Permit Roof 390 Garden Ln 2012 ' CITY OF ATLANTIC BEACH
2 800 SEMINOLE ROAD
J = ATLANTIC BEACH FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000876 Date 7/11/12
Property Address . . . . . . 390 GARDEN LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 16640
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Application desc
REROOF
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Owner Contractor
------------------------ ------------------------
KERNAN, CAROL BOHEMIA ROOFING INC
390 GARDEN LN 3950 ST ISABEL DR E
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32277
(904) 241-0237 (904) 859-3539
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 135 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 16640
Expiration Date . . 1/07/13
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 03
STATE DBPR SURCHARGE 2 . 03
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 135 . 00 135 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 06 4 . 06 . 00 . 00
Grand Total 139 . 06 139 . 06 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
07/09/2012 8:42 AM FAX 0003/0003
Doc#2012144734,OR BK 15997 Page 1345,
NOTICE OF COMMF,NCEMF T i Number Pages: 1
Recorded 07111'2012 at 02:55 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
Permit No. . RECORDING$10.00
Tax Folio No.
L
THE UNDERSIGNED hereby gives notice that improv!enlents will be made o certain real property,and in accordance with S ion
713.13 of the Florida Statutes,the following inforniatim is provided in this OTIICE OF COMMENCEMENT_
LEGAL 37.84 09-2S-29E,16 SELVA MARINA GARDEN PT LO 11,
I,pescriptign of property(legal deserlptirn): RE#172020-5030 LOT 1 RECD O/R 11942-2446
a)$trect(job)Address: 380 GARDEN LANE,A�TLANTip BEACH.FL 32233
2-General description of itnprovcments: COMPLETE RE-ROOF,REPLACEMENT WITH S 1NGLr _
3.Owner information - —... ,
a)Mame and address: KERNAN CAROL,390 OARUEN LANE,AT NTIC BEACH, FL 32233
b)Name and address of fee simple titleholder Ulf other than owner)
c)Ii serest in property OWNER tsl ---��
��4.ContractoO,Information
a)Name and address: BOHEMIA ROOFING CO.,INC. 3950$T,ISABE OR E,JACKSONVILLE,FL U277 CCC1328464
.' b)Telephone No.: eo4-8ss-asae - ax Na. (Opt.) W4-353-700
$,Surety Inf6rmation
a)Name and address:
b)Amount of Bond,•
c)Telephone No.
61enderFax No.(Opt,)_
I
a)Name and address:
--� _ hone No.
7. Identity ofperson within ss:State of Florida designated b _
a}Name and address: y owner upon wh m notiocs ar othercuments domay be served:
b)Telephone No.:_ Fax Na. )
Op t_ _
8.In addition.0 himself,owner designates the following person to receive a c py of the Lienor's Notice as provided in Section
a)Nla ne and address:
b)Tciephone No.: ax Na. (Opt.)
is
is specified):,piration date of Notice of Commencement(the expi�Qtion date is one y r from the date of recording unless a different to
sp
WARNING TO OWNER; ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF
C:OMMENCIEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I.SECTION 7 3. ,
FLORIDA STATUTES,AND CAN RESULT IN V06R PAYING;TWIG],FOR IMPROVEMENTS TO YOUR PROPEJ TY,
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POS 7ED ON THE JOB SITE BEFORE THE Fi
INSPECI-IOIN. IF YOU INTEND TO 08TAIN FINANCING,CONSUL YOUR LENDER OR AN ATTORNEY BEFO`
COMMF,NCWNG WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
r..rsarv7cv OF r(NgLLAS 10.
