Permit Roof 369 3rd St 2012 OLAJ
, .,`1 f CITY OF ATLANTIC BEACH
1 . 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
.. / INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000385 Date 4/05/12
Property Address 369 3RD ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5644
Application desc
REROOF
Owner Contractor
EILERS ELIZABETH T K & D ROOFING & CONSTRUCTION
369 3RD ST 2758 DAWN RD SUITE 1NE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 553 -1381
Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF
Permit Fee . . . . 80.00 Plan Check Fee . . .00
Issue Date . . . . Valuation . . . . 5644
Expiration Date . . 10/02/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 80.00 80.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 84.00 84.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: i f
Job Address: 3 " /c \
Owner of Property: r = ' c l'O
Address: [0 ! �f 11 ; ■' T
C'( S Telephone:
Roof Contractor: / 1 _'J Rc 4 r `-\" State License Number: C = / 3 a -, s .�—
Contractor's Address: �^
C l C' Fax: Email: 1,< r � hcf �Q/ . 6, "
Telephone: �L% f - � � ) /
Scope of Work: e_- C c') Roofing Material r ,/' r ✓L (, &S
l� FL Product Approval # g- Valuation of Work: $ y t
Required Inspections: Sheathing /In Progress -Dry In / Final
If re -roof: Assessed Value of Structure: _ < $300,000/ >$300,000; Roof -to -wall 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 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 B5ORE RECORDING,YOUJ NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: 6 Date: 0 o� �� •
AS TO OWNER: dam- `��
.�p� or tQ and ubscribed b?■ day of , ) /A/t �� 2 0 ! C
D � 5 tMi f P►opf Duval efore me this -
Notary's Signature:
Notary Public, State of Ohio '24.trsonally known
0 Produced identification
My C: remission Expires Sept 13, 2014 Type of identification produced ^�
SIGNATURE OF CONTRACTOR: Date: 3 J
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of 20
State of Florida, County of Duval
Notary's Signature: . L.V �i
- 13.ee.rsonally known
DATHA A. DEUBLER ` fl Produced identification
Type of identification produced
Notary Public, State of Ohio_
800 Seminole Road Atlantic Beach, Florida 32233 -5445
My Commission Expires Sept 13, 2014 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845
F: \roof permit applicaton 2010
NOTICE OF COMMENCEMENT
_
State of Florida. County of Dirtml
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.
I. Description of property (legal description of property and address if available r.
r7 • • , n -' + of imvi'vem_nts:
Yi ccf usi n3 .Shin: IPS
3. Owner information: '/ : ` lr
ann Address i l )I_3 . s C / '` . 4 I )!, r . .<<
b) Interest in property: 3 �
c) Name and address of simple titleholder (if other man owner):
4. Contractor Information: _
a) Name and Address: k n Po eci 14 ,1 756 Dawn P � � ! UQ X , }'1 � aDC - 7
b) Phone Number: Cj 014- 541- 1 100 J
5. Surety Information:
a) Name and Address:
b) Phone Number.
Amount of Bond: $
6. Lender Information:
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 spy 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
C.i o different date is specified:
✓ H
Ce WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
co 2
0 NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
° a 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
C7)
- IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
CD r • a? POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCrNG,
CC (..5 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
O c s ° YOUR NOTICE OF COMMENCEMENT.
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C w e %
"N r . ' �f / . Y i . mss
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o Q, Signature of Otter or Owner's Authorized Officer/Director/Partner/Manager Sienetor)'s Printed Name & Title /Office
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na y -J
ram D)- zo
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# E o The foregoing instrument was acknowledged before me this day of 1 / A { < t '! ' , 20 /. )-by
o ai w
GZtrziorr as for
(Name of Person) (Authority Type. i.e. Officer /Attorney) (Name of Party Instrument was Executed for)
DATHA A. DEUBLER IL- I 1 c'� • �r
Notary Publhw, State of NOTARY PUBLIC. STATE OF FLORIDA
s
io Print Name- I) c; i - L � w. _� . � +4-1-c.--/ 4-1-c.--/ 4-4-C. I
MV "IlignNS16n S e pt E
13 2014 P�,�,
.�I'ersonally Known
Identification/Type: J '
V ` cahp4- its�tant to Section 92.525, Florida Statutes. Under penalties of perjtm�, I declare that 1 have read the ! \ fo � p> � g that the facts''stated m it are true to the best of my knowledge and belief.
Signature of Natural Person Signing Above
Revised 10/1/2009