412 Whiting Ln 11-00002133 Roof A JV
,� ` . :, ` CITY OF ATLANTIC BEACH
4-4 mum ' ' 1 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
r -013,19,
Application Number 11- 00002133 Date 5/26/11
Property Address 412 WHITING LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
reroof
Owner Contractor
BERNARD, LEROY BLALOCK ROOFING, INC.
412 WHITING LANE 10737 NEW KINGS ROAD
ATLANTIC BEACH FL 32233 SUITE 106
JACKSONVILLE FL 32219
(904) 766 -6190
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 60.00 Plan Check Fee .00
Issue Date Valuation . 1500
Expiration Date . . 11/22/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 60.00 60.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 64.00 64.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1`1
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09 -
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: /z /Z+ t
Job Address: L i I Z LJt-'+ c- ' 01.- -- %0_
Owner of Property: \a^ -Z_ ev a
Address: ` t L�
e Telephone:
Roof Contractor: C140 `
$ ` ) O State License Number: CCC t 3 a1 -7 3 t a
Contractor's Address: 0 Mai c� - % yt'S vtl ) �Q , FL 3 a t
Telephone:W c-\" 71.'4 Fax: c� -7ff /
�'' �O(P�'(e) Email:
Scope of Work: Qe Y`ooP Roofing Material 1()C'Glf\ ru hher 9 r4 rut
FL Product Approval #FL in 6 Valuation of Work: $ I SOO
Required Inspections: Sheathing /In Progress -Dry In / Final
if re -roof: Assessed Value of Structure: X < $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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT"
Signature of Ow Date: .J )Z-0
AS TO OWNER:
Sworn to and subscribed before me this day of , 20 E(
State of Florida, County of Duval � f
WILLIAM L POPE Notary's Signature:
Notary Public, State of Florida ❑ Personally known
My comm. exp. Oct 19, 2011 ❑ Produced identification
Comm, No. DO 714218 Type of identification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of , 20
State of Florida, County of Duval
Notary's Signature:
❑ Personally known
❑ Produced identification
Type of identification produced
800 Seminole Road • Atlantic Beach, Florida 32233 -5445
Telephone: (904) 247 -5800 • Fax: (904) 247 -5845
NOTICE OF COMMENCEMENT Doc; 2011116161 , CIRCUIT COURT DUVAL
OR BK 16611 Page 40i,
Number t
Recorded 05/25/2011 at 03:11 PM
JIM FULLER Pages: CLERK
COUNTY
Permit No. RECORDING $10 00
Tax Folio No. — — - - --
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1 . Description of property (legal description): 3/ " l � j -,)-5 -..2W: (� /� „ U ( a r / /
a (job) Address: .4 /!;',2 W h r14-,' -__,C -�„ 13 -R— A � '`'' r r r + � Y� ( �C ('tS Ut T
2.General description of improvements: C l P M. (ry- 4 t— ✓ - --
3.Owner Information _
a) Name and address: r L 6 uv2i eli y (z_. vi WIT IN c, 01 t
b) Name and address of fee simple titleholder (if other than owner) 2-2 `"
c) Interest in property __
4.Contractor Information `
�� Yl a) Name and address: ( 1 t S c l Bi c,)( ` tU4 "'J i� 0 _ `�
"J b) Telephone No.: `l 0 (�1- `7l 3y �l C No. (Opt.) n S r�Clrc' �C X FL 3)
5.Surety Information Fax No. (Opt.) 1
k a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No.
6.Lender (Opt.)
a) Name and address:
7. Identity of person within the State of Florida designated by owner upon w om noti
es or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one 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 713.13,
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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA WILLIAM L POPE
COUNTY OF PINELLAS 10 _��
Notary Public, State of Florida Signature of Owner or Owner's Authorized Office ector /Partner /Manager
My comet. exp. Oct 19, 2011
C omm, No. DO 714216 n ti� - r l
Print Name
The foregoing instrument was acknowledged before me this .25 day of , 20 ! ( , by
as (type of authority, e.g. officer, trustee,
attorney in fact) for (name of party rty on behalf of whom instrument was executed).
� n *1y Kr o�uh OR Produced Identification Notary Signature i C� ,�-�
Type of Identification Produced
-- Name (print)
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, l declare that I have read the fore oin and
the facts stated in it are true to the best of my knowledge and belief. g g that
FORMS 'NOC,nsd2010
Signature of Natural Person Signing (in line # 10.) Above