Permit Roof 371 10th st 2012 ej : p � CITY OF ATLANTIC BEACH
r Pik r) 800 SEMINOLE ROAD
\ : : ; '' ATLANTIC BEACH, FL 32233
r
� ° INSPECTION PHONE LINE 247 -5814
''.....r1 9'
Application Number 12- 00000539 Date 5/04/12
Property Address 371 10TH ST
Application type description ROOF PERMIT
Property Zoning RES SF DISTRICT
Application valuation . . . 8500
Application desc
REROOF
Owner Contractor
STARRATT, ROBERT AND DONNA A.J. WELLS ROOFING
3941 ALCAZAR AVENUE 5432 WELLER PL
JACKSONVILLE FL 322076001 JACKSONVILLE FL 32211
(904) 553 -0069
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 95.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 8500
Expiration Date . 10/31/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 95.00 95.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 99.00 99.00 .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:
3 7 ( fd 4'1. See 1 4414 seem( Pi- 31 Perm Number:
Legal Description Parcel #
Floor Area of Sq.Ft. q • t
Valuation of Work $ f 50 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): Conunercial Residen • .
If an existing structure, is a fire sprinkler system installed? (Circle one . . - o N /A
Florida Product Approval # F L " I 0 4. 71 • ` SA ''S`.Y
For multiple products use product a prform
Describe in detail the type of work to be performed: Re- R D D i
property Owner Information:
Name: I D OP/'f Si-effete
Address:
City State —Zip Phone
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: A7A-t4Is R• er4, .P . K- Qualifying. Agent: A l` Ti-t..0.. ■•■ Z (( S
Address: 2.1 AOtM4 "-D Avt City ac State r• - Zip 31--- t Co
O f f i c e Phone '>-) 'f • S S 3 • � o t o 3 Job Site/ Contact Number So./ • 104 • I 4-1'4 Fax # 1-.Y • S I • `f t $ 3 _
State Certification/Registration # C cc- 13 2 T IV7
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 o c� ndi to rtify that no work or tnstallatton. has ormnenc d prior to
A I d ( c of d I ce laws regulating construction in thislunsaiction. Itus permit
the i o a v oid f work that ai wor will do the work d installations
l be perfsmre to meet the sconstr I construction fall
a any time mi le rd work i work is not commenced within l i six pa ate p e r it or y ust be secu or for is riv Work, , Plu Sign a Wens, (F� a ny
at any Hme er work is commenced 1 u that separate permits must be seeuredlor cleeh•+ea! ore, I La J r'o
Boilers, Beaters, 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 E BEFORE R T. ORDING YOUR NOTICE OF
I hereby certify 1hat� have fl e this application give tion and know the same, to be tare and correct. All provisions of laws and ordinances governing
th e of work will be c n with whether ecifie herein or not The granting of a permit does not presume to authority to vro ate or C ancel the
provisions of any other federal state, or local law regulating construction or the performance of construction.
Signature of Ownerr l ��A% Signature of Contractor
Print Name QD 66 StArt 44tr. Print Name A ( 1 t/r" v C41 S
Sworn to and subscribed before pie S to Da sub scribed before me
r ) ^ 20 i z ter y er, t _ 7.0 / 1
this _MN. Day of �!{ % � p 4
t !3
Notary Pubic
Notary Public
Revised 01.26.10
, , - w) nl :r IIC 9 ...c �, F Q a:3
` 7 V1r -' L. .r_'0lLI A ._ i
pt
MAY-4-2012 15:25 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
Doc # 2012099017, OR BK 15935 Page 885,
Number Pages. 1
Recorded 05/0412012 at 03:47 PM,
QTYCE O, COMMLKEMENT JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RCCORDING 510.00
Permit No. ( 2,+ S 9
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.De.cription of property (legal discrrpdon):
Ft) Street ('job) Address; .771 l ofk ALMesl_bAd.vi telefof f P�
2.Oencral description of improvements: fle" J?oo.f'
3.Owncr Information
a) Name and address: Ac 5 ?b't">
b) Nantc and address of fee sinmple titleholder (if other than owner)
c) Interest in property Pririew CF,d a Cc
4.Contractor Information.
a) Name and address; AT .'4 t5 oP\+p
b) Telephone No.: '7 - SSA-- or d 9 Fax No. (Opt) %Y •WSJ- cF L
5.Surcty Information
a) Name and address:
b) Amount of Bond:
c) Telephone No.; , Fax No. (Opt)
6,Lcndcr
a) Name and address: W^
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Nwi a and address:
b) Telephone No.: Fax N o. (Opt.) _
8..In addition to himself, owner designator the following person to receive a copy of the Licnor's Notice as providcxi in Section
713.13(1)(b). Florida Statutes:
a) Name and address:
b) Telephone No -: Fax No. (Opt.)
9.,Expiraction date of Notice of Cotrnnencement (the expiration date is one year from the date of recording unless a different date
is specified):
WARNi,NG TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED JMPROPER 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 Fi.NANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Srrn7 t OP NORMA -
COUNTY oe PINFtd AS / . ..
Sigantuxe Owner or Owner's Authorized Qi tccr/Dixector/Partner/Managcr
,, stAfro? `
Print N c
The foregoing instrument was acknowledged before me this j 60.. day of A•Pf r , 20 I. , by
_ &-4- # :i 'f i 1 as 6, r : - (type of authority, e.g. officer, trustee,
attorney in fact) for (name of party on behalf whom instrument was executed),
Personally Known OR Produced Identiification 7C• Notary Signature
Type of. Identification Produced -1:=141C ( . St Name (print) , A.. ILA 03.3 w u ; arc
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it arc true to the best of my knowledge and belief.
PORNISNOCivnanla
w.✓� A' �r" ' i
Notary Puo!ic State n` Floiiaa ' Si. azure of Natural Person Signing going (in line #10.) Above
' AuiB titi,lvier
My Cc mmiss:0n [:I)892070
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