410 S OCEANWALK DR RERF21-0214 .'3 ;11- " REROOF SHINGLE PERMIT PERMIT NUMBER
, - RERF21-0214
CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD ISSUED: 9/7/2021
`'3 c.0" ATLANTIC BEACH, FL 32233 EXPIRES: 3/6/2022
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: PERMIT TYPE: i DESCRIPTION: s VALUE OF WORK:
410 S OCEANWALK DR REROOF SHINGLE SHINGLE ROOF $8225.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169463 0526 OCEANWALK UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
PATRIOT ROOFING
SERVICES, INC. 1695 Hereford RD MIDDLEBURG FL 32068
OWNER: ADDRESS:, CITY: I STATE: I ZIP:
PODZAMSKY SUSAN 410 OCEANWALK DR S ATLANTIC BEACH FL 32233-4573
BURNS
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date:9/7/2021 1 of 2
` Building Permit Application Updated 10/9/18
:,, City of Atlantic Beach Building Department **ALL INFORMATION
% 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`j3 v''' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 10 aC 4)too k BY. Permit Number:
Legal Description 42-II 01-- !Z 0' - 4i, 37--,23---.4.11 RE# r/
Valuation of Work(Replacement Cost)$ $,2,25.51 Heated/Cooled SF 4341 Non-Heated/Cooled- / L->
• Class of Work: New Addition DAlteration dRepair DMove ❑Demo DPool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial 47Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes 44.No
• Will tree(s) be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: Ke, 4: ..zD sti tv-�,/- .f 315
Florida Product Approval#(1- 101,2y, / 1 FL /Ot.g4 for multiple products use product approval form
Property Owner Information )��
Name 5i)' 131,0)_iP ik Address Lib LA-11.11( .0K.5
City f f4,vf1' ) A fL State FL zip 32233 Phone g'�',,r/-77e-3610
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Pafrir."t �In Sr", ,,e • Qualifying Agent 1.X:11 Pen.i1, j '�
Address u,9'..5.j.4,e.-Eri/ J ILD City A4,AjI , —LJ
State -f% Zip_j2p t '
Office Phone ? Job Site Contact Number `] '9 eft ib - 113,
State Certification/Registration# Cr, I33 E-Mail
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, Co NSULT WITH YOUR NDER OR AN ATTORNEY BEFORE
RECOFIDING YOUR OTIC O • OMMENCEME
(Signatur- wn• . gen 0 (Signature of Contractor)
Signe and sworn to(or affirmed)before meth' day of Si ned d sworn to(or affirmed)before me this 7 day of
g nm i to ZUL/ b �� � ,
(Si: ature of Notary) (Si.nature of Notary)
t it.
�� Y t Willie C.Richardson _�t 'Yq Willie C.Richardson
NOTARY PUBLICoP f. NOTARY PUBLICPersonally Known OR STATE OF FLORIDA , Personally Known OR `_ _STATEOFF[ ]Produced Identificatio . . Comm#GG210238 I )Produced Identification '''.41,��� ?Comm#GC;210 R8 A
Type of Identification: iN E 19�� Expirc s R/��/Y022 Type of Identification: 191� Expires 8/12/2022
NOTICE OF COMMENCEMENT
State of 1- Tax Folio No.
County of DOL/A4
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.c�
442-Legal Description of property being improved: �-/3 L) 5 —c2 ,L 65/-.ZS &gr
37-a5- 079.1- p e. * X a/k Lit .2 /4574 a11 )) fL 3. _
Address of property being improved: 7'�n_ L% C°1.�.)td � D: S /4f 7/G L'..iii 2233
General description of improvements: — f
Owner: 5td2.J ax-,AAS Petizo.kt_54Address: We) f
Owner's interest in site of the improvement: iG27jG
Fee Simple Titleholder(if other than owner):
Name:
Contractor: i7 7 gerr Ices ZL-
Address:`t75 f cf, AD Ales✓'`�i Fz -32'
Telephone No.: 9:91-/---c>1-773.2 73.2 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:
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 41.
Signed: /!a/ _1_ 111,
Before me tt 7 r day of 41111i97:64-77 4 in the Count of Duval, tate
Doc#2021233013,OR BK 19898 Page 1137, Of Florida,has personally appeared
Number Pages:1 Notary Public at Large,State of Flori a,C unty of Duval.
Recorded 09/07/2021 12:20 PM, My co:.ui 'one ;'res: ��Z/21JZZ .t►_r Willie C.Richardson
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL '• -•.• no '• <` NOTARY R/13 b
COUNTY Produced Identification:/ . ,A -''STATE OF FLORIDA
RECORDING $10.00 vim:;: ?Coma GG210238
�� Expires 8/12/2022