Permit Roof 75 W 4th St 2010 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
+� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001206 Date 10/01/10
Property Address . . . . . . 73 75 W 4TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6155
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Application desc
reroof
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Owner Contractor
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MOYANO JACK C. WILSON ROOFING CO.
75 WEST 4TH STREET 4522 ST. AUGUSTINE RD.
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 396-1546
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 85 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6155
Expiration Date . . 3/30/11
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
Permit Fee Total 85 . 00 85 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 89 . 00 89 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc#201023W/9,OR 3K 15384 Page 2005,
NOTICE OF C ffl NCEMENT Number Pages: 1
- Recorded 10/01/2010 at 02:07 PM,
JIM FULLER CLERK CIRCUIT COURT.DUVAL
COUNTY
Permit No. RECORDING$10.00
Tax Folio No.—Iw
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the fallowing information is provided in this NOTICE OF COMMENCEMENT.
1.Description ofproperty(legd don). I'7• — aye Qe- 14 6Ch
a)Street(job)Address: • b a�3`
2.General description of improvements: E.eA0QV U)k� r i
3.Owner Information
a)Name and address: mu!' -3 oaf 'X V &J 'zh rte' 3
b)Name and address o fee simple titleholder(if other than owner)
c)Interest in property .
4.Contractor Information
a)Name and address P- G)I-11son 01.
b)Telephone No.:epi T�l o—t�-�(�. Fax No.(Opt.)
S.Surety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt.)
6.Lender
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
g.In addition to himself;owner designates the following person to receive a copy of the Lienoes Notice as provided in Section
713.13(l)(b),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date of Notice of Commencement(the expiration date is one 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 I1I01PROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IlV[PROVEMENTS 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT
STATE OF FLORIDA
COUNTY OFA' 10• sG�
NAVA,! Si ofOwnerorOwncesA Officer/lhrector/Partner/Manager
C) 0
Print Nance
The foregoing instrument was acknowledged before me this day of 20_10_,by
to as ,t trW (type of authority,e.g.officer,trustee,
attorney in fact)for (name of party on behalf of whom strument was executed
Personally Known OR Produced Identification Notary Signature "'��
Type of Identification Produced Name(print) ���L/ J
OR
Verification .Under penalties of perjury,I declare that I have read the foregoing and that
the facts staand belief `
ommission#DD 944280
* *= My Commission Expires
y°n;?►;;° r December 03, 2013 S of Natural Person Signing(in tine#10.)Above
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: ;75 0 ,6 CA i-I?ermit Number:
Legal Description 9LI-1 C 14 Parcel# 91`/70US
�a �' oor ea of f Sq. t. t 'Sq.F'
Valuation of Work$_0Proposed Work heated/cooled �i3a non-heated/cooled 7/
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)((circle one):. Commercial Residential
If an existing structure,is a fire sprmlder system installed?(Circle one): es o N/A
Florida Product Approval# F L I q$I, a L_.)44q 0 F G. 1-)5 33.1, FL_1 S�
For multiple products use product approval forin
Describe in detail the type of work to be performed: YL7o r ` if7
skin
Pro "ern Q `S'
Name: l Address: 1
City State(--i-Zip Phone q -Q 4 7 0
E-Mail or Fax#(Optional)
Contractor Information: /
Company Name Quali in Agent: atm V O 5
Address: City. State Zip Q ao 7
Office Phone L - Job Site/Con ct Number,tj 9 1--n i n 7 :M1e Fax# -- 7 ob
State Certification/Registration#
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 cert fy 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 tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six6)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 hereb cert that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofYwork will be complied with whether spped ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,sta ,or local lww regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print NamePrint Name
Sworn to and subscrib d before me Sworn o and subscribe be ore me
this Day of ? 6cT .20 EO this 'f Day of 200
Notary Pub ' ��� C mini ss ao�aazso Notary Pu .,�,,....,,,,,.. .....
i o n
i:° �• Cn Chrnmission ExPires �JH�(R(�I�S{T]J FHyE��? VC;rS�
=+o.N�l��.!+_-('Q'TT'TT�T531�M�MM.'l..lp
MV bgt 03, 201.3 yEj`�FT' aa280
l�+�aMm I
�" My Commission Expires