Permit Roof 118 4th St 2011 A.r
\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
....„") INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002323 Date 7/11/11
Property Address 118 4TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 3500
Application desc
reroof
Owner Contractor
C. BERG, RANDALL ROMANO BROTHERS ROOFING, INC
4982 ARAPAHOE AVE. P.O. BOX 33037
JACKSONVILLE FL 32205 ATLANTIC BEACH FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 70.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 3500
Expiration Date . 1/07/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 70.00 70.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 74.00 74.00 .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
` 9 7-14- - 41- - --cc . Permit Number:
Job Address:
-CO t(0 2 S - Z'E Ail— !'C t-O 4 (3L Z‘ Parcel #
oor Legal Description t. t
' no n- heated/cooled
Valuation of Work ', • #D Proposed Work h /
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial es.de
If an existing ,
structure, is a f ire s rinkle system installed? (Circle one): es N N /A
Florida Product Approval use product approval pproval form
For multiple products p 2C. r� C�
Describe in detail the type of work to be performed:
prope Ow ner Information:
- 024 ET 4 L Address: i f (o O G. '�f 4G�"r cl- 1.1_,(L Came: i9 �'� 6 State(Z Zi (32 L t o Phone 9 O'f - 3 5 Z -19' 'i 1 - G ee
City ''f � G/L �O I/i c. �. � — p
E -Mail or Fax # (Optional)
Contracto Infor mation: r QQ
00
Iv►-'' l ro�' ' .1e - Qualify' g ' gent:
4ddre
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Company Name: M State / __ Zip _
P ,
L ,i �t�S 4 • . ,,.,.C
office Phone a ■1 _r' ob Site ' intact a er 9 bl D —es 7_ Fax
State Certification/Registration # C A-. 8 913
krchitect Name & Phone #
Engineer's Name & Phone #
ee Simple Title Holder Name and Address
3onding Company Name and Address
Vlortgage Lender Name and Address
s lica f is permit made to obtain a permit e or do the work eet th installations tandards of all indicated.
ws regulating construction in a this jurisdiction. o of ix This n months commenced becomes ssuance of a permit o c that m nc workwi n be xperfo ye lls, Pools, Furnaces, at .any time
Seaters,
and is commenced. en is not commenced within six (a) at separate months, permits or u construction be secured foor r work is ca Work, Plumbing, ro Signs,
vork is Conditioners and that permits must be secured for Electrical Work, Plumbing, Signs,
ranks and Air
WARNING TO OWNER: YOUR FAILURE
PAYING TWICE NOTICE OF
COMMENCEMENT MAY RESULT i Y
TO YOUR PROPERTY. IF YOU INTEND TO BEFORE OBTAIN IN IN NSU E F WITH
YOUR LENDER OR AN ATTORNEY NCEMENT. NOT
hereby certify that I have read and examined this a plication and know the same to be true and does not All provisions
to ' of law and o d i a g or cancel h s
me e of will be complied with whether specid herein or not. The grating of a p presume
provisions of any other federal, state, or local law regulating construction or the performance of construction.
,inature of Owner
- Signature of Contract .0011/
Print Name PA 'rint .. 4- .
Name # / ��� '
,wo a t and subs 'bed before me Swo o as -ub ribe• �. - • - me
gg.� , 20 11 this . 411. of 4jJ4 _ 20
his Tway of ( ---- S a ��" � I t t s' t �l . - &V i
� ti A C . w1 ," 1 �.��►► -- - e e ER 1 .,.W .•.: .I
Notary I% ` y EXPIR' . Feb a , 2014
dotary Public ' • I 4 : MY COMMISSION # EE02213 a ' Bonded Th Notary " • ' .nden raters
" 4: , ' EXPIRE A ugust 3 0, 2014 ' - * ' - d 01.26.10
(407) 808 .0153 FloridallotaryServlce.aom
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Tax Folio No.
Permit No. County of
State of ----- --- ---
To whom It may co
The undersigned t eby informs you that Improvements will be made to certain real property, and In
accordance with Sect) 13 of the Florida Statutes, the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: , t 74C1
Lar G :3i.oc.*'7 -c
Address of property being improved:
", Z
[l.,.i '
� r, 2.
General description of improvements: • L.-1.J lestra
Owner 7-$.44 C L `. - ' I: 3 z - L..1
Address • F YtT • ►
it if Owner's interest in site of the improvement 064'1/C'�2
i
Fee Simple Titleholder (if other than owner) . ► i
�,� e . Name
Address' • i �7 G'r
• Contractor � --
1 / C f • . c, • { _.
Address
j'-11. / Phone No. fiat t ;SID Fax No.
Surety (If any) Amount of bond $
'\ ta Address
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name / .as
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: A
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
0 "--\
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Aril
Address
Phone No. Fax No.
W 1-
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a w €
• WNER i!
different date is specified): W S
s •
THIS SPACE FOR RECORDER'S USE ONLY 11 D TE Ch 11 V
W
Before me this L i of - _ ••• 01 in the
/ of Flo�la. t epP� t
/� herein by a r
W tu
himself/ mselr! heats n an d that : sraoemen and dedara6one herein y U
are true and 0 > u!
Doc #20'11148462, OR BK 15649 Page .1876, } c�,, �-- ..0`.1:: 8
Number Pages: 1 (�� �C "= i ' - : 1 ��la
Recorded 07 %Or -2011 at 02:43 PM, Co of
JIM FULLER CLERK CIRCUIT COURT DUVAL Notary comm's t expi res: State
COUNTY Personally Known _ _M� _ __ —. or • «" ' i. RECORDING X10.00 Produced Identification --