190 Club Dr ROOF 2012 f. Jel
\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
s) ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 12- 00000237 Date 3/01/12
Property Address 190 CLUB DR
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 8000
Application desc
REROOF
Owner Contractor
MAHLER JOHN E & DANNETTA G JUSTIN LARSEN CONSTRUCTION INC
190 CLUB DRIVE PO BOX 1942
ATLANTIC BEACH FL 32233 4784 CATTAIL ST
MIDDLEBURG FL 32068
(904) 241 -0320
Permit ROOF PERMIT
Additional desc . INSTALL METAL ROOFING
Permit Fee . . . 90.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 8000
Expiration Date . 8/28/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .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: / ) lam` )h Or( Fe z 6cF Permit Number: 1 2
Legal DescriptionZ "6 /6` .2 5 -a ?/' (J � 1 j t Parcel #
Floor A rea of Sq. t. Sq.Ft
Valuation of Work $ 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 /proposed structure s • 1 ne : Commercial
If an existing structure ' - _ - 1 in 7 er sys • ? (Circle one): Yes N N /A
Florida Product Appro al # A/
For multiple products • • ro • uct approval form
Describe in detail the type of work to be performed:(C.._rT)O
Property Owner Information: / /
Name: \") A �[ J Address: ( ?( .I» i n 1c A c i& cA.
City (aL /3,e Q</.., State CZip 3 "3 Phone old ey (a Gib
E -Mail or Fax # (Optional)
Contractor Information: v /
Company Name: , 3L./.50•- � l n , .,�l n �J/ )/\ Qualifying Ag- t:
Address: �(7 �`f r ( S City ,L . i�� State Zip 32D •
Office Phone 6'U'/ �/( �� Job Site/ Contact Number � Fax #
State Certification /Registration # (Cr t3).q3 y7
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 certj 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 commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo 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 ertify that I have read and examined this a placation 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 specified herein or not. The granting of a permit does not presume to give authority violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor �
g g _
Print Name , ✓J"1 E, frfl Print Name ,/5'0
Sworn to and subscribed before me Sworn to and subscribed before me
this Day of , 20 /2_ this Day of GeJroa- , , 20( Z.—
Notary Pub it c Notary Pu Ib is
Revised 01.26.10
WILLIAM L. POPE WILLIAM L. POPE
puhlir CtAta of Finride .. _ . _
I'crnnt .Number Tax Folio Number
NOTICE OF COMMENCEMENT
Doc # 2012042715, OR BK 15863 Page 530,
Number Pages: 1
1• -� I (:
OF FLORIDA Recorded 02729 %2012 at 10:04 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
('OU'N''I'Y OF DUVAL COUNTY
RECORDING $10.00
1 4 1 1 : UNDERSIGNED hereby gives notice that improvement wiii oe mauc w ce1 ta111 i cn,
property. and in accordance with Chapter 713, Florida Statutes, the following information is
provided in this Notice of Commencement.
I . Description of property (Address):)9� C L ) 1� D ril 14.-t 3233
2. General description of improvement: r o.„ r7V
3. Owner information:
1. Name and Address: \A,, Mh L, - l5 e /,'7 4
2. Interest in property: a;,.)
3. Name and address of fee simple titleholder (other than owner):
C'ontactur's name and address:}' a
`
a. Phone number: )0
}� Y � -‘7/t cx� ZI sue' - �-^ ( � � •� ,
�o b. Fax number: 904i �: Y ( ()- f C � is 4S2 3Z,z�
S \ Information:
a. Name and address:
b. Phone Number:
c. Fax Number:
d. . -mount of Bond: 1
b. :Lender's name and address:
a. Name and address:
b. Phone Number:
7. 'Person within the State of Florida designated by owner upon whom notices or other
documents maybe served as provided by 713.12(1)(a), Florida Statutes.
u. Name and address:
O. Phone number:
Fax number:
N. In addition to himself /herself. owner designates
of
to receive a copy of the Lienor's Notice as provided in
Sccuon 71 _ .12(1)(b). Florida Statutes.
Expiration date of Notice of Commencement (the expiration date is one (1) year from the
date of Recording unless a dif:' r 1 date is sp ified)
,
St�naturc of Owner:
� / T.