Permit Roof 871 Ocean Blvd 2012 V
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000740
Property Address . . . . . . 871 OCEAN BLVD Date 6/12/12
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . .
10430
Application desc -----------------------------------
reroof
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
BOOTH ALLISON J ET AL & GEORGE BOBBY CAMPBELL ROOFING INC
PATTERSON KIMBERLY B 2363 SE 144TH STREET
2003 SW LAREDO ST STARKE
PALM CITY FL 34990 FL 32091
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 105 . 00 Plan Check Fee
Issue Date . . . . . 00
Expiration Date . . 12/09/12 Valuation . . . . 10430
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 105 . 00 105 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total 109 . 00 109 . 00 . 00 . 00
. 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
V
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000740
Property Address . . . . . . 871 OCEAN BLVD Date 6/12/12
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . .
10430
Application desc -----------------------------------
reroof
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
BOOTH ALLISON J ET AL & GEORGE BOBBY CAMPBELL ROOFING INC
PATTERSON KIMBERLY B 2363 SE 144TH STREET
2003 SW LAREDO ST STARKE
PALM CITY FL 34990 FL 32091
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 105 . 00 Plan Check Fee
Issue Date . . . . . 00
Expiration Date . . 12/09/12 Valuation . . . . 10430
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 105 . 00 105 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00
Grand Total 109 . 00 109 . 00 . 00 . 00
. 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Bobby Campbell Roofing 904-964-7876 p.2
BUILDING PERMIT APPLICATION
CITY OF ATLAWIC BEACH
800 Sefninole Road,AtImitic Beach,FL 32233
IOJ'fllfilc,el(1911OM4)247.51gt26 Fax(904)�247-5845
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Legal Descrit on Pern*Nu m her:
P 11 11111rcel
Valuation of Wort[ Proposm I Work heateWcooled # q. t
Cll"s Of Work(circle one): -"..% ---- nou-heste&cooled
(Rew I Addition Allerafio. Repair t4oe Demolition
Use of existiOg/Proposed st 11-�
Iran existing stiructure,is rurc"s POOVS13a window/door
P 6circleonc): Commercial
R
Florida PrOduct Approv a re spir 11 er Vstelb installed? Residential
For multiple p a] # One):
roaucts me— -- Yes No N/A
Pra'"t aPprOv`a`rT0—rm F/ 71
Describe in detail the type of work to be Pcrforrned:
P
ame r a a H:
Name: 0.
city dress:
E-Mail or Fax#(optional) Sto zip--.Phone
COMPanY Name:
Address: *Z S Qualifying Agent:
Office Phone Job City
SLvt C04ification/Registration# 115n�t Nu�mbff ate ip,
Architect Name&Phone# #
Engincer,s Name&phone#
Fee Simple Title Holder N d Address
Bonding COMParty Narrie and Address
Mortgage Lender Name and Address
4WIcauon's hereby made to Obwn a permit to do the work and insWtaij-ans asind, re
us"aoce 0%a Permit and that all work will be performed 10 meet 1,W
and ca a I certify that no work or injalla,
vo"k il not Commenced if!thin six(6)Montils,or Y. -nandards of all laws regukting const.,tion in
w0r`tucomnenced. 'underiumdt)iatsepa,.4teper)nilsn
TQRb and Air Coxftoj�W construction or w k thisjoisd,'IT hal c0Mmencvdp.-jw 1.the
Wtion. Thispermithic
or Ism,%,"dedorabandonedfora i*dqf,,bq6)mo omes null
ust be securedfor Eka Wark, Pt,,66W nihs at
S4&�, a"Y time after
Radek"ealtis,
WMMING TO OWNER: YO
CO NCEMENT MAY RESM rr ILURE TO RECORD A NOTICE OF
TO PROPERTY. IF YOU 1,T IN OUR PAYING TWICE FOR IMPROVEMEjWS
LE I END TO OBTAIN
NDER OR AN ATTO FINANCING CONSULT WITH
Y BEFORE RECORD
C "r ING YOU�i NOTICE OF
1 hely,cet!6 that I have read and examined his NCEMENT.
