Permit Roof 632 Camelia St 2012 =r' CITY OF ATLANTIC BEACH
ATLANTIC
SEMINOLE ROAD
ANTIC BEACH,FL 32233
j INSPECTION PHONE LINE 247-5814
Application Number 12-00000685
Property Address . . 632 CAMELIA ST Date 6/01/12
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
-----Application-valuation . 4000
Application desc
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REROOF
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Owner Contractor
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_
LONG EUGENE B & MARY F SHORE ROOFING COMPANY
632 CAMELIA ST 914 7TH AVENUE SOUTH
ATLANTIC BEACH FL 322332522 JAX BEACH FL 32250
(904) 241-8842
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Permit ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee 00
Issue Date Valuation 4000
Expiration Date 11/28/12
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Other Fees . . STATE DCA SURCHARGE 2 . 00
ATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
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Permit Fee Total 70 . 00 70 . 00 . 00 . 00. 00
Plan Check Total . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 00 . 00 . 00
PERMIT' IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09-
CITY OF ATLANTIC BEACH
Date: �`��5— C2`
ROOFING PERMIT APPLICATION
•
Job Address• l_/ �JZ (°.F*1 lv)f {R-
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Address: , „ y)1_ �r� _•S Telephone•
Roof Contractor. 410 t L Poo 1�i� tJ State Ucense Number. GG19 4,fYi
Contractor's Address: ��� J4V< .1y►� c i �"j '�2 Z,��
Telephone:_ �y/- tS 5 q 2. Faas 2 4 I-55 3 Emalh-
Scope of work: krlb,, Roofing material 3�0,Ue c
FL Product Approval#_ / .. y e Valuation of Work: $
Required Inspections: Sheathing/In Progress-Dry In /Final
If m4vof: Assessed Value of Structure:_<$300,000/ >$300;000;Roof-toMali improvements required;
(Applies to Angle family stmtures 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!OB SITE BEFORE TIME FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANC/NG, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT-
SIGNATURE OF OWNERS i 1 A
AS TO OWNER:
Sworn to and subscribed before me this _day of 20L])N .
J
State of Florida,County of Duval
Notary's Signature: \,))-
0 Personaly known MARJORIE M.ADAM UP
EZ Produced identification a NOTARY PUBLIC
-Type of identification produced STATE OF FLORIDA
Comm#DD0933778
-----SIGNATURE-OFCONTRACTOR:_ h- Dom; �rj-) 1'CE 190 Expires 10/30/2013
AS TO CONTRACTOR:
Sworn to and subscribed before me this 1 day ofNA\4 20�.
State of Florida,County of Duval t 4
Notary'sSignatur 1CJ9 �� •S (`4 91`x^ _ 1���Jul
erson�aly known
PProduced Identification
Type of identification produced
800 Seminole Road-Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800-Fax:(904)247-5845
F.Voof permit applicaton door 7/28/09 -
zf�y MARJORIE M.ADAMS-HARRUP
®� NOTARY PUBLIC
-+STATE OF FLORIDA
-STATE
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Doc#2012115293,OR BK 15957 Page 1453, aprsa�raainrsaM/adnllaaapamb
Number Pages:'I ;
Recorded 06/0112012 at 03:52 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY1�` ��i '
RECORDING$10.00 anlsar St Con*yakk.&�, l '
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NOTARY PUBLIC
-- _5'1'ATE OF FLORIDA
Comm#DD0933778
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