Permit Roof 49 Ardella 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002948 Date 11/29/11
Property Address . . . . . . 49 ARDELLA RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 8860
-------------------------------------------
Application desc
REROOF 1956 . 3
-------------------------------------------------------
Owner Contractor
------------------------ ------------------------
CONSELICE JOSEPH J BRC HIGH TECH ROOF DIVISION
49 ARDELLA ROAD 6372 GREENLAND ST STE 6
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32258
-----------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF
Permit Fee . . . . 95 . 00 Plan Check Fee 2 . 50
Issue Date . . . . Valuation . . . . 8860
Expiration Date . . 5/27/12
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 95 . 00 95 . 00 . 00 . 00
Plan Check Total 2 . 50 2 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 50 101 . 50 . 00 ^^
City of Atlantic Beach
REPRINT
CUSTXR RECEIPT
Dper: DSNITH Type: CIC Drawer: 1
Date: 11/29/11 01 Receipt no: 13627
Description Quantity Amount
BP 28 BUILDING PERMITS
1.88 $181.58
Tender detail
CK CHECK 15128 $181.58
Total tendered $181.58
Total payment $181.50
Trans date: 11/29/11 Time: 14:59:22
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job'Address: �I ARAR-Loq 41) ATL Bch 01- Permit Number:
Legal Description � Parcel#
oor ea o q. t. t
Valuation of Work$ ��to Proposed Work heated/cooled�_ non-heated/cooled 3000
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): mmercia Residentia
If an existing structure,is a fires rinkler system installe irc a one): Yes No N/A
Florida Product Approval# N G .3
For multiple products use product approval form
Describe in detail the type of work to be performed: /RE- R00,C ✓1z�n / -+�`{j
Property Owner Information•
Nanne:AlylElP/Citn/ Q^/tLL ; rRRiG►Arior✓ Address:_ 49A LI-A QQ-
City ATLAIV rIC ,eCAe State FtZip 3.423 Phone -.�64 -- 5'VOO
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:_8KC f1 &# TECH 90OF D)Vi w • Qualifying Agent: 7E99Y 90W,6
Address:_/y'8a1i 04D 5T. .4M&# r1A19 RD City Z-r4.A_. State FL. Zip .
Office Phone a28$ vY3l Job Site/Contact Number Fax# 49Z V10
State Certification/Registration#_ CCC. t'>S 399
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 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 sir((6)months at any time after is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, 1�urnaces,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 herebcertify 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 speci aed herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
provisions of any other feder state, or local law regulati construction or the performance of construction.
Signature of Owner Signature of Contractor V-1
L�
Print Name Print Name C
..........................-.................................................................................
7
Sworn to and subscribed before me Sworn to and subscribed before me
this&I"Day of of/ ABE 20 this JV"*Day of ®✓f ,Eg 20 /f
Not lic S. BRIAN HYNES 4' ',
tazy u HYNES
MY COMMISSION#DD947667 : = MY COMMISSION#DD947667 Revised 01.26.10
it" EXPIRES December 17,2013 EXPIRES December 17,2013
(407)398-0153 Floritlallot (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 Commencemept.
;U ;o z c.
i. Des cri tion of roperty(le al description of rope and address if available). m E3 G
rtrtyy ). C>C .�O ss
A�DEIGs� R,b, yl. ffcN f<. :z a 33 o z c is
-+,-ro
2 p -<r- Vic;
General Description of improvements: z in n
ick ' ROOF G) ri ren a
3. Owner Information: a rn a U;
a)Name and Address:SUS C'C /SL`s IC's A�E'yE 47;4 oyzg Fl 3.�t.2.3.? o m z,
b)Interest in property:_ � � S�I' PLrE. 70 o u,
c)Name and address of simple titleholder(if other than owner): o"' x
C G
o
4. Contractor Information: BRC High Tech Roof Division, Inc. Suite 113 $ox 335 0-
C
a)Name and Address: 13820 Old St, Augustine Rd,, Jacksonville, FL 32258 C 2;
b)Phone Number: 9 04-2 g S-04 3 7 rrnr
b� a
5. Surety Information: <
a)Name and Address: D
b)Phone Number. r
c)Amount of Bond:$
6. Lender Information:
a)Name and Address:
b)Phone Number:
7. Person within the State of Florida de ignated by owner upon whom notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates
a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida�tutes.of to receive
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement(The expiration date is one(1)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
1, 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,
CONSU T WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOURVOITICE OF CO CEMENT
Signator of Owner or Owner's Authorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me this-dH day of ,yt7,/.'�n9/��C2 Z0by
S. Bv21/�l rr/ 14 V. Zs' as s't/G°J"Are/� _for Z'DE CO.v's'EL e,E
(Name of Person) (Authority Type,i.e.Officer/Attome
Y) (Name of Party instrument was Executed for)
S. BRIAN HYNES
MY COMMISSION#DD947067
NOTARY P , STATE OF FLORIDA
EXPIRES December 17,21113 Print Name: • i(',�'M AI
M71 3' FloritleNotarySeryica.epm
❑ Personally Known iF� ' I)R1 v. 41 e,'
j ,Identification/Type: 4/9G? 7
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,I declare that I have read the
foregoing and that the facts stated in it are true to the best of my knowle0e and belief.
i �
Signa of Nafura erson Signing Above
�� Revised 10/1/2009