01W WOrk wilt be coWfted with whef,;W, !)hcOdon andknow the same to be 0*,Ne and correct Allprovisionjo
Provisions of any otherfeay.01, t,,, or tcl?leg herein or not The granting of a per flaws and i
ov ordnances gowniV this
"I"11911411,Vg lonstMcgon mit does�0;Preju e to grve awhorlo,10 violate or canc,
or L'fg Peif'Ohnlh,�e fc0n&jrUCj1,n. I the
Signature Of Ownera
Print Name J"�� �-<z Signature of Contractor
Print Name
S,w and subscr- ore me C-1
thi Of 172- Swom to and subscribed before me
BALLARD this —1 �=Day of
u NOTARY PUBLIC
LORIDA otary u
COMM#EE1598ae MYCOMM EE 067928
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Expires 1/27/2016 EXPIRES:Februa 7 2015 d 01.26.10
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OF aw
NOLIC'v nv Doc#2012121041,OR BK 15966 Page 717,
.CEMENT Number Pages: 1
Recorded 06/12`12011.at 01�04 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Permit No. COUNTY
Tax Folio&0'*-.-* ',"'""'*111_11*1__.__-.-_----- I- � ..-___ RECORDING$10.00
................
THE U'NDFRSIGNED herei.,y gives notice t1lat be M"de to(erlain I_e4l P"OPerky,and in 3"ordance%,j;jtj)se<j
713,113 of the Florida Statute ir)PrOyemients will
S'thcf0l1(nV'n9 infOrmatiOn is Provided.in tf�j-,jINOTICE OF COMMENCEMENT.
l.De5CriP1i0n Of Property(legat dwscrOlivlo:
a)Str _....... .......... –---—--------------1-11-1.__.............
2 eet 000 Address:
�,--Gerleral description of improv ..........
ements:
.............
.......... ........................ ..........-
........... .......__
formation __.............
a)Nameand address-.
ss Qf fee Simple tillel1j.11der(if
h)Narne and addre, ot ler than wmler) 'c
_f
Z�avl
c)Intere.,g in prope
4,C(,,Rtractor Infonnatioll .................. .....................
a)Name and address��
q't
b)Telephone NO.: .... .........
Infon
.nation Fax No,
opt-)_
a)Name and addrcs,.j'
b)Amokint of Bond-, ..........
elePhoneNo,- —----------
6,Lender Fax
a)Name and address:
................. ................ ...............
Phone No..
7. ldent6�17
... ............
L
ly r
Persoll within the State Of Florid ner upoll whom notice"'' mewS May kx'!servef
a)Name and address: S or othe?,10cil
b.)TelePhone No,: ..............
S,Iriadditio,itohim,self.(:)w"'
ner esig.nates the fo o.,virl,per.son to recei
i)(b),Florida S ............
'lea COPY offfie LierAor's No ice as Provide u1soc6on
a)Name and address: d
WT'OePhone No_
9�ExPiration date of N-yotice ..........._Fax
is sPecifird). or k--Onlmenceme e C-wration da O�(Opt.) . ................... ........................
te"�" Yesr from the date of recording uniess a differvnt date
..........
WARNING TO OWNER. ANY PAYMENTS MADE BY THE OWNER AFFER THE EXPIRATION OFTHE NOTICI:()F
'COMMFNICEMENT ARE('ONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I�SECTJON71-3,13,
FLORIDASTATUTES,AND CAN RESULT IN VOUR PAIVING TWI , -
A NOTICE C E FOR IMPROVEMENTS TO YOUR PROPERTY,
OF COMMENCEMENT MUST BE RECORDFDAND POSTED ON THE JOB SITE BFFORE THE FIRST
IINSPECTION. IF YOU INTENDTO OBTAIN FINANCING,CONSULTYOUR LENDER OR AN ATTORNFY OFFORE
COMMENCING WORK OR RECORL)I�N(; YOUR NOTICE OF CONIMENCENIFINT,
S rATE OFFUM IDA
")11'NTV OF PJINF LLAS
..............
w
Print Ln
The tbrego'T19'ns"Umcat was acknowledged betbrenjethj,�z
............... ..... y...........
as f...........
((Yl*(if authority,eg.ofrjeer,tru_qee,
in fact)for v�,,- _\�
Pemonally Known !_�L __ __'.....___(name of part),of, behalf of whom ift-';t�yment wRR executed),
OR PrTAluced Identificatifjn L---"
.......... Notai��sigmature
Type of Identif ...........................
Ication Produced I
).-t Name(print.)
Verification punIL"t to SeLji0j,92,S,?5, OR ......................
the facts stated ill it am iTue to tile Florida Statutes,. LInder perialtie-s of pe,�jtjfy,f dec4are that I h a"e read the fom-going a n d t h.at
best Of r4 knO-Vvledge and 4ief
rORMS
BRIAN GLEN CARMAN
Notary Public-Seal
State of Indiana
My CoaWssion Expires Feb 26,2020