Permit Roof 377 1st St 2010 f a' , CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
► n ATLANTIC BEACH,FL 32233
o '
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001253 Date 10/14/10
Property Address . . . . . . 377 1ST ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6260
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Application desc
reroof
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Owner Contractor
------------------------ ------------------------
WOLF ADAM H ET AL AND ACACIA ROOFING COMPANY INC
COTTELL ROBYN PO BOX 1777
P.O. BOX 331070 ORANGE PARK FL 32067
ATLANTIC BEACH FL 32233 (904) 298-2170
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 85 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6260
Expiration Date . . 4/12/11
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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.
/° - Z 5�3
CITY OF ATLANTIC BEACH I I I I I
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 -
I OFFICE:(904)247-5826.FAX NO.:(904)247-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: L 2.VALUATION OF WORK: 3.SQ.FT.UNDER ROOF
-32-7 Fr-a+ J-{. Atlantic Beach, FL 32233 4 a
4.LEGAL DESCRIPTION: 5.CLASS OF WORK 6.USE OF STRUCTURE:
❑NEW BUILDING ❑DEMOLITION 19 RESIDENTIAL
1-01(kL BLOCK_SUB DIVISION-T'(-? /� mol - £ ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL
7.DESCRIPTION OF WORK 50 ALTERATION ❑ACCESSORY BLDG. S.FIRE SPRINKLER:
❑REPAIR 13POOL/SPA ❑YES ❑N/A
[�
'- ICO •- ❑MOVE ❑OTHER IONO
PROPERTY OWNER: CONTRACTOR: ARCHITECT f ENGINEER:
9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
16.NAME: 24.LICENSEE NAME:
J-- G�.r Z
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LI N SOV
377 Ffl; t- 64 . e
18.ADDRESS: 26.ADDRESS:
11.OFFICE PHONE: �12FO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
5'o/ a9lr-0!1`7 `J1'+Y o19ir6?/`7/
13,CELL PHONE: 21.CELL PHONE: 29.CELL PHONE:
FOV 7 74Y 7S-'9-./037
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
FEE SIMPLE TITLE OLDER:
(IF OTHER THAN OWNER). BONDING COMPANY: MORTGAGE LENDER:
31.NAME: 33.NAME: 35.NAME:
32,ADDRESS: 34.ADDRESS: 36.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 period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Wells,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
222 WARNING TO OWNER: 222 IJr
YOUR FAILURE TO RECORD A 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER or AGENT CONTRACTOR
LILftent,Power of Attorney or Agency Letter Required) (Qualifier Only).
Signed: Aa- Date: 1,1 7 Z 10 Sign ' Date: I fit)
Before me this day of ( T�,I,c� 2007 In the county of Before me thi 2007 in the county of
Duval,State of FI 'da�rall pearedDuval,State o Florida,has personally appeared
-- "&) too i'.F - at 64 x
herin GX1f/he I Irms that all statements and declarations are herin by himself/Kerself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large,State of F-C- ri-tL.14, P004.1- Notary Public at Large,State of ,County of
rsonally Known ❑Personally Known
❑Produced Identification- ❑Produced Identification-
Notary Signature: Notary Signature:
�r
•' �
a Commission DD 787538 ;� Commission DD 787538
Expires May 12,2012 :,= Expires May 12,2012
Badod TMuTray Fa*Warow 8 3WM9 �� Owd d 7Mu Tmy FWD m a oe9994eS7919
COAB FORM BLDG01:REVISED:10/26/2007
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida.County of Duval
THE,UNDERSIGNED herchy 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 r des tion of pro erty and address if available):
rg/L b ""?4� /r p k 4 t z2f 1, y g,--14 a(.4 /A —T
2. General Description of improvement}; /j
e /`e
3. Owner Information:
a)Name and Address: ,t,. GJ.A S7 J fi^ .f ��r etif /t-;T�..��ic. /JC.-.L•. �l J�v?��3
h)Interest in property: C ry
c)Name and address ol'simple titleholder(ifother than owner):
I. Contractor Information:
a)Name and Address:
h)Photic Numher: & rb
41� 5. Surety Intormation:
a)Name and Address:
b)Phone Number:
c)Amount ofRond:$
6. Lender Information:
a)Name and Address:
h)Phone Number:
7. Person within the State of Florida designated b} owner upon whom notices or other documents may be served as
provided by 713.13(I)(a)7.Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
R. In addition to himself7herself.Owner designates of to receive
a copy of the Licnor'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 C'OMMF,NCEMF.NT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713. PART
1, SECTION 713.13. FLORIDA S fATU FS. AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVUMVNTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MIDST BE RECORDED AND
POSTF.D ON Ifill:JOB SITE.BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT \N'TTH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOl iRN -IICT( F COMM EN 'FM ENT.
signature of Owner or Owner's,kuthorized Otficer/Director-Partner-Mianager Signator-,'s Printed Name&Title/Office
The foregoing instrument was acknowledged before me this Ion day of &1r .20 by
as for
(Name of Person) tAuthonth Type,i eWVAPLIB
(Nain WR - strumeit was Executed fix)
�:+�Yt""•s OERRICKM.B AVER 1,OF 1'I,ORIDA
Commission DD 787538
� Expires May 12,2012
ea'md'""Troy F°inWwomOo.�es'zote "15�crsonallyKnown �
Identification/Type:
Verification pursuant to Section 92.525.Florida Statutes. Under penalties ofperjur;.1 declare that T have read the
fill-r041inu an.t th"t thn t.-tc—ta.t",it ,.—t--t..the best of my knowledge and belief: