Permit 872 Amberjack Lane CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000236 Date 3/04/10
Property Address . . . . . . 872 AMBERJACK LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3882
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Application desc
REROOF SHINGLE ROOF FL PRODUCT APPROVAL 5444 . 7
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Owner Contractor
------------------------ ------------------------
MCKENZIE JEROME & CHARLENE PERFORMANCE ROOFING LLC
509 CAMELIA ST 2235 MERCATOR DR
ATLANTIC BEACH FL 32233 ST. AUGUSTINE FL 32087
(407) 210-1503
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3882
Expiration Date . . 8/31/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 70 . 00 70 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
SS
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
�M X33 It
Application Number . . . . . 10-00000236 Date 3/04/10
Property Address . . . . . . 872 AMBERJACK LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3882
----------------------------------------------------------------------------
Application desc
REROOF SHINGLE ROOF FL PRODUCT APPROVAL 5444 . 7
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
MCKENZIE JEROME & CHARLENE PERFORMANCE ROOFING LLC
509 CAMELIA ST 2235 MERCATOR DR
ATLANTIC BEACH FL 32233 ST. AUGUSTINE FL 32087
(407) 210-1503
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3882
Expiration Date . . 8/31/10
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 70 . 00 70 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: L----Q- Akk--k+c- (3wJ- FL- 32.Z33 Permit Number: '122
v
Legal Description 3o-L0 38- 23-MkC 2:23,< «,r, uo�,+al Parcel# t-1 t1,lto -Dom
Valuation of Work$ 3,$f 2•��
Class of Work(circle one): New Addition Alteration RePai M emolition pool/spa window/door
Use of existing/pro osed structure(s) (circle one):. Commerclaesidentia
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval# '514414 71
For multiple products use pro uct approval form
Describe in detail the type of work to be performed: c-
r� e_F
Property Owner Information:
Name: "Serooe.[Ctnnrlt^a- Address: 817-
City
?ZCity Al-ta,it. %3uoh Statef Zip 32-233 Phone c-lEt- 33Kg
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent: R,.,_ u A 440;t-&S
Address: 22 I5 M ercoi%r On- City orlon'- State FL Zip Sao-)
Office Phone Uz-)- 2to- iso3 Job Site/Contact Number Fax# 3u- 2z1-�1�3
State Certification/Registration# Cec. os'7 `54
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a perod of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, furnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc.
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 YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether speci ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Ow r Q1'YU 1G M�((l Signature of Contracto
Print Name Print Name
Sworo an subscn d before me Sworn to a subsc 'bed before me
this f'� D of PIAR5 { , 20 l� this 2S y Qt 2010
No b c Notary-Puliji
ASHLEY VINSON ASHLEY VINS%vised 01.26.10
NNOTARY PUBLIC
NOTARY PUBLIC
STATE OF FLORIDA
STATE OF FLORIDAm
Comm#DD0925944 - Com#DD0925944
w.:.,,' Exr*es 9/16/2013
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal description of property and address if available): '
30-Leo 1,9- 23 -Zit E U,44- t
2. General Description of improvements:
Q.e-rwF
3. Owner Information:
a)Name and Address: 'Sore"A( C t"rle_e {4.ae sZ,c- in 2. ktjocAroc _ "s- 3 2233
b)Interest in property:
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: Per2235 #Aerc•t•r bL Or" FL IWO
b)Phone Number: LAu-1-zt0- ISo 3
5. Surety Information: Doc#2010048598,Gil BK 15171 Page 53,
a)Name and Address: Number Pages: 1
b)Phone Number: Recorded 03/03/2010 at 12:25 PM,
c)Amount of Bond:S JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
6. Lender Information: RECORDING$10.00
a)Name and Address:
b)Phone Number: ---—----- --- —
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates of to receive
a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART
1, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
NOTICE OF COMMENCEMENT. ,
Y ,
"Al :a Yvan I
Si natu of Owner or Owner's AuthorizeA O icer ect r/Partner/Manager Signatory's Printed Name&Title/Oftice
The foregoing instrument was acknowledged before me this�—day of 20_10 by
� � 1 'it�2ie�i f
(Name of Person) (Authority Type,i.e.Officer/Attorney) (Name / Party Instrument was Executed for)
ASHLEY VINSON (
NOTARY PUBLIC NOTA Y PUB I STA`T,EE O-FF FLORIDA
STATE OF FLORIDA
Comm#DD0925944 Print Name:
E>�ines 9/16/2A13 r Personally Known
)<,Identification/Type:
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,I declare that I have read the
foregoing and that the facts stated in it are true to the best of my knowledge and belief.
Signature of Natural Person Signing Above
Revised 10/1/2009
HP OfficeJet 7410 Log for
Personal Printer/Fax/Copier/Scanner Information SystemsCiTY O
904-247-5845
Mar 04 2010 11:43AM
Last Transaction
Date Time Type Identification Duration Pages Result
Mar 4 11:43AM Fax Sent 913212391973 0:26 1 OK