Permit Skylights 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001190 Date 9/29/10
Property Address . . . . . . 1157 E LINKSIDE CT
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1425
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Application desc
REPLACING 3 SKYLIGHTS ONLY
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Owner Contractor
------------------------ ------------------------
DERKSEN JELTSJE RAVEN ROOFING
1157 LINKSIDE COURT E 2041 BELOTE PL
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 237-1758
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Permit . . . . . . ROOF PERMIT
Additional desc . . 3 SKYLIGHTS ONLY
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1425
Expiration Date . . 3/28/11
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 60 . 00 60 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BLILDING PERmiT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: //,J- -7 4Ca5- ,1-
-Permit Number: /D CIO
Legal Description!I dl-2 3 1-7-25- ,a5e- -1,-1ye- L, e- U,,,,I 11.+ Parcel# ;,,-? -� 3 7 s-6 T
kloor Area ot Sq.k't /5- Sq Ft
Valuation of Work ProposedWork heated/cooled /'/J:� no�-hpntedlcooled
Class of Work(circle one): New Addition Alteration Repair Mo Demolition poollspa window/door
Vo 'i r
Use of existing/proposed structure(s) circle one): Commercial Reside
If an existin struciure,is a fire spriWer system installed?(Circle one): No K-NMA
9 1 4- e s��1,
Florida Product Approval# f-'Z- I Y 7
For multiple products Use Droduet approva orm
Describe in detail the type of work to be performed: ce-
Property Owner Information:
Name: 3 e- R-e r-kf e Address:t/5--)
qL
E-Mail or Fax#(Optiona �ZPhone *o
Contractor Information:
Company Name: a vrn 9-0,gp�- Qualifying Ze
Agent: l'on
Address:- 7 7 Lt At-, 131-. city
State _Zip
Off ice Phone lazy--- -9- 111 S-k Job Site/Contact Number q
V-6 4-q-ao-r Fax# YO 0— 5—gF6 — og,,.k/
State Certification/Registration# (f r
Axchitect Name&Phone#
Engineer's Name&P�one#
Fee Simple Title Holder Name and Addres—
Bonding Company Name and Address—
\4ortgage Lender Name and Address
0� is here de a, a pe m', d the wo"k and installq'i�nN as indic or installation has commenced prior to the
0 ..d om tthe, a,law thisjurisdiction. Thispermit b&comes null
k a oeriod of six(6)in onths at any time after
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e u red E Tkili�,Pools, Fiirnaces,Boilers,Heaters,
k_, d rt d p, a _,_i t
"As"a�j, 'naift" rs,et,
WARNING TO OWNER: YOUR FAMURE TO RECORD A NOTICE OF
COMMENCEMENT M-AY RESULT IN YOUR PAVING TWICE FOR F"ROVENIENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCMG CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDINC- YOIAi NOTICE OF
CONEVIENCENIENT.
'herebv f.,�rgfy that I have read and examined th-s ?plication and know Lhe same to be true and correct. Allprovisions oflaws and ordinances governit-ig this
ype'of work will be complied with whether spelci7ed/ierein or not. The granting of a permit does not presume lo give authorU to violate ncel the
2rov7sionsofany otherfederal,state, or local aw regulating constrixtion or the peifiormance ofconstruction.
')ignaftire of Signature of Confi-act
'rint Name
. ....... ......... Fint Name
tzb�.2 ...............
A. S.JACKSON If .. ....... .......-....... ........ ...........
A- S. JACKSON 11
DD676978 Sworn to and s
2011 thisjltw W06-
111�o may zi I ZU1 I-
4 C-H
tary iSEE PERMITS FOR ADDITIONAL
REQUIREMENTS AND CONDITIONS. Revised0l.26.10
FILE COPY '
REVMWEDBY. DATE:
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /0 am
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
44'&' Department review required Ye No
,, " A
Property Address: //,r? e Building
Applicant: ROVIVI 4001WON 6- Planning &Zoning
Tree Administrator
Project: /�IICA Public Works
Public Utilities
Public Safety
Fire Services
A
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: NjApproved. F�Denied.
