Permit Roof 1941 W Sevilla Blvd. 2012 ` ''4 A ,'1, CITY OF ATLANTIC BEACH
1 , 800 SEMINOLE ROAD
j . ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
�Jf3
Application Number . . . . . 12- 00000467 Date 4/20/12
Property Address 1941 W SEVILLA BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 13083
Application desc
FL 10124 -R6
Owner Contractor
NIELSEN TRUST HANSON ROOFING INC
1941 SEVILLA BLVD.W. 2714 CORTEZ RD
ATLANTIC BEACH FL 322334578 JACKSONVILLE FL 32246
(904) 641 -6328
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 120.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 13083
Expiration Date . 10/17/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 120.00 120.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 124.00 124.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
44,
1ti
Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: j gq/ ; tic 111 vcL L,, j- Permit
Number:
Legal Description S -!?ULU t dtet,s 6 i ),DT 16 Parcel
Floor Area of Sq.Ft.
Sq.Ft
Valuation of Work $ i � U� 4 ' Proposed Work heated /cooled non -
heated /cooled
Class of Work (circle one): New Addition i lteratio• Repair Move Demolition
pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial �esidentia.l)
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # 10 i'tk - (D _
For multiple products use product approval form
Describe in detail the type of work to be performed:_
12L R 6k -tv6te,_ - a Ski Kok
Property Owner Information: 1 1 f (� {� I ' 7
Name: .t h I.l Address: 1 `l I �Q )tU @uCL w
City /A inn WNW State - ip -2 , - 2-7 - i3 Phone 4'0 E /
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: ly e n �r,�S w� Zs t.. Qualifying Agent: 'fft . att.K. 6 ►1
Address: ,,�,7ij �� Rb. City ' .c_1t.se,.tv1 Ck State FI
Zip Z2.WCe
Office Phone - 6 Job Site/ Contact Number ! - 333 - ?(1694. Fax # I -044 -64 — 6'34tr
State Certification /Registration # 05781 ±
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. 1
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.
•
1 hereby certify that I have read and examined this application 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.
1 •
•
Signature of Owner 1:1 :,:� _ . •
Print Name / •
Sworn to and subscrib - d be ore me
this 2.0 D . of ' 1 T , 20 [ 2
r.-
/t it i : r4. ;m ir � \ � _„ MICHAEL J. ETUE, JR.
,� Notary Public, State of Florida
Notary Public 1 -:: Commission#DD973420
My comm. expires Mar. 22, 2014
•
Signature of Contractor u kL_-
Print Name
Sworn t9.and subscrib d before me
this /e/Pay of , 4 , 20/ 2_—
- e,(2--ic--ae 13 W % >/--;- f - - k-----
Nota ublic
, ,, 4 y p� { �,' JEANNETTE M. NIELSEN
_ r 1. , S i Notary Public - State of Florida 0
g ; ; : My Com Expires Jun 30, 2014
Commission # DD 989725
"440, °� Bonded Through National Notary Assn.
Doc # 2012087197, OR BK 15919 Page 2180, Number Pages: 1, Recorded
04/20/2012 at 02:53 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
•
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): - eNC (IA ar - CIFl. Q Ira , • r
a) Street (/ob) Address: • 1 "..., ;j]��=:,'� �n ► J 7-3
2.General description of improvements: ' eve f
3.Owner Information _ r I /; , J
a) Name and address: i f {.. g 1\)1C 4AJ 14 1 �P4 �� . 011 (3 , Ij 4i' iP {� 0,24 f � y.2, 3 �
b) Name and address of fee si ple titleholder (if other than owner) 1 '
��I " "" c) Interest in property _ a A d A,ue 12--
Contractor Information
a) Name and address: /. L yv` Rea/
b) Telephone No.: Qs - -. 533 .:F0 C. Fax No, (Opt.) 104 -(I . ( - 6
�� 5.Surety Information 414 a) Name and address:
l b b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
Phone No.
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.: 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, CONSULT YOUR LENDER OR AN ATTO EY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEME T. t
STATE OF FLORIDA
COUNTY OF PINELLAS 10 i,. �,
Si • r e of Owner or Owner's Authorized Officer/Director /Partner /Manager
Print e t - e N� -l. _ _E. A _ 2 •
The foregoing instrument was acknowledged before me this 1 O day of i , 20 / 2, by
as (type of authority, e.g. officer, trustee,
attorney in fact) for (name of party o b i al ; f w • ins ument was executed).
Personally Known OR Produced Identification V/ / Notary Signature �f�
•
i
Type of Identification Produced DL. Name (print) —_t34i t ' Jr
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read t e foregoing and that
t ac s s a e 1 y knowledge and belief. �j
+ tar P c J. a te of Florida p�Z�ry (/
F. - a � Nof Public, State of lor Commisaion*DD973420
lure of Natural Person Signing (in line # 10.) Above
My Comm. expires Mar. 22, 2014