250 Camelia St 11-00001887 Roof ,; CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001887 Date 4/06/11
Property Address 258 CAMELIA ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5000
Application desc
roof over
Owner Contractor
HINSON, RAY ROMANO BROTHERS ROOFING, INC
258 CAMELIA STREET P.O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 5000
Expiration Date . 10/03/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .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
1 / A I 3723
lob Address: 2— 5g C (l l� '1 l) Permit Number:
.egal Description Parcel #
Floor Area of Sq.Ft. ', Sq.Ft
Valuation of Work $ 0 00 Proposed Work heated/cooled non - heated /cooled
Class of Work (circle one): Ne Addition Alterat !Await"' Move Move Demolition pool/spa window /door
Jse of existing/proposed structure(s) (circle one): Commercial Residential
[fan existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
lorida Product Approval # f 1 ? '6L3
?or multiple products use product approv form
)escribe in detail the type of work to be performed: Xe / D 0 / ' 5 lea i to -'1
'roperty A ll ' ner Information:
Name: P' _ \ o f ( " Z $ K " (4 St/•0 C', -
/'t 1 j,� f O ( �► Addres f
Jity ! a . ( c State f4Zip) 7 -2-.9 / Phone h 7 - V — yi
Mail or ax # (Optional)
Contractor Inform on:
s I
0..{' � al fy' Agent: ''
Company Name: 0 �q�v '� � �'� Quali A ent: � it a � n d
4ddress: 7 0 9ti, 5 fiv t-(''4— (.✓CS 4" City (t ?1c ' /4-- Fe State ‘-- Zip 3 Z. 2
Mice Phone AV 2 ti 6 --56 yd Job Site/ Conct Number 70 y $,877 Fax # 7c y 2 tied y ,f4
.hate Certification/Registration # C (6 - q - 9 3
krchitect Name & Phone #
3ngineer's Name & Phone #
.Tee Simple Title Holder Name and Address
3onding Company Name and Address
Vlortgage Lender Name and Address
l pplication is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
ssuance 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
vork is commenced. I understand that separate permits must be secured for Electrical {York, 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.
•
'hereb cert that I have read and examined this a plication -and know the same to be true and correct. All provisions of laws and ordinances governing this
ype 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
srovisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner rk 44-4167-t.-- Signature of Contractor
Print Name Print Name
Sworn to and subs' �`. ' - s e me ., j' / / Sworn to and subscribed before me
:his Day o . 20 this 11 Day, of i - p V ) -) L , 20
/ , � � , t_ )1k ( ( v',
Notary Public kltv, , Nobly Public - state N Florida k r ,
`T My Comm. Expires Nov l2, 2012 J11SAN K . SULLIVAN
Commission # 00 837083 w COMMISSION 0 0o701 7s2 Revised 01.26.10
' '�,� '' 41, EXPIRES: August 05, 2011
1. I - 800 NOTARY i Notar Discount Assoc Co
,% ' :a .."" "iAAAl9,a,■ww..
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of 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 des?"ption of property being improved: ' `
'7. e. 5 '
Address of property being improved: - > ,' r ? , ( ? !; �, 4 t - y t
General description of improvements: /t/l' L •- r J 2 ! ` //`i
Owner �` I , r 1 > ,'
Address ' > t ~; �'1 C >(' ✓ f r< n r> �' 4 i is 3 r,
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address ,,"
i , Contractor T �1 -� <: ;r. " - > � 07a-o ! ,�
�
Address ;-� r` , re. ,i., < 4 ,4 4414,4 4 it (.?(-4 2 y .�
Phone No CrfOill `/�r i -' ' Fax No r- ) c'
, 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 (the expiration date is one (1) year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER //
Signed: v i�le� DATE ! / / /i`/
Before me this 11 day of r/ in the
County of Duval, State of Florida, has personally appeared
herein by
himself/ herself and affirms that all statements and declarations herein
are true and accurate -
L70C ii U "i "i t j UUJ, Lit< t ? bbn4 Page d&"1. •
Number Pages: 1
Recorded 0406/201 1 at 1048 AM 1 5 — OP ^rif viLS�
.AIM FULLER CLERK CIRCUIT COURT DUVAL Public S _" r T
COUNTY Notary','" ' ��
My comisf+i � � ' �'1 \u�`,ii�!�!
RECORDING $10.00 Personally Kn• Z''i1"D "'hil''' 61Ut L,11g rt1t
Producediden i T 5A7. ,.iLK1:uTiiw??1R77
Cetsrmi :aion # 00 887063