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422 Ocean Blvd ROOF20-0072 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP: REVOCABLE INTER VIVOS TRUST AGREEMENT OF GAYLE G MILLER 6847 SAN SABASTIAN AVE JACKSONVILLE FL 32217 COMPANY:ADDRESS:CITY:STATE:ZIP: SHORE ROOFING COMPANY 914 7TH AVENUE S JACKSONVILLE BEACH FL 32250 TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 170170 0000 ATLANTIC BEACH JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 422 OCEAN BLVD ROOF NON SHINGLE SHINGLE AND FLAT ROOF $8200.00 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $95.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $47.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.14 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 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. 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. 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. 1 of 2Issued Date: 12/16/2020 PERMIT NUMBER ROOF20-0072 ISSUED: 12/16/2020 EXPIRES: 6/14/2021 ROOF NON SHINGLE PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 TOTAL: $146.64 2 of 2Issued Date: 12/16/2020 PERMIT NUMBER ROOF20-0072 ISSUED: 12/16/2020 EXPIRES: 6/14/2021 ROOF NON SHINGLE PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $146.64 ROOF20-0072 Address: 422 OCEAN BLVD APN: 170170 0000 $146.64 BUILDING $95.00 BUILDING PERMIT 455-0000-322-1000 0 $95.00 BUILDING PLAN REVIEW $47.50 BUILDING PLAN CHECK 455-0000-322-1001 0 $47.50 STATE SURCHARGES $4.14 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.14 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL FEES PAID BY RECEIPT: R14376 $146.64 Printed: Wednesday, December 16, 2020 2:10 PM Date Paid: Wednesday, December 16, 2020 Paid By: SHORE ROOFING COMPANY Pay Method: CREDIT CARD 404715511 1 of 1 Cashier: CG Cash Register Receipt City of Atlantic Beach Receipt Number R14376 rf l,r' Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone:9p04)(247-58'26 Email: Building-Dept@coab.us fl 7 IS*REQUIRED. Job Address: ` rla. V 0.,Ei4 \ 3 Iv Permit Number: tC,V } Legal Description 5-•C( I I -1_S'-),y EIH-hi-Ac/3e i-d/3i/ 3 RE# / f? 00QO Valuation of Work(Replacement Cost)$ O LX. 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 (residential If an existing structure,is a fire sprinkler system installed?: Yes No Will tree(s)be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) No Describe in detail the type of work to be performed: Re 12CGU F 3< ye 4 r S ht'N5'I t'J /MY /•r`/ ?' iin+-Ir 4-c-- k 1)t,r .i313-5"Lr1 1i)r ,/+j $h e(t On 10 ,0 Florida Product Approval(4I'415:5-5' f"'l X53 3 , I for multiple products use product approval form Property Owner Information Name AG it_ l y1 t (( ^ Address y ©Cef/ 3 - City r t -1 M' ti c, o e9Lk State l Zip 3 )1 ,3 j Phone C1GL-/ -7 3 / - 7/ 5j'' E-Mail LA, c-c" i 1 \'Z - 0—'1( U c c m r' ff .N 4 Y" Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Ac.-.00NameofCompanySv:'( _5 Cu Qualifying Agent 111-0 7'1/i.S S ItLUI_ Address k. l ( fh AVc City a State ( Zip 3 21,; Office Phone G'-4- j-/( jt/,Job Site Contact Number 91 cl State Certification/Registration# 05:4 I!E-Mail 7L. j1-' l r Cr cpm Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Expiration Date 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 RECOR ING YOUR NOTICE OF COMMENCEMENT. JA , , Signature of Owner or Agent) Signature of Contractor) Si: „cjiosiaiwurij + • - • - .•e this_day of Si and sworn to(or off' •d)before me this day of w A MI M My Corn 111"Tires OfgrACOre Notary) ot. mrw Mrcugn National Notary Assn nY.a'y TONI GINDLESPERGER I Personally Known OR I Personally Known OR,II-- MY COMMISSION#GG 353178 roduced Identification 1 Produced Identificati Fiu 'au' '" EXPIRES:October 6,2023 3 sa _o O F`O' Bonded Thru Notary Public Underwriters NOTICE OF COMMENCEMENT 1 State of f- ' Tax Folio No.r 7O I"7d-C..X)6"-' County of i—it/Al 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: 5-,(LC( /6-15 44 i.e: /14.i,4,..) t-IL /3„,:j., 4_,,, i-a,(30.a7-3 Address of property being improved: 3. LX'fj411 /3 /,,0 /40/1-44,,_' F3e4& 1=----/31.--z_3 S General description of improvements:J C...j ' J F Owner: Ci3y le /1,'11e_.' Address: Zak o('.:C.A 11 /3/UJI) r)M4.44`14 13,-„4 41 13z2 33 Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: Contractor:.SIiU(Z,1.L4)-`I41.S (2-Li Address:oir ci 1)...4 )4 VL 5 X [3e -t L.1, /-I 3 Z _s-o Telephone No.:9O4-2,141 — i La. Fax No: Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: 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: 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 Statues. (Fill in at Owner's option) Name: Doc#2020271670,OR BK 19482 Page 2391, Address: Number Pages: 1 Recorded 1210712020 10 55 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Telephone No: Fa COUNTY Expiration date of Notice of Commencement(the expiration dat, RECORDING $10.00 is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER r' j 7 / Signed: x JCs T, yN I Date: l p PAMELA JEAN S'C E Before me this ! ) day of /J{ in the County of Duval,State 4.,---... NotaryPLc c-State of Florida Of Florida,has personally appeare. (y c+ I Commission r GG 153592uNotary Public at Large,State of Flor da,Count of Du al.d': My Comm.Expires Dec l 2021 I) ` Pf.fr, Bcrled thrcu5hNatioralNotarvAssr My commission expires: .. > i 0 - / Personally Known: or 1J `( (x D a 3(.." 5 9 J — 0 r 1 1r l't lit