1471 LAUREL WAY RERF20-0210 REROOF SHINGLE PERMIT PERMIT NUMBER
RERF20-0210
CITY OF ATLANTIC BEACH
Iry ~" ISSUED: 12/7/2020
800 SEMINOLE ROAD
°1119r ATLANTIC BEACH, FL 32233 EXPIRES: 6/5/2021
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: I PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1471 LAUREL WAY REROOF SHINGLE SHINGLE ROOF $14250.00
TYPE OF ' REAL ESTATE BUILDING USE y
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170704 0035 HIDDEN PARADISE
COMPANY: = ADDRESS: CITY: STATE: ZIP:
DS KILLIAN ROOFING &
GENERAL CONTRACTORS, 1051E. Mimosa Cove Ct JACKSONVILLE FL 32233
INC.
OWNER: ADDRESS: CITY: ; STATE: ZIP:
BACKMANN VALERIE P 1471 LAUREL WAY ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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.
-----1111031.111111.11111
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $125.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$129.00
Issued Date:12/7/2020 1 of 2
�iD'ir,`, Building Permit Application Updated l0/9/18
�, City of Atlantic Beach Building Department **ALL INFORMATION
,J
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
"JtttIS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1471 Laurel way AB FL 32233 Permit Number: i E_R 7C-) -• t>Z I C
Legal Description 54-97 17-2S-29E . 13 HIDDEN PARADISE LOT 6 Ru1170704-0035
Valuation of Work(Replacement Cost)$ /l'7/ .-5 - Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ENew ❑Addition ❑Alteration ❑Repair ❑Move DDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ckftesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes lI No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) IANo
Describe in detail the type of work to be performed: REROOF RESIDENCE
`�",.N CSI
Florida Product Approval#FL-10124 . 1, U4�� FL ,l1J � for multiple products use product approval form
Property Owner Information
Name CLIFFORD BACKMANN Address SAME
City AB State FL Zip 32233 Phone 904 514 9847
E-Mail
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Informationy (3141- Me of Company /��l//j +��J/ 1
e G' - „CA_ Qualifyin ent '/� e C (�i I 11 Levi
Address/6'5 /1/l''�C _lCOQ Cr- �. City State ' r-L- Zip 3,2-)--73
Office Phone Job Site Co tact Number .5I'&F_'
State Certification/Registration# r-CC (C, 3 E-Mail c- a/e cdc /(Ci 111 el vv . GC;1A--,
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt 12 Expiration Date e1/3C/>2//3C/>2/
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 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 I ANCING, CONSULT WITH YOUR LENDER AN , ORNEY BEFORE
RECORDIN , ZR N ICE OF COMMENCEMENT. /' c
C
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this 12- day of Signed and sworn to(or a'red) befm ' is F----day of
\i ,i` , LaZ.r, , •y (- P ��� (�(�\( • M .4
(Signature of Notary ' Allry _n. '. . ) ,
�.W •'',•P7n�' TONIGINOLESPERGER
4;"," JACK SCABAROZI �°•• � �°"-_ MY COMMISSION#GG 353178
e�? Commission#GG247125 ,] Personally Know I -'` •;.:
[ I Personally Known OR " "" EXPIRES:October 6,2023
--% Expires August 9,2022 4 .'<
u'f.OF.P`OP•' Bonded Thru Troy Fain Insurance 800-385-7019 ■p■ ','. `°`"• Bonded Thru Notary Public ,202 titers
NOTICE OF COMMENCEMENT
State of FLORIDA Tax Folio No. 170704-0035
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:
05515 HIDDEN PARADISE 5609 54-97 17-2S-29E LOT 6
Address of property being improved: 1471 LAUREL WAY ATLANTIC BEACH FL 32233
General description of improvements: REROOF
Doc#2020271806,OR BK 19483 Page 589.
Owner: CLIFFORD BACKMANN Address: SAME Number Pages 1
Recorded 12/07/2020 11 41 AM,
Owner's interest in site of the improvement: RESIDENCE RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
Fee Simple Titleholder(if other than owner): NIA RECORDING $10 00
Name:
t
rfvc_
r�i�l,GCN //2..„,,.
Contractor: �j . ✓�`� 4 (..3_"c_ -
Address:/C, ' `V i/ 'sw '✓ - ( C
Telephone No.:7vti 41( 16'6 5 Fax No:
Surety(if any) NIA —
Address: Amount of Bond $
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: N/A
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: N/A
Address:
Telephone 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 St es. (Fill in at Owner's option)
Name: /(/
Address:
Telephone No: Fax No:
Expiration date of Noti a 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 OWNER
Signed: Date:
Before me this \ Z day of Ni ,ve.4^(1)�-s- in the County of Duval,State
vpV> JACK SCABAROZI personally pp c. y(�,.ei(c nr,n7^
Of Florida,has appeared ' l von 1. C 1 �C
_, Commission#GG 247125 Notary Public at Large,State of Florida,County of Duval.
o; Expires August 9,2022
''��oF ;°P` Bonded Thru Troy Fain Insurance 800-385-7019 ' My commission expires: I,iS.-9 17eJ7 Z