Permit Roof 160 Mayport Rd 2010 ,� 1- ���
ri
r' ; u - `x 1 CITY OF ATLANTIC BEACH
` � "� ) 800 SEMINOLE ROAD
- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
J;119
Application Number 10- 00001465 Date 12/15/10
Property Address 160 MAYPORT RD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 8000
Application desc
reroof
Owner Contractor
DIXON, O. J. ROMANO BROTHERS ROOFING, INC
160 MAYPORT ROAD P.O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 90.00 Plan Check Fee .00
Issue Date . . . Valuation . . . . 8000
Expiration Date . 6/13/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 1 / 17 r J� �e , Permit Number:
Legal Description Parcel #
Cp Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 000 , Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Additio& Alteration repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): , ommercia_L., Residential
If an existing strucure, is a fire sprinkler system mstalle . (Circle one): Yes No 4111
Florida Product Approval #
For multiple products use product approval form i
Describe in detail the ty e of work to be performed: Poo d C�O�'1` CvJiti'k car sA PI _ , ApeW
ko tlett I 4
Property Owner Information:
Name: ,b4i,1 A//) b
i'Q r / i"14 Address: C1 " .y�� Z ),
City /4-7 .✓ )46 ,�:� ‘ State,Zip 223,'3 Phone6°Uy/ 4T - .5 <"
E -Mail or Fax # (Optional)
Contractor Information: pp ee ll
l�L'Mar'0 Er r`,S /LOc , —ANw
Company Name: � Qualifying gent: \,y R-0/9-4 01,9-
Address: & VC, c y p, - ASS /d M t' 4'" City All L . / State Zip .
Office Phone 7c- 8 (� S l Site/ Contact Number N C5 it-- c--p q8 Fax # 9c' Li V e ' )
State Certification/Registration # CCC- /1.) Sg 93 1
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 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 of work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod 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.
1 hereby certify that I have read and examined this . application 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, . e, or local law r, • ulating construction or the performance of construction.
1
Signature of Owner ; - - Signature of Contracto
Print Name A h n t Pl r rvt e,^ Print Name
Sworn to and subscribe • se • - ' = Swo tv . n. P
' `i �� M: . a � ,� -
this Day o this � ay o i ` = � ;,, : ` PalleRMI 20 La
DANIEL S. ROMANO Public - State of Florida
41L
Notary Public ! V! My Conlin. Expires Nov 12, 2012 ' u. ic'` W
a. Commission # OD 837063
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of County of
To whom it may concern:
The accordance undersigned Section 713 of the Florida Statutes, the following wing In ormaton certain is stated real property, this In
COMMENCEMENT. �/
Legal de . io,n of properly Improved: / C .() /'1 r4 / ii 4 / C ��
Address of property being Improved; / C' "1 I " d 4/ Lc X 7 - '
General description of improvements: r ; ' C? C
Owner AA X n / r� f .�►�1 P.
Address r C • C ` _ 7•
Owner's Interest in site of the im.. vernent
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor / a n r%%../ /3 U (') - n
Address 4 Y/b / c s s /a .11.,. 9 c i ! -- A'"i huh ,' =7 1
Phone No. 'Fax No.
Surety (If any)
Address Amount of bond $
Phone No. Fax No.
Name and address of any person making a loan for the rxmstruction 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 713.08 (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 . te of recording unless a
different date is specified):
THiS SPACE FOR RECORDER'S USE ONLY • R �'`
Signed .A . .1 DATE J ' /
Befo - this 7 - - - In the
County of Duval, State of . ride, has personally appeared
fterefn by
00C 8 Zo 1 028 3UZ. CJ ri its 1 546 f age OOO. himaettl herself and affirms that at statements and declarations herein
Number Pages: 1 are true and a -,
Recorded 12,15,2010 at 10:1 AM. ; \�
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10 00 No?. - b!- .1 of Co y. _ _
My con
Person- n.
Produce I. ri 7{� .0 3•� .r•, .r ,:• or
• - 4 s __._ _._9 ubll - St>!ht fZt Florida
y Comm. Expires Nov 12.2012
,,w.; M Commission # 00 837003