558 Aquatic Dr RERF20-0239 re-roof permit ,wry REROOF SHINGLE PERMIT PERMIT NUMBER
A d CITY OF ATLANTIC BEACH RERF20-0239
-''k`� 800 SEMINOLE ROAD ISSUED: 12/22/2020
:1-_,1,11-0'' ATLANTIC BEACH. FL 32233
EXPIRES: 6/20/2021
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.
1OTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
:hat may be found in the public records of this county, and there may be additional permits required from other
;overnmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
558 AQUATIC DR REROOF SHINGLE shingle re-roof FL18335 $7300.00
TYPE OF REAL ESTATE ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: I GROUP:
171818 5186 AQUATIC GARDENS
COMPANY: ADDRESS: CITY: STATE: ' ZIP:
SHORE ROOFING JACKSONVILLE
914 7TH AVENUES FL 32250
COMPANY BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
EVANS BRIAN K 558 AQUATIC DR ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II`
'OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
OUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
tECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
toll 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: 12/22/2020 1 of 2
REROOF SHINGLE PERMIT PERMIT NUMBER
-. RERF20-0239
_. CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 12/22/2020
�`r�r / ATLANTIC BEACH. FL 32233 EXPIRES: 6/20/2021
Issued Date:12/22/2020 2 of 2
Building Permit Application Updated 10/9/18
J
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
`uriisr IS REQUIRED.
Phone:[Q (904) 247-5826 Email: Building-Dept@coab.us Q C `l G,
Job Address: 55 6 t-362(9 j 1 r[_ D12 . Permit Number: L-1`l ) D- 3 - /
Legal Description 3 8 -59 /7-.a 5 -aqE J . 1 'C_6.1.-f)e„os RE# /7/T/g-5/8
Valuation of Work(Replacement Cost)$7,`3&)4 - Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition DAlteration ❑Repair ❑Move DDemo ❑Pool ❑Window/Door
, • Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proosed project? TlYes(must submit separate Tree Removal Permit) I INo
Describe in detail the type of work to be performed: i ed),00� 3c)yece / tfrgce, sti,''f/'J
syr/144-g— t) 61.y /
Florida Product Approval# /_( / 4633.5" for multiple products use product approval form
Property Owner Information
Name .3r (I 4) e V i4A/S _ Address 5-53 /44)0411'
City 1�pJt+A_ e c. State 1:7 Zip 3,24133 Phone 3!7 w7
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information �/,,
Name of Company .S'1 f0/ / �Fi M� C. . Qualifying Agent �/Tv/�1 AS,S/T/Q/ G
Address 9 ay ( th 4v�e-•S J City j.. tQ�( (3C4 41 State /- I Zip ,3-ZL.ro
Office Phone 9 1- 9g Job Site Contact Number aaG ` a 35
State Certification/Registration# ezt...o i 1I! E-Mail �/t5Hole t. �r�/ . 10'7
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date - 4
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECOG" FL
"�NO` TIC- OF COMMENCEMENT.
(Signature of Owner or Agent) 44 (Signature of Contractor)
SiII
• e•A.114-sworn to 4€Ut6ri bef. - me this U day of Signed and sworn to(or affirmed)before me this day of
) t,L ,..•'J______a of.=ia_da NO 9.4:),4,_ZED., ._,by //�/It911Zs A. VC..
�Jl1Y . l IMF,/Wr% p t
':•� �if MyCJTT.'Oi � ,•
.E,'::.' ace leLt*rcL. tcealh.p.l i e o 'otary J•natur- • t.. .
1 " JENNIFER JOHNSTON
3°
/ MY COMMISSION#HH 057579 j
[ ]Personally Known OR [MMP sonally Known OR i .„.,. EES:wow Y7,� ,
( oduced Identification ,,) [ Produced Identificatiol 1 ” i*t%. Bonded'Thu , P1t&Unds1 is
Type of Identification: I t &. Oil— 11 I v Type of Identification: _ • : - ——
0
NOTICE OF COMMENCEMENT �/
State of fr 1 Tax Folio No. /1/ 87 8 OC
—s/
County of 1.)vt/N\
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: 3¶'..5i (7- S .'?-61.q.E- ACS or}T c GAA Oe_AIs
I-df ,/-i4
Address of property being improved: ..3'SQVA
' g r, 'Ta.(... 1)2 Af'I►'}n/14C—/3L LI1 3 22 33
General description of improvements: ?t, /20d i'
Owner: 3 ! /C
r & L/44'A/S Address: 5SS P QtJ1 16- 04a fit-14,44-13r<AF( 322
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: WG BENS Cd
Address: 4'2,07 /21-kg41"( S crtte 13. 6 CI F( 37,2,f d
Telephone No.: cipY-2Y/- Fax Fax No:
a
Surety(if any) 0
0
Address: Amount of Bond$ N j
Telephone No: Fax No: rn o
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a
Name and address of any person making a loan for the construction of the improvements
Name: a U
;T.Y
Address: CO o"
O co
Phone No: Fax No: 2c,
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Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other document rna j
�CA z
be served:Name:
:C1C8
a$w�oZ�o
Address: o § i�o o w
ozixxoix
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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice 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: 12/ F/)
,^1;�P PAMELA JEAN SHOREI Before me this u day of /,' L in the County Duval,State
I fir I'': NotaryPubfc-StateofFlofida I Of Florida,has personallya eare
CommissionsGG1535S2 Pp K Rie4 Ka E✓44S
<`, l' M Comm.ExiresDeta.202t I Notary Public at Large,State,Qf F nda,Co t f�u al./
"•Q•`. .•'• 8ardedthfoughNaticralActaryAssr. I My commission expires: K/1 �' y�(%
Personally Known: or
'/ �� 41 ' Produced Identification: f-IS "071 .57—/S 1—
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