./G
dercle)Cu-7 Address J4'2 ' i' -.r& /3L,r1 S k /1'-3e6 x e i=( 3a4_V4-)
Phone No.J`XX9y 711-f216!9 Fax No.
_.....Surety(if any)
Address 1
hone No. Amount of bond S
Fax.No.
Name and address of any p'rson makino loan for the^-
a - nssruciion of the improvement.,
Name
AddressI
Phone No.
Name of person within the State of Florida,.other then himself,dasio„0ted by owner upon whom notices or other
documents may be ser•!
!Jame -
Addre.ss
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),FloricN Statutes.t ii!in at Owners option).
Name
Address
Phone No.
•=ax No
Expiration dateNotice of Notice of Co mencei'nent(the expiration date is one(1)year from the date of recording UnICSS a
different date is specified): i
THIS SPACE FOR.RECORDER'S USE
ONLY j
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OWNER :::esti@:k..;yk„
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.^.aro s me la dei of DATE •
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` 1 of "c is a persona Iv appeared *.,
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Recorded 03/06/2020 03:28 PM,
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RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
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