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Permit 2009 Selva Marina DrCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000177 Date 2/17/10 Property Address 2009 SELVA MARINA DR Application type description ROOF PERMIT Property Zoning TO BE UPDATED Application valuation 12000 ---------------------------------------------------------------------------- Application desc REROOF PRODUCT #103124.16 ---------------------------------------------------------------------------- Owner ------------------------ CHAMBERS, RONALD W. 2009 SELVA MARINA DR. ATLANTIC BEACH FL 32233 Contractor BELDOM CONSTRUCTION SERVICES INC Q/A:MIKHET,YURIY JACKSONVILLE FL 32225 (904) 472-9203 ---------------------------------------------------------------------------- Permit ROOF PERMIT Additional desc . Permit Fee 110.00 Plan Check Fee .00 Issue Date Valuation 12000 Expiration Date 8/16/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- Permit Fee Total 110.00 Plan Check Total .00 Grand Total 110.00 110.00 .00 .00 .00 .00 .00 110.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. i]oc # 109U0siUU9, uK 8K i515~ Page 508, Number Pages: 1 NOTICE OF COI~ZME Recorded 02/172fl10 at 0228 PM, JiM FULLER CLERK CIRCUIT COURT DUVAL Permit No. COUNTY REGORDiNG $90.00 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. (legal description of property and address if available}: 2. General Descripfion of improvements: 3. Owner Information: ~` p a) Name and Address: ~fh~u.~~ ~ ~~.~~2,QS'/zov9 ~~ ~~ ~, /~/~,~~c~ . b) Interest in property: c) Name and address of simple titleholder (if other than owner): ~4. Contractor Information: p l a) Name and Address: ykR; i~L~~e~ /2143 D,"~-~~P Lk t,~ca/~`~P ~~ JZZ 2 S' ~`~.' b) Phone Number: 9f1+~ 2 - 9ZD3 5. Surety Information: a) Name and Address: b) Phone Number: c) Amount of Bond: $. 6. Lender Information: a) Name and Address: b) Phone Number:_ 7. Person within the State of Florida designated by owner upon whom notices or other documents maybe served as provided by 713.13 (1)(a) 7, Florida Statutes: a) Name and Address: 8. b} Phone Numbers of Designated Person: In addition to himself/herself, Owner designates a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. a) Name and Address: b) Phone Number of person or entity designated by owner: 9 Expiration date of Natice.of Commencement (The expiration date is one (1) year from the date of Recording unless a different date is specified: WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IlvIPROPER PASS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTE ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONS,~,T WITH YOUR LENpBff~QR AN ATTORNEY BEFORE COM1~lENCING WORK OR RECORDING YO NOTICE C Sign ;lea, - weer o~~ Auth Officer/Director/Partner/Manager Signatory's Printed Name & Title/Office :~ • 3034 :. .~ oMM-ss _,~. MY X E PIRfS: August 9,1010 _ T - ~1 • . .~__ ._ 1 "'' Bonded tazy Pul~c tkide .$ ° ~ "' . `~. - The f ~'e" w ed e this _~ day of ~ISavAl~Y , 20 l0 , by \~`/j ~ p ~dy `~~~~ as ~drr~e~ }'~Bu~ for is-yN~t~r> ~ CGry.~6-~''~_. (Name of Pe on) (Authority Type, i.e. Officer/Attorney) (Name of Party Instrument was Executed for) of to receive 'rs ~l%'/ ., ` ~~ •.~' 'f, J , ..rss~~' 10-~~ CITY OF ATLANTIC BEACH O~ ~ ~ ~/D ROOFING PERMIT APPLICATION Date: _-- ~ [/ / ,Q_ ~ _ I lob Address: .~ ©1~Q Je IGCCc - ~lQ.