Permit 1601 Park Terrace East CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . .
Property Address 10-00000386 Date 4/05/10
Application type d. . . . . . 1601 E PARK TER
Property Zoning . escription ROOF PERMIT
Application valuation TO BE UPDATED
7885
Application desc ----------------------------------
reroof fl 1956 . 3
----------------------------------------------------------------------------
Owner
------------------------ Contractor
SANTACROSE, WILLIAM A. ------------------------
1601 PARK TERRACE EAST EMPIRE ROOFING
2806 GIBSON RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
------------------------------------------- (904) 391-1007
Permit . . . . . . ROOF PERMIT ----- --------
Additional desc . .
Permit Fee . . . . 90 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 00
Expiration Date 10/02/10 7885
--- ------- ------- ----
Fee summary Charged Paid---------------------------------
----------------- ---------- Credited Due
Permit Fee Total 90 . 00 -----90 . 00 ---------- ----------
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 90 . 00 90 . 00 . 00 . 00
. 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
(P�REPAR9 IN DUPLICATE)
Permit No.
State of Tax Folio No.
County of
TO whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real Prop",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:
Address Of Property being improved:
.
General description Of improvements:
Owner
Address 921 e rf�- 11, a 3'u
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
T-e
Name
Address
Contractor
Address
L--O-
PhoneNo._. �Zj— /a.*"Z
Fax No.— 3 SU IYU 7
Surety(if any)
Address ount of bond
Phone No. Fax No.
Name and address of any person maldng 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):
RDERIS USE ONLY
THIS SPACE F70R RECO 7 . - - 911�NER
Signed:(I,/ /,/ "-/
Before — DATE
County of Du —uay OT —in the
val.State of Ronda,has personally appeared
herein by
......S Pherself and 9 rms that all statements and declarations herein
120, Pa.. are t�.
0m""'U"6161,ORE3K152oj Pagei9ao, nd accurate"
Number Pages: 1
Recorded 04/05/2010 at 10:30 AM, seeckwelc
JIM FULLER CLERK CIRCUIT COURT DUVAL CommissiOn#DD598116
COUNTY
RECORDING$10.00 Not Public at Large,Stat of Cou of E Pire$1000bel-27 2010
M mmission expires: "ayFal"'Instimrice.inc 8w,3M7019
Personally Known
Produced Identification or
Olt
CITY OF ATLANTIC BEACH
Date: ROOFING PERMIT APPLICATION
JobAddress:-.. 1�oi K -re-o-, 1--14s+- —M6
---&+/ t- A, 3 2233
Owner of Property: lzo M QL a�.,e
Address: —11�������`Telephone:
Roof Contractor: -Cme 1`5 66 0--`A1!3 S^lc-s 411-1 Xe-rll<-State License Number: e-C-C, 13.2 44 0 0 7
Contractor's Address: aT-oc.-( albsorl( 17, -n.,
, _4 , 04- )r-t 3.a
Telephone: qoq-39 I- ( or-') Fax:..104-3 91 - 1"07 Email:
Scope of Work:---R=,D:E Roofing IVIateriaIA"-AA#4—
FL Product Approval# E-1 I I Valuation of Work: L
Required Inspections: Sheathing/in Progress-Dry In /Final
Ifre-roof: Assessed Value of Structure:_<$300,000/_>$300,000;Roof-to-wall improvements required?
(Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD 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.
LENDER OR AN ATTORNEY BEFORE RECORDIIVO YOU IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
R NOTICE OF COMMENCEMENT-
SIGNATURE OF OWNER2�
e:
Dat
AS TO OWNER:
Sworn to and subscribed before me this 5 da f 20-1 v
State of Florida,County of Duval yo -
Notary's Signature:
seecheir El P sonally known
CommissiOn#DD598118 [I Produced identification
Expire.,�,October 27 2010 Type of identification produced
Bonded Troy Fain-Insurance Inc ��77
SIGNATURE OF CONTRACTOR: Date: 4415 /10
AS TO CONTRACTOR:
Sworn to and subscribed before me this 3' day of
State of Florida,County of Duval Notary's Signatur7e:
C-Ae,
g,
g jbo*&S *. bet
P
Pe onally known
j.r COMMission#DD598116 P fi
El P duced iclent�iification
OCtober27 2010
z*� xpires
Bonded Troy Fain-insurance Inc 800-385-7019 Type of identification produced
800 Seminole Road-Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800-Fax:(904)247-5845
F:\roof permit applicaton 2010
THE CITY OF ATLANTIC BEACH
BUILDING INSPECTION DEPARTMENT
ROOFING INSPECTION AFFIDAVIT
Re: Permit#
(print name) licensed as a (print type)Contractor*/Engineer/Architect, or Building Inspector*
License#:
On or about did personally inspect the roof-to-wall connections as required
by Rule 9B-3.0475 at
(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. )
ade the necessary corrections to comply with the Hurricane Mitigation Retrofit Manual.
0"
��p
/Signature
STATE OF FLORIDA
COUNTY OF
Sworn to and subscribed before me this dayof op r,,t- 20 ( o
Byy Notary Public,Stat of Florida
$60V* jamos V.. is rz es-
A Comm* #
Ission 00598118 (Print,type or stamp name)
Xpires October 27 2010
Bonded Troy Fain-insurance Inc 800-385-7019 Commission No.: 40 aolp//'�
Personally Known_=�f®r
Produced identification
Type of identification produced
*General, Building,or Residential Contractor or any individual certified under 468 F.S.to make such an inspection. Lhis form must
be on file atthe Buildin Department Prior to calling for a Hurricane Clip Inspection,
F:\roof permit applicaton 2010