Permit Roof 354 19th St 2011 CITY OF ATLANTIC BEACH
AA
800 SEMINOLE ROAD
j ` ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 11- 00002242 Date 6/21/11
Property Address 354 19TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 7000
Application desc
reroof
Owner Contractor
SIMPKINS, EDDIE TIM BATES ROOFING LLC
354 19TH STREET 55066 COOK DRIVE
ATLANTIC BEACH FL 32233 CALLAHAN FL 32011
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 85.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 7000
Expiration Date . 12/18/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 85.00 85.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 89.00 89.00 .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: 354 19 ST, ATLANTIC BEACH, 32233 Permit Number:
Legal Description 1913 354 19 ST, ATLANTIC BEACH, 32233 Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 7,000.00 Proposed Work heated/cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration X Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial X Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No X N /A
Florida Product Approval #FL5444 Certainteed LANDMARK ARCHITECTURAL SHINGLE
For multiple products use product approval form
Describe in detail the type of work to be performed: REROOF ASPHALT SHINGLES
Property Owner Information:
Name: Eddie Simpkins 354 19 ST, ATLANTIC BEACH, 32233
City ATLANTIC BEACH State FL Zip 32233 Phone 904 - 677 -2254 E -Mail or Fax # (Optional)
Contractor Information:
Company Name: TIM BATES ROOFING , LLC
Address: 55066 COOK DR., City CALLAHAN State FL Zip 32011
Office Phone 904 -707 -2233 Job Site/ Contact Number 904 - 707 -2233 Fax #
State Certification/Registration # CCC1328963
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. 1 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 rm
eit
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 o six (6)
months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical Work, P lumbing, Signs, We s, Pools,
Furnaces, Boilers, 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 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, state, or local law regulating construction or the performance of construction.
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Signature of Owner Signature of Contractor ,
Print Name EDDIE SIMPKINS Print Name ,8 P)
Sworn to and subscribed before me Sworn to and subscribed before me
this , 1 bay of (/1/l/ e , 20/ i thisQL Day Addi 2-:,(.471-. . _ ..,.....� •d>.� ��..,
CAVIN T. KING CAVIN T. KING
+` Comm# DD0787855
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rr u Comm #DD0787855
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s. a xp, es e 1 12 Florida Notary
Notary Public %, r ;,,.,, Florida NotaryAssn., Inc Notary Pub is ' � F ` "'�r Assn., Inc ? ,,;
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5 f 2 4 ' 1 it 73 Revised 01.26.10
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of FLORIDA County of DUVAL
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: 354 19TH STREET, ATLANTIC BEACH, 32233
ATLANTIC BEACH, FL 32233
354 19TH STREET , ATLANT I C BEACH , 32233
Address of property being improved:
General description of improvements: REROOF ASPHALT SHINGLES
Owner EDDIE SIMPKINS
Address 354 19TH STREET, ATLANTIC BEACH, 32233
Owner's interest in site of the improvement 100%
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor TIM BATES ROOFING LLC
1; 4 Address 55066 COOK DR . CALLAHAN , FL 32011
Phone No. 9 0 4- 707 -2 2 3 3 Fax No.
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 /'' L
Signed: d - 1 DATE /C�/'� /
Before me this day of in fit
County of Duval, State of Florida, has pew dally aipeared
Doc R 201 i i 3e 25, OR BK 15e35 Page 338, himself/ herself and affirms that all stater rnrts ec a n •
Number Pages: 1 are true and accurate a
(7, Comm# DC0787855 Recorded 06, 2'1'2011 at 01:21 PM. Expires 5/12/2012 JIM FULLER CLERK CIRCUIT COURT DUVAL • '';, s� r'�:,�m„d"`` Florida Notary Assn., Inc
COUNT °•. r� , n , nr.esuu nuree.. wa.a
RECORDING $10.00
Notary Public at rg tate of , County of I); 4 , ).7 /
My commission xpires:
Personally Known or
Produced Identification /�/"