~)Yt~ ~ ~+Y(~M,~t+C U`C~~ f ~l i1 Z 2 3 Owner of Property: ~O~la /t~ ~e. C d e,~ s Address: X00'4 ~-Je1 ~L1~ ~(~`K0. ~ ~~iC~.~ t skcT~{ephone: l ~0~~4 ~O - ~ S/2 Roof Contractor: ~°! L.~kC~/i't~~,C"~'+~~ /IdC1/U/, ~t q' State License ~N^umber: C CC /3 2 ~ ~Sg Contractor's Address: I L 1 g 3 ~EJ%7`f~X C~2tL K L k /CC~ ~1+'s ~~2 mil`( 3 2 2 2 5 Telephone: ~ 7O~/~'~Z' g2 O 3 Fax: Email: Scope of Work: ~ Roofing Material CcS u `~ FL Product Approval # ~03 /~ ~. ~ ~ Valuation of Work: ~ ~ fODO Required Inspections: Sheathing /{n Progress-Dry In /Final If re-roof: Assessed Value of Structure: _ < $300,000/ >$300,000; Roof-to-wall improvemerrts required? ( Applies to single family structures only) "WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAY-NG TW1CE fOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE E F-RST INSPECTION. F Y l TEND TD OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY FORE RECD DING U N ICE F COMMENCEMENT" ~ ~ g ~ ~. Date: ~/ 7 /D __ .... . SIGNATURE OF OWNER: ~ ~Y/1 , ~p~'d;;•• JASON DRACH AS TO OWNER' -~: *_ MY COMMISSION !~ DD 5bsus /~~h .~,..;aa EXPIRES:Augus19.201C ii Sworn to and subscribed before me this ~ day Of ~E A(1 20 (~ "••',F oF,Ct°`'` ~cnded Thru Notary Pubic unCerwri"" State of Florida, County of Duval Notary's Signature: ^ P Hall n ced identification Type of identification produced ~GdKtoA- OR.tv~'fLS l-ic~~~ Z SIGNATURE OF CONTRACTOR: _ Date: ©~ 1 °~/O ~ ,~,. AS TO CONTRACTOR ' ~tpPY' UB~ {• •'~~- JASON DRACH MY COMMISSION ti DD 583034 : Sworn to and subscribed before me this 0 ~ ~ ~h da of FEB~RR 20 ( y .;"' ~e `';,~F Fa,, EXPIRES: August 9, 2010 u~,~dEu rn~~ NocaryP~m~~ u~ae~~ae~s State of Florida, County of Duval Notary's Signature: ^ Per y kno (gCPFo i entification _ Type of identification produced j'L~IOH O2lv~QS r GIG~N~b 800 Seminole Road • Atlantic Beach, Florida 32233-5445 Telephone: (904) 247-5800 • Fax: (904) 247-5845 F:\roof permit applicator 2010 .~ J :. ;„r THE CITY OF ATLANTIC BEACH BUILDING INSPECTION DEPARTMENT ROOFING INSPECTION AFFIDAVIT Re: Permit# ~~ _ ~~~ I, /1~,~ ~'VII~I,~.Q,'~ licensed as a C~ L Contractor*/Engineer/Architect, or Building Inspector* (print name) 9 (print type) License#: ~.CC i32~ ISIS On or about ~ lr`1 ' Vt'~' `-'t~ did personally inspect the roof-to-wall connections as required by Rule 96-3.0475 at ~,o~`~ ~O(p+ ~a~,- -~~ i~ A~) ~~ + ~+/ ~ 1 ~ 3 ~ (Job Site Address) Based upon that examination I have determined: (circle one) The roof- to wall connections were installed according to the Hurricane Mitigation Retrofit Manual (Based on 553.844 F.S. ) I made then cessary corrections to comply with the Hurricane Mitigation Retrofit Manual. Signat e STATE OF FLORIDA COUNTY OF Sworn to and subscribed/bef~or~e me th~is~day of 20~~ BY ,/~ 1~~~ U • ` urn- G~-C~~ , Personally Known or /Produced identification ~nL Type of identification produced _ N tary Public, Stat of Flori/da d ~t (Print, type or stamp name) .....dr+~°"' y,~„ Di:aoan-+ a w~Ir~E ,~1~,..,.~~,. Commission No.: ;n; :.: MY COMMISSION#DD634126 EXPIRES: Mey 21, 201 ~ ~' ~ ~' Bonded ThN Notary Public Underwriters M 23~ ~(~ o ~ ~ ~ ~~d *General, Building, or Residential Contractor or any individual certified under 468 F.S. to make such an inspection. This form must be on file at the Buildins Department prior to calline for a Hurricane Clip Inspection, F:\roof permit applicaton 2010