Permit Roof 1885 Hickory Ln 2012 `a ✓, fY CITY OF ATLANTIC BEACH
t .$) 800 SEMINOLE ROAD
"' ATLANTIC BEACH, FL 32233
.A � . v" INSPECTION PHONE LINE 247 -5814
" Oniv
Application Number 12- 00000035 Date 1/11/12
Property Address 1885 HICKORY LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 12000
Application desc
RE ROOF
Owner Contractor
RICHARDS, KENNETH ROMANO BROTHERS ROOFING, INC
1885 HICKORY LANE P.O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 110.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 12000
Expiration Date . 7/09/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 110.00 110.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 114.00 114.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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 of property (legal description of property and address if available):
i3 g j' ,!1,'cad ,ve A41 1x-11 ' 3 33
2. General Description improvements:
, . e, ,, ; ,
3. Owner and Address: I dr V : �� 1 !'
a) Name and Address: � /fps-
ff /�'� /�✓� �i�'`/�'l'
b) Interest in property: //ern e ,,p,
c) Name and address of simple titleholder (if other than owner):
Contractor Information: 77 r a) Name and Address: J�,,•r, ., f fohs £ba1fr pc) 'box 330 33'7 All h 7223S
IN b) Phone Number: Ott 4 G /d .
5. Surety Information:
a) Name and Address: Doc # 2012006328, OR BK 15819 Page 2145,
b) Phone Number: Number Pages: 1
Recorded 01;11:2012 at 09:23 AM,
c) Amount of Bond: $ JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
6. Lender Information: RECORDING $10.00
a) Name and Address:
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, Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself /herself, Owner designates of to receive
a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
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
I, 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,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instrument was acknowledged before me this day of ,7 u_o"r y , 20 )2
NOT Y PUBLIC, STATE OF FLORIDA
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
R g Job Address: / to Permit Number:
,... r �A/�/G'
Legal Description /SS c /•/.'e. /n. Parcel #
N'16or Area of,r,(S'q.Ft. Sq.Ft
Valuation of Work $ /Z , /700 Proposed Wdrk heated /cooled 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 Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No (1\171
Florida Product Approval # j. Qt 31 + 7
For multiple products use product approval form . n'� w rzr [h^ ,
Describe in detail the type of work to be performed: ( j , �,.,r i /4 7‘ 64,,,,, - /Vat `e i J f •'4", 4 't'IFr c
�. oir, --ae. � 5 / ` „ ✓s l
Property Owner Information: �y � �
Name: 0P,µ -v 1. a, el 4 .-4e f Address: / b 6-,,,„6-
City 1 4, -L.g �-� G l3Ge1A Staten Zip 1033 Phone
E -Mail or Fax # (Optional) 1
Contractor Information:
Company Name: 11 ,m D 11'v. 1 NG. Qualifying Agent: 1�,..r•vy nos `."',o
Address: J UK 1.1.4... /r • City Me btJ i / State ri Zip 3,P212 Office Phone 9QL/ 714 ` yq / Job Site/ Contact Number R & X41 c Fax #
State Certification/Registration # CCC. 1'378' V13 f
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 aperiod of six 6) months at any time after
work is conzmenced. 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 BEFORERTCORDING YOUR NOTICE OF
1 hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of law • nd ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to gm • •rity to violate or cancel the
provisions of any other fede al, state, or local law : • ating construction or the performance of construction.
Ft d g 2603 - 414 6 e'3 - ��'
Signature of Owner v - . � Si g n ature of Contractor r
Print Name 3 C 1 � F R. t C b 5" Print Name v n fN-�•"''
Sworn to and subscribed before me Sworn to and subscrib before me 20 a This 4 : ,y o f a utme 2 1 a ' t A -_".. , . •..
1
, ` + •� *_ MYCOMM!SSIOt} " DD 957760
� ;►�''" '• -S:- ROMA
,_ , .�` � '•� = EXPIRES• Fahniary 1A, 20
Nota' Publi '
re Notary Public - State of Florida i' ., Pubilfmru PublicUnderwriters
$+ �.= My Comm. Expires Nov 12, 2012 1 s �7 hd S Commission # DD 837063 1 Revised 01.26.10
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