Permit Roof 390 Skate 2011 j L.411 r
' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J t �� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
r x31>'
Application Number . . . . . 11- 00001714 Date 2/23/11
Property Address 390 SKATE RD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5750
Application desc
REROOF
Owner Contractor
SAMPSON, LUCY THE FIDUS GROUP LLC
390 SKATE ROAD 301 KINGSLEY LAKE DR
ATLANTIC BEACH FL 32233 UNIT 501
ST AUGUSTINE FL 32092
(904) 874 -1010
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 80.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 5750
Expiration Date . 8/22/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 80.00 80.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 84.00 84.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
f f d ,
` - ` " /1 - 1 7/
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: -a /11 /
Job Address: 390 -956 it k'cl • / /fin C i h , re_ 3 33
Owner of Property: Lc) cti -Sao') (- O `
Address: 3Cl/3 S 4< Qc. • '9J" /a(1-)"1l Err) Telephone: i- H,' 88S3
Roof Contractor: e I 'dV
• % 3 6 1-1-C- State License Number: (CC /3 2 70 9 a
Contractor's Address: 301 11135 kaj La& bi - `6 a St
Telephone: 90-4'Z3D " 5S / 8 Fax: 9'04 7 Email: Dai1'1PSC 1- 'dvS9'► f -Q
Scope of Work: Re r coo -F. Roofing Material sh ( .
FL Product Approval # ( 1 q , 5 (P Valuation of Work: $ 5 SCE, C>U
Required Inspections: Sheathing /In Progress-Dry In / Final
If re -roof: Assessed Value of Structure: ✓ < -D $300,000/ >$300,000; Roof -to -wall improvements required?
( Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD 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 ATT • RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: It/1 4_ L ■ , A_ �s , �A.� D a t e: ` 2 J // // )
AS TO OWNER:
Sworn to and subscribed before me this / I day of re Y> , 20 / / .
State of Florida, County of Duval ��
Notary's Signature: (1 (� — s
[tersonally known PGa., LORI L. TORZSA
❑ Produced identification • .? : • = Not Public - State of Florida
- • : � ; • e My Comm. Expires Mar 22, 2013
Type of identification produced I S,,, Ft •�, comm # DD 872896
( _, °� ��' �`` Bonded on National Notary Assn.
SIGNATURE OF CONTRACTOR: /, ? 1 s Date: �I 1 I V1— — — — — — — — — _
AS TO CONTRACTOR:
Sworn to and subscribed before me this I 1 day of I 0 , 20 I I
State of Florida, County of Duval
Notary's Signature: (r)elnt Q\ C—
G-Personally knownw•u�:�. -aw=
❑ Produced identification .',;"'P „d,, LORI L. TORZSA
Type of identification produced * • ` s'' s Notary Public - State of Florida
rr ' y omm. Expires Mar 22, 2013
o Commission # DO 872896
800 Seminole Road Atlantic Beach, Florida 32233-5445 %, „ , • • Bonded Through National Nita assn.
Telephone: (904) 247 -5800 • Fax: (904) 247 -5845
F: \roof permit applicaton.docx 7/28/09
•
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 1 1 ` (j' —7 _ 0C0 C-)
State of 1C;r , C nt County of
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF
COMMENCEMENT. _
Legal description of property being improved: %31 - 01 tr. ."5 '• 9 -- cl b
PT 0 c ri,..��:I Prlrn Un 2
J A
Address of property being improved: 39 o •-� 1 � T '` J •
3, -3 '�,
General description of improvements: rt .0 0.'
Owner Li) C y � v-TS nn '1 ` ��11
Address 3 q0 S �CA�<.. (2-,1t• 4"7J I/.I,�)47
Owners interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
� Contractor T1 F '� C(` `f G (Z.Z L, p L L_ C--
Address - t K n 11E J
\k Phone No. C/C •I - 2 3c: - ` lc 4 g Fax No. c 1 G - 2 3C --
Surety (if any)
Address Amount of bond $
Phone No. Fax No.
Name and address of any person making a loan for the construction 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 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement (t a exp date is one (1) year from the date of recording unless a
different date is specified): 6= 11
THIS SPACE FOR RECORDER'S USE ONLY o NER
Signed:` 1 ALi/ 0114 <' ' ATE
Before me tr / / day of /-- ls.VaZZAY • If in the
Countieel o fpl• dpsasp =ared
herein by
himself/ herself and affirms that all statements and declarations herein
UCC 8 �U I I U4«O !. ' K �K i JOL3 rage ! <�3_ are true and accurate
Nurnoer Pages
Recorded 00.33 2011 at 01 19 PM. ROBERT =ACHM N, JR.
(�
JIM FUL_ER CLERK CIRCUIT COURT DUVAL �O .N #{
COUNTY
,� _ *A' .. Y ° . :;.�►
RECCRDiNG $10 00 Notary F.ib'% 'S'r< -, Staten
My comnitatin Miter^ F:nf AaNroaryCoryinA onm
Personatyftnermr ' or
Produced Identification f O L M C S 2Z -