Permit Roof 221 Pine 2011 cl , ,,, `} CITY OF ATLANTIC BEACH ....
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
, INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002385 Date 7/25/11
Property Address 221 PINE ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5275
Application desc
REROOF
Owner Contractor
DUGUID, BEVERLY BRC HIGH TECH ROOF DIVISION
221 PINE STREET 6372 GREENLAND ST STE 6
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32258
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 80.00 Plan Check Fee .00
Issue Date Valuation . . 5275
Expiration Date . . 1/21/12
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.
BUILDING PERMIT APPLICATION •
~``, CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job'Address: 02 / P /,/G 5 ATI,q„J77C 6"c4 Permit Number:
Legal Description
-• Floor Area of Sq.Ft. Parcel # Ft
Valuation of Work $ 4 . Proposed Work heated/cooled 02 / s9 q
• non- heated/cooled
Class of Work (circle one): New . Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residentia
If an existing structure, is a fire sprinkler system installed? (Circle one): • - lo N /A
Florida Product Approval # /?.V4 . 3
For multiple products use product approval form
Describe in detail the type of work to be performed: 4' - /WO, - 12 &i4uvC a .ed . 3 704-
,4 No -14,44 3 Q a. t,c : e, -I.p„i 4v
Property Owner Information:
eEvei )Ly aier
Name: 0. Address: d o� J I/Ii✓e7 S T.
City ATL - , ' cH • State a Zip 302023Phone 02'/(P - y/ 7 7
E -Mail or Fax # (Optional)
Contractor Information:
Company Naine: BRe A QO2/7 t/4 Qualifying Agent: SE ie re Y /PO1 c/, .
Address: /,37 .20 O1 b S T. Air 6 WS Ti.✓F RD• City Sp NC • State f2 . Zip S t2 s
Office Phone yb9 .2 88 - p y , 3 / Job Site/ Contact Number 9'(0 3 - 29 s' Fax # 42 - 9390
State Certification/Registration # CC C 05 3 98
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 certib that no work or installation has commenced prior to the
and
a void f is not comt and w thin six (6) or construction or of all is suspregulating nded or abandoned for a_ pe zod of six jurisdiction. months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, 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 1 have read and examined this a plication 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 speci zed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
prov of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner 4.% ,/ _ / _ __. _ ter' Signature of Contracto Cgs
Print Name &u_e r.ic i Kj.ks.� ,
� Print Name ,aC.Y2y2y' C' 126(14-- Sworni to and subscribed before me /(
this - tt�Day of Sw� Sworn to and subscribed before me
,2 0 // this J'`�f Si! V 20 J(
Not ublic ; ;per '! S. BRIAN HY .I.411/:-.. -
'
NES Nota • • ublic .;:e..•.•••.':
+ = MY COMMISSION # DD947667 '' +c MY COMMISSION # DD947667
„ EXPIRES December 17, 2013
46: �VLS�II�d�e�4hlber 17, 2013
'
(407)398 -0153 FbridallotaryService.com (407)398-0153 FloridallotaryService.com
•
NOTICE OF COMMENCEMENT
Permit No.
•
Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description . property (legal description o,f_prope� and address if availabl-):
or , 1 IG'< ( ec7 47/4/./ / c.,
2. General Description of improvements: � c..•4 / 3 L Z 3j. •
Rea
3. Owner Information:
a) Name and Address: 13e k,c.2 f y 01, , '.0 1 / ,Z 2) - ilvt.) c S 72 c r /
b) Interest in property: --/-c .c. fu� /3--etc / =/ 32 Z 3
c) Name and address of simple titleholder (if other than owner):
N /F
Contractor Information: BRC High Tech Roof Division, Inc.
a ) Name and Address: 13820 Old St. Augustine Rd., Jacksonville, FL 132258 Box 335
b) Phone Number: 9b4_2gg_p4q�
5. urety Information:
a) Name and Address: f 4"
b) Phone Number:
c) Amount of Bond: $
6. Lender Information:
a) Name and Address: /VA
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Horida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person: Ni
8. In addition to himself/herself, Owner designates
a copy of the Lienor's Notice as provided in Section 713.13 (1) of to receive
O
a) Name and Address: N �). Florida Statutes.
b) Phone Number ofperson or entity designated by o ner:
mp v
9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording 0 z c, 9 8
different date is specified:
g u nle ss a H r . M co
r;:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER. THE EXPIRATION OF THE c m
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART c m o c al
1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT M YOUR PAYING TWICE FOR o
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND �'
POSTED ON THE JOB S1TE.BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, 0 o,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING 5:75 a
u.
YOUR NOTICE OF COMMENCEMENT.
n . 2i
`Sig ure of Owner or t ner's Auth sized Officer/Director/partner/Mana er Si
8 gnatory's Printed Name & fD
c ia'
The foregoing instrument was acknowledged before me th x'
I d of Su � 20 / by r-
e / /A /✓ � ‘ $ as ,/O TA RY for ,BEv,E/d24 e Aviaro /�
(Name of Person) yN (Authority Type, i.e. Officer /Attom
eY) ame of Pa nstrument was Executed for)
/
„
_ * : ' MY COMMISSION # D0 3. BRIAN HYNES NOT •, 1.1,..0,r/
•
947667 PUBL S >,.--. OF FLORIDA
-• '' * • Print N ame: .-S"•• �jQ //4 V ��.,ti.E s
?;.• EXPIRES December 17, 2013
007) A-0153 FloridalloterySerrice.ppnl 0 Personall Known lc?. ,0/piie�' b /C•
K IdentificationJType: AL D.ZO -O(o/ -lb -97/-0
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the E )
foregoing and that the facts stated in it are true to the best of my knowledge and belief
ed . f� �^
j - Signature of Natural Peron Signing Above
Revised 10/1/2009