Permit Roof 410 Garden Ln 2011 \ it CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r ,� INSPECTION PHONE LINE 247 -5814
Application Number 11- 00003006 Date 12/15/11
Property Address 410 GARDEN LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4600
Application desc
REROOF
Owner Contractor
TOOMER SHORE ROOFING COMPANY
410 GARDEN LANE 914 7TH AVENUE SOUTH
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 241 -8842
Permit ROOF PERMIT
Additional desc . .00
Permit Fee • • • • 75.00 Plan Check Fee .
Issue Date . . . . Valuation . . . . 4600
Expiration Date . . 6/12/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
a
CITY OF ATLANTIC BEACH •
ROOFING PERMIT APPLICATION
Date:
... / ^ - / V -." 6)//
Job Address: 1 1 / U 6- CA r d- r L cx " -e -
- . _ _OwnerofProp • • - �� ....__.. -- --
Address:
WO Zrc1.✓ dtn L 4n e . 4 ik, ...4 , U - 4 (Telephone: 96`i - a S/.7 - d" 7' 7c
s k or c A? of � State Ucense Number:
Roof Contractor. Y
Contractor's Address: 9/ .
- 74-4' 4 ✓e -)
s 4. . 4, 4 j 3.21 ..0 0
Telephone: ''a V- 2.1t - .2 9'l 2 Fax: P - 914//-Pi 93 Emaik P /c .t .54•'‘K
Scope of Work: 29c Jov1 Roofing Material ivy r G ✓115 ; „ ct
FL Product Approval #
it I ga/• 4 + 1 / l f^` , Valuation of Work: $ I l® 0
Required Inspections: Sheathing /In Progress -Dry In / Final
if re -roof: Assessed Value of Structure: — < $300. >$ 0: Rooflocirall 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 INTEND MO C HINT MUST BE CONSULT WITH YOUR
ON THE JOB SITE BEFOR r THE FIRST INSPECTION
LENDER ORAN,�TTORN fi. E ORERECORD R NOTICE OF COMMENCEMENT"
- - / Date: 1 ' l
SIGNATURE OF OWNER: , .�. ' /
AS TO OWNER: 20 �`
Swom to and subscribed before me this day of , MARJORIE M. AD
State of Florida, County of Duval _ ,�` NOTARY PUBL
Notarl/s Signature �= . n via. ` STATE OF FLORIDA
❑ Personally known �+ Comm# DD0933T78
• 'Produced identification ' ' •
Type of identification producee - N
,�x (� 'E Expir 1 0/30/2013
/ /,�
SIGNATURE- OFCONTRACLOR: - Date: / " 1 S' 2°11
- - - -- - - -- — -_. - - - - - - -- -- -
AS TO CONTRACTOR: day of < L 20
Sworn to and subscribed before me this -- . 1110 State of Florida, County of Duval Notary's Sign : 1i,�. - ^ �- `■ L. - ,
Personally kn . wn it
Produced identification
Type of identification produced
800 Seminole Road • Attantk Beach, Florida 32233 -5445 -
Telephone: (904) 247-5800 Fax: (904) 247 -5845 FAroof Pew appacaton.doa 7/28/0 _
-FAUP
� BLIC LORIDA „.44............."-:,.. 33778 ADAMS
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s 'i'CE 1 '' Exp 10/30/2013
NOTICE OF C NT
(PREPARE
tN0. Tax O IE .
Stele of
To whom limey concerto er191w made to a reel P, and le
�flodteon 713 of the Florida Statutes, is hi this NOTICE of
WON description of property being improved:
/ 3 �� I, it- 3)2
Adder a property being WW1:Neck
General description of Improvements:
oanet G d S G .. G 1 .. es, n 7 i C- I1 c- a+ t
Addreen
tr /O r. r 4 mn L ".
Owner's honest in site of improvement
Feet 'T�eht of�terthan owner)
Name
Address
r A .4., 4o,ti J. .)war Z • �� �?�/ 42co 3
PhoneNa 90 y- z.2 L - �t 5 FarrNa v.k,I t' dress �l d bond $
• •
Ads Fax No. .
Phone No. .s�►� ..
Name and address d astl► person
making a wan for the constna On-O �'
Mama . . •
Adder Fax No. '
Phone of person NO. or other
Name ofperson dean the Stale dtaodde, other than hkeself, designated by owner upon whom notices
documents may be served= .
Name
Address Fax
• Phone d the Liana's Make as provided w
In addition to WINE owner d the following person w receive a copy
Sedion713.08(2)(b), Florida Statutes. (RI iMOwner's ).
Name
Address Pee No. .
Phone No-
rat (g n dale d one (1) year horn the date d recording unless a
ndsledNdbedCo __ __ -_ __ .. ,
SPACE FOR USE • T . t . . a iptiii O a? ' C P • I !
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Doc # 2011269413, OR BK 15797 Page 73, 0 `vti '
V
Number Pages: 1 Ili i . ' t '! casedor1 ial • Recorded 12/15/2011 at 08:28 AM, 'a n tes:
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY P 4til�
RECORDING $10.00 M ARJORIE M. A DAM NOTARY PUBLIC �� STATE OF FLOR
I , " I. . 0 ''' Comm# DDOA X377
Expires 10/30/2013