(Circle one.) Comments:
=BUILDIN�
PLANNING &ZONING Reviewed by: Date: 0
TREE ADMIN. Second Review: ElApproved as revised. F-19enied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. FjDenied.
Comments:
Reviewed by: Date:
Revised 05/14109
OCT-4-2010 09:16 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
Doc 0 2WV23045a,OR tm 153M Page 625.
N9M9,E QF COMNMEEMEM Nwmber Pag":I
RecoWed I0104i2010 at 09-19 AM.
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
Powit No..10 'I b RECORDING$10.00
Tupolio
gj
TM UNDERSIGNW hemby gives notice that iaq"v==nt&will be made ta certgin red property,and irk acoordmoe wM Section
713.13 ofthe Florida Statutes,the ffillowing fabramdon is providcd in this NOTICE OF COADIENCEMMNT.
,� .0 /67-4'�7
1 Doscription of property(Ugai&xc*gjon).- e�u / A
a)Street(job)Address:/I S-7 -A F1__
2.0camml t1mcrikon of improvGments:-ze,
3.0wn=InfbMatiork 32033'
A.4— e:,- J IIS'-? Z66h,-ole cf'
a)Name and addi.m. 4E P- C--
b)Name and 96 si, owner) 1W
addrws of mpYs titlaol (if other than e?--
a)Tnterest in PrOpOrtY
4.Contactor Wormation
a)Nam and addran-9,-^)CV xre.-d c,
b)Telephone No.:ff 91- 2177- _�FaxNo.(Opt)
5.surety lnfiv�
a)Namo and address:
b)Amount of Bond,
c)To1cphone No.: Fox No.(Opt)
a)Namo and ad&m-
Pbone No.
7-ldcatiLy of person within the State of Florida designated by owncr upon whom notices or otber documcaft may be served-
a)Namo and addren: q Z q1-C
b)Tolophonc No-: Fax No.(Opt)
9.1h addition to himseM owner designates dw following pawn to receive a copy ofthe Liam's Notice as provided in Section
713.13(l)(b),FWda Statutes:
a)Name ar-d address:
b)TelepbDne No.: FZK No.(Opt)
9.r�V, jration date of Notice of Commencemezit(the expix-ation date ig one your from the daft of recording uWass a diftmit date
iq
WARWINIG TO OWNER: ANY PAYMENIS MADX BY THE OWNKR AMR T=EXPIRATION OF THE NOrICZ OF
C0MMNj=Mj&NT ARS CONSWERED IMPROPER PAYMENTS UNDAR CMAPTER 713,PART lt,SECII ON 713.13,
nowmA swrffns,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OIF COhMNCEMENT MW BE RECOIWICD AM POSTED ON THE JOB SITE BVORE THE FIRST
V MECMON IF YOU INMEND TO OBTAIN FINANCIN%CONSMT YOUR LENDER OR AN ATTORNEVIEFORE
COMM-;cING WORK OR 3tEM1KD.jNG YOUANO:-n�CZ OF CO
STATZ OF
10
I'aa ftegoing W%triimietrt was adwDvAedged bafm m--this 3rz/day of Oe4ole- 20_Zo
by
T4 e 7)1�1;e A as 40 M a am W^0 r (type of authority,e.&,oMesr,trutee,
attorney fx%ct)for (name of pafty on &If o wh instrumest was execut*.
M
PmendlyKnown V'OPPro&w-ed A.SAW"I we
, comiWSSION#I)DC,
Typo of Jdantification ftdvcad___N EXPIRM-_
Vetificti5ca pursuant to Section 92.525,Fice.da Statutos.Under penalties P I doclare that I have read the foregoing and ibsk
the fam staW in it aro tnx to the best of my�mowlcdgo and beUef.
sigamm of Natural Pama sigming rm UrA#10.)Abrm