5igrsutur �#0 eror r' A th fnd Offi/ccer,/Ditr�*Ctor/Yuri a/Manager
Print NA111e
The foregoing instrument was acknowledged before me this jl!�'dav of y
a rO AIA_ il l(Vkla,")as
a of authority,e.g.officer,trustee,
(type attorney in falrt)for (name oY arty on behalf of whom in trimers as ex
Personally Known OIL Produced Identification Notary Signature
Type of Identification Produced Nan1e('print)
:�� � �
OR
c., MY COMMiSS1ON A DD 868281 �`
Verification pursuant to Section 92.525,Florida Statutes, Under penalties of pe jury th;it nd�t� $and t a
the facts stated in it are true to the best of my knowledge and belief -.,is;,,., tlonded ,ru eta i
I -
F0RMslN(V,rvsd2010
Sign;d((re ot'Nttu il Yarxon Signing(inline t�lU.)Abdvc
I
07/09/2012 8:42 AM FAX 0002/0003
BUILDING PERMIT APPLICATION
CITY 'OF ATLANTIC BEACH
800 SeminolIF Road,Atlantic each,FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: 390 GARDEN LANE, ATLANTIC BEACH, FL 32233 Permit Number:
37-84 09-2S-29E.16 SELVA MARINIA GARIDEN PT LOT 11, LOT 12 RECd O/R 11942-2245
Legal Description Parcel #
6e3
Floor re o q. t. sq.Ft
Valuation oflWork S. 1 Proposed Work heated/cooledd non-heated/coaled
Class of Work(circle one): New Addition test, aa.i Move Demolition pool/spa window/do r
Use of existing/ osed strueture(s) c>Irele one): Commercial Residents
lf:tn existing Structure,is a fire sprinkler system i stalled?(Circle one): es No N/A
Florida Product Approval# FL101 24.16
For multiple products use product approval form
Describe in detail the type of work to be perform d:COMPLETE R -ROOF, REPLACEMENT WITH
SHINGLE
ProneM Owner information:
Narne:KERNAN CAROL Address;390 GARDEN LANE
City ATLANTIC BeACH,FL Slate_„_,Zip 13aa33 Phone 904-424-3801.
E-Mail or Fax-9{Optional}
C:ontractgr information:
Company Nainle: BOHEMIA ROOFING CO.,INC, Qualify1,ng Agent: IVANA HODULOVA
Address:$050 StISAeeL OR E City JAC SONVILLC State FL Zip &277
Office Phone 964-959.3539 Job Site/Contact Number 904.082 2114 Fax# 904.353.2740
State Certification/Registration#ccc1Ns454
Architect Name&Phone#
Engimer's Name&Phone# I
Tee Simple Title Molder Name and Address
Bonding Company Name:and Address
Mortgage Fender Name and Address
Application Is hereo made to obtain a permit to do the work and installations as indicut d, I certify that no work or installation has commencee,prior to tilt
issuance of a permit and that all work will be pr-rformed to tneet the stane4m4e oj•all laws reguialing construction in thisjurisdiction, This permit l eeomrs null
and void if work is not commenced within six(6)months, or ij'conStru4.tipn or work.is sus ended or abandnned fora period of six L(6)months at a y lime mar
work is cnntmencticl I understand that separate permits must he secured for Electrical"Work, Plumbing, Signs, Wells,Pools,Futaoces, Boi4is, Heaters,
Tanks and Air Conditioners,etc-
WARNING TO OWNER: YOUR. FAILMING
TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR TWICE FOR IMPROVEM NTS
TO YOUR PROPERTY. IF YOU IN'T'END TO OB AIN FINANCING CONSULT ITH
YOUR, LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE F
COMMENCEM NT.
I herel certify that 1 have read and w-vaminod this a.ppplication an0nnw the same to Ge it ti and correct, .411 provisions of/invs a r� 'nances g varninR this
tyle qJ work will be cotttplied with whether specs ed herein up nal. Thr. granting of a permit clogs not prem me to jz ve oulho ity violate o caruel tl
provisions of any ether federal,state,or local law regulating corrstZlion or the.pe-forma gee ofeunstruction.
Signature of Owner Signature n
of Contractor
0 Print Name i-0 ........... ................... Print Namc X10O P e D V-i- t V Ar
AJ ...,.,,,. ..............
_..
Sworn tjD 9 EMASTER
thiti D DD 868281 201Da .G
;t= ay 19 2 �i MY M t D 95 1 0
I E nary t 14
No
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Revised 01.26.10