Permit Roof 1855 Beachside Ct 2010 ' .= CITY OF ATLANTIC BEACH
3 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
J rf l %Nf' INSPECTION PHONE LINE 247 -5826
Application Number
Property Address 1855000 BEACHSIDE Date 11/23/10
Application type description ROOF PERMIT CT
CT
Property Zoning TO BE UPDATED
Application valuation . . . 11000
Application desc
REROOF
Owner
Contractor
TEMPLE, CHARLES R. NELIGAN CONSTRUCTION (ROOFING)
1855 BEACHSIDE COURT PO BOX 49249
ATLANTIC BEACH FL 32233 JAX BEACH
FL 32240
(904) 247 -3777
Permit ROOF PERMIT
Additional desc . REROOF FL5444.7
Permit Fee . . . 105.00 Plan Check Fee .
Issue Date .00
Expiration Date . Valuation 11000
5/22/11
Other Fees STATE DCA SURCHARGE
STATE DBPR SURCHARGE 2.00
2.00
Fee summary Charged Paid
Credited Due
Permit Fee Total 105.00 105.00
Plan Check Total . .00
.00 .00 .00 .00
Other Fee Total 4.00 4.00 .00
Grand Total 109.00 109.00 .00
.00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: i 55 €ec'c.V)St Cour\ -- AA - V - Inkic, bear Permit Number: /0 � /o
Legal Description 14a - V O a S -- a 5( E 3 5 Cc - Parcel # \695t2- 05 S 8
Valuation of Work $ 1\. OW ,
Floor Proposed W ork heated /cooled non-heated/cooled
non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(1) circle one): Commercial esident i )
If an existing structure, is a fire sprin er syst nstalled? (Circle one des - No
7
Florida Product Approval # \ 4L) s ' • ` �
For multiple products use product approval form
Describe in detail the type of work to be performed: `b oo - ° P - \ cics , m e . —
Property Owner Information:
Name: Ckle6ke:-.)7e D, Address: esxc s ode; C,u.c r
City : -\- \AGet\ c- ?)eacit) State c'LZip 3ZZ33 Phone a -1
E -Mail or Fax # (Optional) c
Contractor Information:
Compan Name: ... .....' . . a . .. ► u .
�—�= Qualifying Agent: C'beh ki.gqa
Address: .0. • a49 City , env le. beoch State' r-t - Zip 3aa4b
Office Phone , -1 'go Job Site/ Contact Number 5V:2) g- -E5-fOe Fax # 'a.aa.- S#1 t5
State Certification/Registration # C 1°.0 139
Architect Name & Phone # f
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. 1 certibi 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 f 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, Signs, Wells, Pools, Furnaces, Bo 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 hereby certify that I have read and examined this placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, s e, or local law regulating construction or the performance of construction.
Signature of Owner ,.,f ,/ Jj
/ , Signature of Contractor k ,
Print Name -� .
.�i� f l Print Name tcSc ‘AA
4
Sworn to and subscribed before me Sworn to and subscribed before me
this 19 Day of ves c- , lb this \ Day of j��y,}em�je_f , 20 1b
Nota ` n 9MJko .i« iA�. ' +;.�,aa CIa r' i'i' _` °' t _ ',:,,,,AM- ji7 ?%�',
N EUZABEThI ANN' NQ Pu. 1c • ' w : , 4"*" �'
s* • *: MY COMMISSION �t DD1i737S� : +_ MY COMMISSSO$ * D�
.'• '-t' EXPIRES March 22, 2014 EXPi M
447) 3153 FbAd.No sryServios.com ( Wp153 FbaldeNdMS' o oln
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.
1. Description of property (legal description of property and address if available):
`ta1-1 09 - a� - act f= Bc3`s:Rl5;r�c> o2,55 extkaiS\6e. Cc�c.c, -- Ni-�c c�et:c�i It,c;k�. 3' :
2. General Description of improvements:
' V Re0c c'r mend
3. Owner Information:
a) Name and Address: Cho..c e-� \ ernci < \(?Ff) e}c\ ,A . 12 \ctr )) �`c•AAACt 333
b) Interest in property: �. ae \F
c) Name and address of simple titleholder (if other than owner):
‘Pt 4. Contractor Information:
N �
a) Name and Address: r, �7CK ` fi
,c n, - t, i <a11dt .11c� ► C- 'a '�XSC(1Jl,� ��
Phone Number: a �,b� \9`j(� (1�.�h ( 3 �4 (
`� b)
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 may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of
a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. to receive
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 COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
I, SECTION - I I FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR CE OF COMMENCEMENT.
to �� ' X Gh,gez s ie - r� e of Owner or Owner's horiz icer /Director/Partner /Manager Signatory's Printed Name & Title/Offi6e
2
The foregoing instrument was acknowledged before me this G
g ` day of lac Jembex l0 , by to .
as for Z
(Name of Person) (Authority Type, i.e. Officer /Attom
o ey) (Name of Party Instrument was Executed for) , E X z;
tr
a O NOT Y PUBLIC, STATE OF FLO R � J � w
c, Print Name: �� \ZcA�h '� f\��� 1.-04 \ \�
n 0
a
- Personally Known .'''''.d-..
Q X Identification/Type: 'F1,•- x �Cl vt c � y ei(1S
C= d Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury. I declare that I have read the
I ^ z foregoing and that the facts stated in it are true to the best of my kno . d.•'- and b- li ef.
w
E ` 0 i
a� .� /
i O u) 0 = o Natural Person igning • ..ve
Revised 10/1/2009 LL