1853 Selva Grande Dr RERF21-0015OWNER:ADDRESS:CITY:STATE:ZIP:
BRINKLEY ROBERT J 1853 SELVA GRANDE DR ATLANTIC BEACH FL 32233-4526
COMPANY:ADDRESS:CITY:STATE:ZIP:
PRIME ROOF
CONTRACTING LLC 13725 BEACH BOULEVARD, #13 JACKSONVILLE FL 32224
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169542 5028 SELVA TIERRA
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1853 SELVA GRANDE DR REROOF SHINGLE SHINGLE ROOF $15988.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $130.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $134.00
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: 1/20/2021
PERMIT NUMBER
RERF21-0015
ISSUED: 1/20/2021
EXPIRES: 7/19/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 1/20/2021
PERMIT NUMBER
RERF21-0015
ISSUED: 1/20/2021
EXPIRES: 7/19/2021
REROOF SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $134.00
RERF21-0015 Address: 1853 SELVA GRANDE DR APN: 169542 5028 $134.00
BUILDING $130.00
BUILDING PERMIT 455-0000-322-1000 0 $130.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14635 $134.00
Printed: Wednesday, January 20, 2021 8:44 AM
Date Paid: Wednesday, January 20, 2021
Paid By: PRIME ROOF CONTRACTING LLC
Pay Method: CREDIT CARD 415314037
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14635
~+; CENTRALSQUARE
RERF21-0015
Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone : (904) 247-5826 Fax : (904) 247 -5845
Job Address: 1853 SELVA GRANDE DR Atlantic Beach FL 32233
Legal Description 38-28 09-2S-29E SELVA TIERRA LOT 14
Permit Number: __________ _
RE# _________ _
Valuation of Work (Replacement Cost) $ 15,988.00 Heated/Cooled SF 2078 Non-Heated/Cooled 904 ---------
• Class of Work (Circle one): New Addition ~ Repair Move Demo Poo l Window/Door
• Use of exi sting/proposed structure(s) (Circle one): Commercial ~
• If an exist i ng structure, is a fire sprinkler system in stalled? (Circle one): Yes No @
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describ e in detail the type of work to be performed : Replace roof with asphalt shingles
Florida Product Approval# FL 10674-R12 (shingles) FL 17420-R2 (synthetic)
Property Owner Information
for multiple products use product approval form
Name : BRINKLEY ROBERT J and BRINKLEY LESLIE J Address : 1853 SELVA GRANDE DR
City ATLANTIC BEACH State ~E~L __ Zip 32233 Phone ~9~0_4-~8~6_1~-9~6_4_4 ______ _
E-Mail ________________________________________ _
Owner or Agent {If Agent , Power of Attorney or Agency Letter Requ ired) ___________________ _
Contractor Information
Name of company : Prime Roof Contracting , LLC
Address 3500 Beachwood Ct., Suite 207
Office Phone (904) 530-1446
State Certification/Registration# CCC1329505
Architect Name & Phone#
Qualifying Agent: _M_a_r_k_Y_o_u_n_g __________ _
City Jacksonville State _F_L __ Zip 32224
Job Site/Contact Number _(,_9_0_4,_) _86_0_-_0_2_30 _________ _
E-Mail office @ primeroofingfl.com
-----------------------------------Engineer's Name & Phone# _________________________________ _
Workers Compensation FRSA Self Insurers Fund Inc . 01 /01/2021 870-040093/3EE6142
Exem pt/ Ins urer / Lease Emp loyees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or i nstallation has
commenced prior to the issuance of a permit and that all work will be performed t o meet the standard s of all t he laws regulationg
construction in this jurisdiction . I understand that a separate perm it must be secured for ELECTRICAL WORK , PLUMBING , SIGNS ,
WELLS , POOLS , FURNACES , BOILERS , HEATERS , TANKS, and AIR CONDITIONERS , etc.
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
RECORDING YOU NOTICE OF COMMENCEMENT.
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%:t,~ai:'fl.~ EX PIR ES: Sep t 17, 202 2
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''1111111''' Bon ded Thru Aaron Notary
Type of Id entificat io n: _____________ _
R
E
RERF21-0015
Doc# 2021012864, OR BK 19540
Recorded 01/16/2021 11:43 AM,
RECORDING $10.00
Page 823, Number Pages: 1,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
NOTICE OF COMMENCEMENT
\PREPARE IN DUPUCATEi
Permit No. ___________ _
State of _F"'"lo_rid~a ____________ _
Tax Folio No.=--,---------------County of __ D_u_v_al _____________ _
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes, the following Information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: _______________________ _
38-28 09-2S-29E SELVA TIERRA LOT 14
Address of property being improved: 1853 SELVA GRANDE DR Atlantic Beach FL 32233
General description of improvements: _R_e-_ro_o_f _______________________ _
Owner BRINKLEY ROBERT J and BRINKLEY LESLIE J
Address 1853 SELVA GRANDE DR ATLANTIC BEACH, FL 32233-4526
Owner's interest in site of the improvement _______________________ _
Fee Simple Titleholder (if other than owner) _______________________ _
Name ___________________________________ _
Address _________________________________ _
Contractor Prime Roof Contracting, LLC
Address 3500 Beachwood Ct., Suite 207, Jacksonville, FL 32224
Phone No. (904) 530-1446 Fax No. Email: office@primeroofingfl.com
Surety (if any) _________________________________ _
Address ____________________ .Amount of bond$ ________ _
Phone 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 _________________________________ _
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), Florida Statutes. (Fill in at Owner's option).
Name ___________________________________ _
Address _________________________________ _
Phone 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): _____________________________ _
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