Permit Mech 51 Forrestal Cir (vault) e � =� s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
A TLANTIC BEACH, FL 32233
A" INSPECTION PHONE LINE 247 -5814
4 : 1 :011
Application Number 12- 00000581 Date 5/11/12
Property Address 51 FORRESTAL CIR
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4345
Application desc
REROOF MODIFIED BMU
Owner Contractor
CHAMBLISS ROBERT L & MARY E JOHN GILMORE ROOFING, INC.
22 OAKS DRIVE 11647 GWYNFORD LANE
JAX BEACH FL 32250 JACKSONVILLE FL 32223
(904) 880 -8044
Permit ROOF PERMIT
Additional desc . REROOF MODIFIED
Permit Fee 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 4345
Expiration Date . 11/07/12
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.
BUILDING PERMIT APPLICATION
Y CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
•
Job Address: 51 jr-es -1--+ 1 0 r allay C &&(11 Permit Number: / ) — S 9
Legal Description Parcel if
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $4 Proposed Work heated/cooled non- heated /cooled
Class of Work (circle one): (1Ve Addition Alteratio' Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): , Commercial Reside iat' ,
If an existing structure, is a s inkler system 'Walled? (Circle one): es No /4.) Florida Product Approval # —Li 01 2 •/O 1L- 47q, /3
For multiple products use product approval form
Describe in detail the type of work to be performed: RC'P-Ocf S i der.c -e _
Property Owner Information: 1�'/ • .
Name: 2.- d�°.f aa1'btI S Address: � U4 D12-- i :.ii • t
City Statta.Zip 322 Phone - 62. — R
E -Mail or Fax # (Optional) I
Contractor Information: {� __ � rr
Company Name: C r� t r 1/rltre �tX)?1' _ g , Qualifying Agent: 3 @hit. Cyr) 1, .& ( 1 1 n
Address: b a 03 P t1 $ r City ti dUKSCildil1_ State ( ;32
Zip +Z a
Office Phone D - r: 0 Job Site/ Contact Number 4 i , 5 — � F ' 40
State Certification/Registration # ,(',C 0 S 7 (.7 q ( cur") • C . 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. 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 aperiod 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.
1 hereby certify that l have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be conzplied 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 taw regulating construction or the performance of construction.
// r
■
Signature of Owner 1 � ry1 Signature of Contract. . %�/ . r d— -
Print Name g7 iJ r .�1 I c .. tm ... 9f .. h..l.. Print Name 14 .. i l.A/OAA
Sworn to and subscribed before me Sworn to and subscribed before me
this 4 Day of W1•1 , 20 (7.._ this if_ Day of m", , 20 /2 '
N... i,,
o .( P(% Notary Public State of Florida " MICHAEL 8 RAINS • - v i se d 01
Z
.1`_ 4 , Dennis A v Deusen 4.4 , • MY COMMISSION. EE1 1 My Commission DD892058 ,
mot e o 0 Expires 06/14/2013 r EXPIRES March 14, 2015
DONOT WRI BELOW OFFIC USE ONLY
Applicable Codes: 2007 Florida Building Code w/ 2009 Revisions
Review Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date:
Development Size
Habitable Space Non - Habitable
Impervious area
Miscellaneous Information
Occupancy Group
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone
Conditions /Comments:
•
NOTICE OF CO NCB II M :::NT
(PREPARE IN t]UPIUCATE)
Permit No. Tax Folio No.
State of County of I
To whom it may concern:
The undersigned hereby informs you that Improvements will be made to ertain real property, and In
accordance with Section 713 of the Florida Statutes, the following Informatio Is stated In this NOTICE OF
COMMENCEMENT. n /?
Legal description of property being improved: ,.1 f 4 `'f i� L iT L /C G �I T�
I
Address of property being improved: lt_' " t �. , C • a 4
I
General description of improvements: Re —roof Inc( I
1 owner R 7, a E RT M 8 ss 1
Add r ess_ 22 � 4 (5 U . 'J� G I�' f fl t /J,2 frjt ` . 'jf 7. li�t�
/Owner's interest in site of the improvement Residence
Fee Simple Titleholder (d otter than owner) .
Name
• Address
C.crrOractor John Gilmore Roofing Inc
pr' Addr 11111 -70 San Jose blvd #196 Jacksonvill Fl 32223
I f Phone No. 904 —AAn -8044 Fax No. 904 -880 -6801
n . r , ;
. r .'., \ Surety (f any)
Address • Amount of and $
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improve nts.
Name
- Address
Phone No. Fax No. •
None of person within the State of Florida, other than himself. designated by owner u on whom notices or other
documents may be served:
Name I
Address
Phone No. Fax No.
• In addition to himself, owner designates the following person to receive a copy of the Uenor's Notice as provided in
Section 713.06 (2) (b). Florida Statutes. (Fill in at Owner's option).
• Name
Address •
Phone No. Fax No.
Expiation date of Notice of Commencement (the expiration date is one (1) year from - e date of recording unless a
different date is specified): .7
Doc # 2012103715, OR BK 15941 Page 1930, f� \ ' OWN =R ,
Number Pa es: 1 1 ! 4 /
9
Recorded 05/11!2012 at 08:49 AM, Signed /ia '1 .:4ur /' ` ate
J!M FULLER CLERK CIRCUIT COURT DUVAL before me the "■ ay of pl 1Zl1n the
COUNTY county of \ State of fM F(v.ds ,
: 's
RECORDING $10.00 hon ,1 .. . ed 4), eel' C1"+c. r t S
41111r- -
. . Public a large, state of pip riO coui•r
2 cpAY p4ieGn Notary Public State of Florida
Dens A Van Deusen
'A . o` My Commission DD892058
2
for n o 4 Expires 36/14/2013
L .