Permit Roof 659 Amberjack 2012 CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000880 Date 7/12/12
Property Address . . . . . . 659 AMBERJACK LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7013
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Application desc
reroof
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Owner Contractor
POPE, MILDRED M. GOLDEN ROOFING INC
659 AMBERJACK LANE 2036 SEAHAWK CIR
ATLANTIC BEACH FL 32233 PONTE VEDRA BCH FL 32082
(904) 885-3369
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 7013
Expiration Date . . 1/08/13
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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 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
i
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BLIII?DING CODES.
P64155
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax(904) 247-5845
Job Address: BEg-j A'C,IG LANE Permit Number:
Pjot
Legal Description 3U i'�af 31- oy� S UArf 01 Parcel#
Floor Area o q. t.
Valuation',of Work$ �� Proposed Work heated/cooled_ non-heated/cooled
Class of Work(circle one): New Addition Alteration Repa' Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial esident'
If an existing structure,is af
ire sprinkler system installed? (Circle one): es No N/A
Florida Product Approval# 101 �l-RS Q 1OGZ(o" (P
For multiple products use product approval forte rn
Describe indetail the type of work to be performed: RE',MOVE A*D 1?EFt*E 514WSL4t0 )?vmFWo- 5-yvrg►-t
{ UgrnfG� Son7E SELIP Aomcarm rA .4 ��• �j�ll
Property Owner Information:
Name: 1LDREO VOAE Address: 65'L? AADEQLANE
City I-V C $E4a4 State PL Zip 372,33 Phone PTO 4 Z lylc•1 (ate
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: GOLOE"d 6*0FtJG rAtr- Qualifying Agent:
Address: til?l 5 City �u t 5onv�11 _State Zip=�� —
Office Phone Job Site/Contact Number Fax# SOH-1,n-qq2.$
State Certification/Registration#
Architect Name&Phone#
Engineer's;Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage tender Name and Address
Application i 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 wall 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'i (6)
months,or if construction or work is suspended or abandoned for a peraod of six6)months at any time after
work is comalaenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters,
Tanks and A'. Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COM*NCEMENT 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.
]here cert#fy that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type ojYwork will be complied with whether specified herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner X Signature of Contract
Print Name l� X Print Name .. ................. ... .. ......
..�.../ 1��. .......... .... ............................................ .... ........
Sworn to and subscribed before me Sworn tQ and subscribed before me
thisDay of 20 0, this Q6 Day of c) Lk r-\.P- .20 l a
Not NoWrftblic
Notary Public Stab of Florida evised 01.26.10
Meghan Shellman
lOVMy Commission EE 202941 Notary Public State of Florida
Expires 05129/2016 Meghan Sheilman
�y My Commission EE 202941
OF p Expires 05/29/2016
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"01155
Doc#2012145046,OR BK 15997 Page 2220,
NOTICE OF COMMENCEMENT Number Pages:1
Recorded 07/12/2012 at 08:14 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Permit No. COUNTY
RECORDING$10.00
Tax Folio No. I.j i I Wq-C 000
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.Description of property(legal description): '30- (¢) 3`'_ ' P v 1
a)Street(job)Address: tSel
- +
2.Geperal description of improvements: 9,enac,,,er a.A
3.Owner Information
a)Name and address: ,1.,Ae A NO(
b)Name and address of fee simple titleholder(If other than owner)
c)Interest in property
4.Contractor Information
a)Name and address: 1 r .1 e,FL 3a +
b)Telephone No.: -so- SOC) Fax o.(Opt.)qb'i-1r K 3- y4l)-S'
S.Sutety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt.)
6.Lepder
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
8.In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713. 3(1xb),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Exoiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER 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 FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA r
COUNTY OF PINELLAS 10. , k �.4•' .' U
Signature of Owner or Owner's Authorized fficer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged before me this_tL day of I A 201!a:,a-,by
as (type of authority,e.g,officer,trustee,
All
attorney in fact)for Aname of party on behalf of w o � as
otary Public Steffi of Florida
Personally Known OR Produced Identification Notary Signatur Me9ttarl Spellman 02941
� A I '^ p Expires 05/29/2016
Type of Identification Produced Name(print)[V�- V a r)
OR
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that
the ifiacts stated in it are true to the best of my knowledge and belief.
F0&M$/N0C,rvsd2010 A
Signature of Natural Person Signing(in line#10.)Above