618 W Dutton Island Roof Submittal 5 ,c A I 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
�`-�;s 9.'' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: apt j Cry c ,� -fir? iL Permit Number:
Legal Description 0? - )-5- - ).`I . 3 3- RE# / 7,t 3 t' `, -0`.)-CO
Valuation of Work(Replacement Cost)$ \Ci ‘ .90(7) Heated/Cooled SF Non- ter,
ti�',r
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑ dow/Door
• Use of existing/proposed structure(s): ❑Commercial CilResidential JUL 14 2021
• If an existing structure, is a fire sprinkler system installed?: ❑Yes l.No BY:
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 41No
Describe in detail the type of work tobe�performed:
R*A TAA0.cee.eV\A- 0" e �At- (2 -C \-" I 1 q l9 (-f c i2(4, 2 5/ •5 1 2-v014-61-
Florida
v0r` 1Florida Product Approval# if::t- 1 4 tela gt, for multiple products use product approval form
Property Owner Information
Name ( a\\ 9-3 (\CS Address lei (0,1 ,, kcv'1, Nv,1c;.)'a6 ! 4%
City eir\c..,1N. Q ec h State V Zip -7-ar9-2-;3 Phone CkiY-1:- —13 SE-
E-Mail \J"F-11,CxTtS0 cyclic 1 .Czrn
Owner or Agent(If Agent, Po r of Attorney or Agency Letter Required)
Contractor Information
Name of Company &IC:4..011C. S p�C;‘,r Qualifying Agent LN iq i E., 61-Ciik"16,
Address I0-1? . Su . l).)par A.S RA, City Qrycev;16 State rt... Zip 1?+do1
Office Phone 104- 111 - 41 61 Job Site Contact Number
State Certification/Registration# CCG 1 32&oc.' E-Mail ‘zv+av+IN An v••s Air%)0 <p4AC 4(A- •A VI
Architect Name& Phone#
Engineer's Name& Phone# /1 n, ,
Workers Compensation Insurer �` `,timet l^'N 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 OBT N FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECONOTEOF COMMENCEMENT. ;� ;� p
(Signature of Owner or Agent) 7:3
(Signature of Contractor)
S' ned and sworn to(or affirmed) before me this j: day of Signed and sworn to(or a ' •-- before me • day of
4N Iy , ota•Z I , by L.%l 4+.4 f�y/ y, uk \ wins& - —-�� • - ,JA.-A
_�� 6� o.,:.tj�. a W434)1AB.I�AY EY
State of Florida , . Commission#GG 34956%
�`� My Commission Expires 06/30/2022 . Expires July 1,2023
[ ] Personally Kf�iA] [ ] Personally Known OR •'�E ;«°�' EonJedmruTroy Fain Insurance soo.385.7019
Produced Identification Commission No. GG 204766 duced Identifica 'on
,
Ty]pe of Identification: %%r,i4 /7��'.�,,•3 i irr.•Jr yq pe of Identification: '.�i�. Ne'°Q_ ,
NOTICE OF COMMENCMENT
State of Florida PERMIT#
County of Atlantic beach
The undersigned herby informs all concerned that improvements will be made to certain real property,
and in accordance with section 713.13 of the Florida Statues,the following information is stated in the
NOTICE OF COMMENCEMENT.
Description 618 Dutton Island Rd W
Atlantic Beach,FL 32233
Legal Description I f3 a S _dor E • 3 3 a. Pi 61o4 T LOP 2 t Co 0/2
General description of work reroof 7 iy,—r g-S
Owner Bill Barnes
Address 618 Dutton Island Rd W
Atlantic Beach,FL 32233
Owner's interest in site of the improvement SIMPLE Doc#2021179790,OR BK 19814 Page 54,
Number Pages:1
Recorded 07/14/2021 04:22 PM,
Fee Simple Title holder(if other than owner) JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
Name SAME COUNTY
RECORDING $10.00
Address SAME
Contractor BRANNAN ROOFING,LLC
Address _1032 sierra woods rd bryceville fl 32009
Surety(if any) NONE
Address N/A Amount of Bond$ N/A
Name of person within the State of Florida designated by owner upon whom notice or other documents may be
served:
Owner Bill Barnes
Address 618 Dutton Island Rd W
Atlantic Beach,FL 32233
In addition to him/herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(F),Florida Statutes.(Fill in at Owner's option).
Name AME
THIS SPACE IS FOR RECORDER'S USE ONLY
My Commission Expires
04NE 'S PRINTED NAME
Signed before this !iyia of ?µ' ,2021
/�j�jam!
Signature /Or 49' 41 OWNER'S SIGNATURE
I,j;(• ,, ,personally witness 0,%/ l3f,p,4 S signed this N(
,�wurr, awn K. Middleton
State of Florida
My Commission Expires 06130/2022
'%3�t?��l�r�� Commission No.GG 204766