Permit Roof 500 Clippership ln 2012 !y �`I l
t r� CITY OF ATLANTIC BEACH
4 -1, 7-4 " 's� 800 SEMINOLE ROAD
j tar ze ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000354 Date 3/29/12
Property Address 500 CLIPPERSHIP LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4800
Application desc
reroof
Owner Contractor
GOOD LISA ROMANO BROTHERS ROOFING, INC
500 CLIPPERSHIP LANE P.O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 4800
Expiration Date . 9/25/12
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.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of County of
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal de cripkon of pro erty being improved:
l ie r-h, 1111 k
Address of property being improved: fO C / n� 4, p 1Y/ h- /► / j,E) g ' J
General description of improvements: tCd.-i7
Own 4 1
Address 'S` C /��',/ � L4/) ,'W t Y a. 3 . 3
Owner's interest in site of the improvement _ '
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor 2 . ++, 41/2041/20$5.
Address dir '15c7,23 U
Phone No. Fax No.
Surety (if any)
Address Amount of bond $
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY ` OWN
Signed DATE,-3 — 2 — TZ_ -
Before' me this day of in the
County of Duval, State of Florida, has personally appeared
herein by
himself/ herself angafiirrnsittataltstatements and declarations herein
are true and rate
Doc # 0 012068272, OR BK 15894 Page 2 2.280,
Number Pages: 1
Recorded 03/29 /2012 at 09:56 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL Notary r•r'7'''_ "11•1'sr-w•"or
COUNTY My co io(1dMriwk r . ,
RECORDING $10.00 Person- •y,- °= __
• rj tc__:N1u iall. or
Produ IA• , .
. My Comm. Expires Nov 12, 2012 L
'•;�' Commission # DD 837063 �i
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: SOv C L oper Skip Permit Number:
Legal Description Parcel #
Floor Area of Sq.r't. Sq.Ft
Valuation of Work $ y / 0 U 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) (circle one): Commercial (R dential
milder If an existing structure, is a fire milder system installed? (Circle one): Y es No CZED
Florida Product Approval # SC
For multiple products use product approva orm
Describe in detail the type of work to be performed: IMP f604—
Property Owner Information:
Name: �� S.. oocL Address: .---(1 v (1 �` re C,, Sh,
City 4 . � - J rkn �-r" � . � a 6 Stater—ail, '3 p..13.1 Phone 9. 9_ . : , . 4 / 6 — 9'$% O
E -Mail or Fax # (Optional)
Contractor Information:
Company ame: Rory A A 0 i&oJA Ka a Art Qualifying Agent: D ,�o a-�. 0
Y 3
Address: PO ? k 3 0 3`3 J City A44.^1-14.- Reif. State rC. Zip 32.233
Office Phone qv y ' a f G SG 4') Job Site/ Contact Number 9 %'-- 67/6 — v y,G Fax #
State Certification/Registration # C G #) L 3
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 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 examined thisplication 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 to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner X . Signature of Contractor
Print Name x 1--;s 6 a0o / Print Name I.2rIn e2eorrt O
Swot ,t n . ubscribed before me. Sworn to and subscribed'before me
this o1. PW 20 1 thi• y , .---- -- 20
�` _ _ i t SHIRLEY GRAHAM
*f ! MY COMMISSION N t DD 957760 t •
Notary Public ; �' 1 Notary Public - State of Florida N 11' • . I Thru Notary Public Underwriters
s' 5, ■=` P; My Comm. Expires Nov 12, 2012 K 01.26.10
% commission # DO 837063