Permit Roof 780 Triton 2012 `� CITY OF ATLANTIC BEACH
7. 800 SEMINOLE ROAD
a , ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000144 Date 2/03/12
Property Address 780 TRITON RD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 6500
Application desc
REROOF
Owner Contractor
BALORY OSCAR AND BERLIE E DAVID MERRITT CONST. CO.(ROOF)
780 TRITON ROAD 108 FLORIDA BLVD
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 993 -1697
- -- Structure Information 000 000 REROOF FL 9631.7
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee 85.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 6500
Expiration Date . 8/01/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 85.00 85.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 89.00 89.00 .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 ' 1/
Office (904) 247 -5826 Fax (904) 247 -5845 f —
Job Address: 780 r led Permit Number: 1 41
Legal Description Parcel #
/ � ��' Floor Area of Sq.Ft. Sq.f t
Valuation of Work $ 4' Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing/pro osed structure(s) circle one): Commercial R
If an existing structure, is a fire , pr er s st ° installed? (Circle one): Yes No N /A
Florida Product Approval # y ' ,
For multiple products use pro • uct approva orm
Describe in detail the type of work to be performed: R. -e4C o0-
Property O wner Information:
Name: Os C 6° -7 Address: l 0(-) 1 l n 10
City , -'f" ( 41 8-each State Fi Zip 3ZZ 33 Phone
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Da V 1 d ( f /CH OUR - C Qualifying Agent: Melt SSa / Vie - III
Address: Pb 00? S l 5 Z (p City 'JC<(J JOAtit! t<e r30-, State Pk._ Zip 3,;2,7(16) Office Phone �j Sf"' J yV O Job Site/ Contact Number 993 /4g 7 Fax # Dd O 73969
State Certification/Registration # CC C 1 3 z 5`)J
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. I 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 six (6) 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 I have read and 'red 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 - ' l' eta, •eci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federi, Late, or - - egulatin: onstruction or th' .performance of construction.
Signature of Owner - --e �'t u' ,ai A!
Signature of Contra•: :(�;,...,
vii Nk
Print Name � C � )O / Print ► . - ' y A 1 v fi 1C _ to � l..--
Swo� •,e and subscr'bed before me d : -' ' ore me
.
this . Day of s , & , 20 /Z t' - .: • �:' = , 20
`` 4tAr
Not : ry 4'
NI I Ail T is .'�' i ''' ' : -- My COMMISSION ° ID ii ' • Notary Public
_ ' tember 20, 2013
i %'
." " ;' EXPIRES Sep f �j/ J `/ CC /„��" �'JG /_. L .
(A07)398 0153
NOTICE OF COMMENCEMENT
Permit No.
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property (legal description): /C l � 1 '/ ", � . I'3 3 Z 3
a) Street (job) Address:
2.General description of improvements:�'.�21.::'L'= f-
3.Owner Information o ? l
a) Name and address: -'t. iki 1 �( ''' l C'-� /t ; (; }' / tz :77 +f"C P6 32' C 3.3
b) Name and address of fee simple titleholder (if other than owner)
77
c) Interest in property
� �l.Contractor Information �
F
a) Name and address: it � � � t eY 1`� C4`� (�i ��` }7' i� t✓ - �`r �:;'� ! ;'> 4'n l y � � �jU It 5 1 c
•_. ", t f �"
)' {` b) Telephone No.: `1 ' " `? L1 _ -
`, 5.Surety Information Doc # 2012022127, OR BK 15838 Page 1180,
a) Name and address: Number Pages: 1
b) Amount of Bond: Recorded 02/01/2012 at 02:39 PM,
c) Telephone No.:
COUNTY
JIM FULLER CLERK CIRCUIT COURT DUVAL
6.Lender RECORDING $10.00
a) Name and address:
■ uvuf. rvv.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: j Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSUL UR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF C S E
STATE OF FLORIDA
COUNTY OF PINELLAS 10.
• epfpwner or Owner's ut rized Officer/Director/Partner /Manager
ov
Print Name
The foregoing instrument was acknowledged before me this day of 1- J , 20 /Z by
as (type of authority, e.g. officer, trustee,
attorney in fact) for (name of pa oh behalf of whominstrument was executed).
Personally Known OR Produced Identification Notary Signatur j ,f� -
Type of Identification Produced Name (print) { v i C( 4 t2 I 1 ]
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
.44.V4 DAVID E MERRITT i
FORMSMOC.rvsd20ic #o ,, .S, ' ,,.
MY COiMMI$rfgl{a rttaR il)'t'cnon Signing (in line # 10.) Above
l ' • �faL XPIRES September 20, 2013
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