Permit Roof 231 Seminole Rd 2012 It iss CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
:) ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
f Jii13�
Application Number . . . . . 12-00000709 Date 6/06/12
Property Address . . . . . . 231 SEMINOLE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5850
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Application desc
reroof
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Owner Contractor
MOUNT, RICHARD S PRO ROOFING & ASSOCIATE
231 SEMINOLE RD 25 RUTH DR
ATLANTIC BEACH FL 32233 PALM COAST FL 32164
(386) 931-0497
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . 5850
Expiration Date . . 12/03/12
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 80 . 00 80 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 84 . 00 84 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND T IE FLORIDA
BUILDING CODES.
BUILDING PERma APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 231 Seminole Road Atlantic Beach,Fl 32233
Legal Description 10-816-252 E SALTAIR SEC Parcel
#
oor a o t. q. t
Valuation of Work$ 5850.00 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/pro osed,structure(s)(circle one): Commercial Residential
If an existing structure,is a fire�A"pprintl�le�rssystem installed?(Circle one): Yes No N/A
Florida Product Approval#—_ 's i
For multiple products use product approval form
Describe in detail the type of work to be performed:Reroof
Property Owner Information:
Name: Richard Mount Address:231 Seminole Road
City Atlantic Beach State Fl Zip 32233 Phone 904-891-2765
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Pro-Roofing&Associates Qualifying Agent:Elmer Campos
Address:10752 Deerwood Park Blvd Ste 100 City Jackosnville
OfficePhone 904-394-2959Job Site/Contact Number_386-931-0497 Fax#_904-394-8383
State Certification/Registration# CCC 1328416
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 prfor 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 i work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a__ppeeriod of six/6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wdls,Pools,Furnaces,Boners,ff rs,
Tanks and Air Condl&nms,eta
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 YOU NOTICE OF
COMMENCEMENT.
I hereby cert that I have read and examined thisapplication and know the same to be true and correct. All provisions of 1 s ordinances governing thi
type o)work will be complied with whether s ct ted herein or not. The grontitrg of a permit does not presume to gr ry to violate or can e
Provisions of any otherjedetnl,smote,or local aw,regal g construction or the pe ornutnce of construction.
Signature of Owner / 'j� Signature of Contractor
Print Name a't`e h4� t o✓>1�- Print Name � � dry �
.._.........
Sworn to and subscritd before me Sworn to and subscribed before me
this o�Day of. 20 12. this CDay of v- 20 1'2-
Notary Public r Notary blic
Revised 01.226.10
MARIA Y.FLORES „uutt��
��as v MARIA Y.FLORES
Notary Public-State of Florida .'ro” «��'
°'• "�' My Comm.Expires Apr 8,2015 r . . Notary Public.State of Florida
o Commission#EE 75158 r» aQ My Comm.Expires Apr 8,2015
„°;,,*"„ '�;?FOF o? commission # IF 75158
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of G County of ) ✓ -
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following information Is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: ' 'y + 9
Address of property being improved: _?
General description of improvements: r�r ie'.r,.' 'e,
Owner
Address �i c 'y9rr9te ' 1 -31
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
JAddress
Contractor77 l c h ee fi rm�� ? �` ;{• ? �� *.,,i
� �,��J'\\ Address .101ti� ��.Y;x. �t..�r���' j�:r,lct'•-�'�i .T'�<'f��'c ����1r ►�'c.- 3 Z a:SG„
�i Phone No. �� u re/ - i'� ) Fax No.
Surety(If any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY f, e O ER ,
r j;
Signed:..X ° �� DATE�<0 1,'�
Before me this `C'r= day of U rl _ Z '-- in the
Cour D I to f lorida,hes pe orally appeared
y
DOC#2012117515,OR 8K 15960 Page 2364, himself/he ff a�yp ej�rat all statements and declarations herein
Number Pages:1 are true and _ ��,. MARIA Y.FLORES
Recorded 06/0612012 at 03:16 PM, - No 10y Public-State of Florida
I ' .9 0,' 7MV001mm.Expires Apr 8,2015JIM FULLER CLERK CIRCUIT CQJRT DUVAL �
COUNTY � �.�L,q�,F, is i4 EE 75158
RECORDING$10.00 Notary Pub c a er e
My commission expires:
Personally_Known or
`Pr6du6ed Idem�p ionl -,, L C