Permit Roof 1995 Brista De Mar 2012 `
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;LI 11 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
t.) : 4 °,:- ° " ATLANTIC BEACH, FL 32233
f ,. INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000444 Date 4/17/12
Property Address 1995 BRISTA DE MAR CIR / /12
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 10083
Application desc
REROOF
Owner Contractor
ORMOND MARILYN E INTEGRITY ROOFING SYSTEMS
1995 BRISTA DE MAR 5570 FLORIDA MINING BLVD
ATLANTIC BEACH FL 32233 BLDG 300 STE 310
JACKSONVILLE FL 32257
(904) 260 -1372
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 105.00 Plan Check Fee .00
Issue Date Valuation . 10083
Expiration Date . . 10/14/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 105.00 105.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 109.00 109.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
DuILi)1NG PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: / 99s .6,63m- De- /nom 61e 2 3 . 2 y
y0 ,3 Permit Number:
oq - . - .� cLt/1 ya.t�' U.vi7d Tlvd
Legal Descrip • - • ---L, A ,2
4.41r.3"' Parcel # , ' 6 - /43/6 of Work $/0 D�'3. w oor • ea o q. t.
--� j :: I ed Work heated /cooled q t
o3(v4� n on - heated /cooled
Class of Work (circle one): N Aral'
Alteration Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residents
If an existing strucure, is a fire sprinkler system installed? (Circle on . Ye No N /A
Florida Product Approval # ._j0/
For multiple products use product approva orm
Describe in detail the type of work to be performed: RE -ROOF EXISTING BUILDING, SHINGLE TO SHINGLE
Property Owner Information:
Name: /yl 1)/2,)1,ex..40
Address: / ycki"AeLti')- be c_be J
City y��Z ,k ¢,tom Statejt Zip 3x»-33 Phone 96 V' v1 Y(, -3g '2
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: INTEGRITY ROOFING SYSTEMS, INC. Qualifying Agent: JOHN ALBRITTON
Address: 5570 FLORIDA MINING BLVD STE #310 City: JACKSONVILLE State FLORIDA Zip 32257
Office Phone 904 260 -1372 Job Site/ Contact Number 9'6j tad /3 7, — Fax # 904 260 -1355
State Certification/Registration # CCC 1329868
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 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, F urnaces, 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 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 to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner 77 ) Gi U Z 42,04,_,....k._ �/
� Signature of Contractor / ��
Print Name '
mho L y 2 E -- 0 RA( o2 7 Print Name JOHN - I BRITTON
Sworn to and su crib- before me Sworn to and subscri. -d efore r e
this Day o 10,.44r,1 ,
•
20 / Y this 7 Day of ,�,�,
20 11
Notary Pu li Notary Public - � '/
..u�,,,' istrpo.26.10 1
p a KEN R. STOUT , t ,: c - te o1Flortda5
oo TAI) Notary Public - State of Florida F My Notary Comm Sta Jan 92015 My Comm Expires Jan 9 2D15 's, °'
1y .,p �� Commission 0 EE 45420
+, Commission 0 EE 45420 ''.... Bonded Through National Notary Assn. (
Bonded Through National Notary Assn
Doc # 2012078038, OR BIC 15908 Page 648, Number Pages: 1, Recorded 0 4/10/2012
at 01:52 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
Permit No.
Tax Folio No. p j , —
713.13 3o of the
UNDERSIGNED Statutes, the following information is provided in this NOTICE COMMENCEMENT. EIN d MENT. a with Section
CEMENT.
1 D ! escription of property (legal description —
r L / E .S6z1
a ) Street (job) Address: / � g tn. �� ~ - _. —
2.General description of improvements: „"_..M "l lr�
3.0wner Information
a) Name and address: , ; f • 2,479444 /q �
- � •
b) Name and address of fee simple (if other than owner) 6� iY
c) Interest in poperty
4.Contractor Information Integrity Roofing Systems
a) Name and address: 5570 Florida Mining Blvd. �S. , Suite #310, Jax FL 32257
b) Telephone No.: 904 260 -1372
5. Surety Information Fax No. (Opt.) 904) 26 -1355
a) Name and address:
b) Amount of Bond:
•
c) Telephone No.:
6 Lender Fax No. (Opt.)
a) Name and address:
7. Ideality of person within the State of Florida desi Phone No.
a) Name and address: grated by owner upon whom notices or ot do may be served:
b) Telephone No.:
gin addition to himself owner design the following person to receive a c p Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.:
F.
9.Expiration date of Notice of Commencement (the expiration date is one y a fro m 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 LMI'ROVEMENTS 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
•
COUNTY OF PINELLAS
10.
Signature of Owner or OF mer s Authorized Officer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged before me this ' _ day of
/ r 20 { ��,y j'� 4� Cy�
(type of out rity, e.g. officer, trustee,
attorney in fact) for
(name of party on behalf whom inst ent was executed).
Personally Known OR Produced Identification
Notary Signature
Type of Identification Produced �,IC
Name (print) ST6 ,•; —
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of
the facts stated in it are true to the best o m perjury, I declare that I have read the foregoing and that
elief.
� KEN R. STOUT �
FORMSMr,
OC,,2010 r /`�
1.' T r Notary Public - State of Florida t
• � egyComm. Expkess 4, 2015 ` Signature ofNattual Pe Si in �J�
''s Commission # EE 45420 (in line # ID.) Above
a %..a;,: i• &marl Through National Notary Assn. M