861 Ocean Blvd 2012 roof CITY OF ATLANTIC BEACH
r, s� 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
°. INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-40001046 Date 8/13/12
Property Address . . . . . . 861 '' OCEAN BLVD
Application type description R00 PERMIT
Property Zoning . . . . . . . TO SE UPDATED
Application valuation . . . 6000
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Application desc
reroof
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Owner Contractor
ROSENBAUGH, DEBRA L. D. S . KILLIAN ROOFING &GC (ROOF
861 OCEAN BLVD. 3948 3RD ST S BOX 122
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 509-8470
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6000
Expiration Date 2/09/13
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Special Notes and Comments
need noc
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Other Fees . . . . . . . . . STA E DCA SURCHARGE 2 . 00
STA E 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 THE FLORIDA
BUILDING CODES.
A
BUILDING PERMIT AWPLICATION
CITY OF A'L'LAN IC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 fax (904) 247-5845
Job Address: 3 � 10 C ea 11 P.AVct Ai l"II r Permit Number:
Legal Description Parcel#
Floor Area o q. t /06 Sq.Ft
Valuation of Work$ Ode) Proposed Work heate /cooled non-heated/cooled �
Class of Work(circle one): New Addition Alteratio R air Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circ*' one): Yes No N/A
Florida Product Approval# �G l s7
32.
For multiple products use product approve orm
Describe in etail the type of wor to be performed: '
Property Owner Information:
Name: 'Dl ci, L, R6sev,baL, .k Address: ev( 0 UCt h �`Vt
City_art lMt:r �CLk State L— Zip 3da3-4 Pho V094,&,2-a 377
E-Mail or Fax#(Optional) irc3k , -
Contractor Information:
Company Name: b S Ka V1 9061 f�e o Omt Qualifying Agent: Z>&110 S (< t 4C4
Address: 3g1q 6 i 9-9-S+- Ski} 11L City' zy � State '�=1� Zip 3ad.i'd
Office Phone �y W- 7(,(- 3 Job Site/Contact Number 0 0 Fax#
State Certification/Registration# 6?C'C
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 in 'cated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all l regulating construction in thisjurisdiction. This permit becomes null
and void if wk is zTot commenced within stx(6)months, orif constuctoorork i suspended or abandoned for a�pperzod ofsix(6)months at env lime after
k iscomeced. I undrstand that separate permits must be secured for Elecl�ws
ca/Work,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Healers.
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAIL TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO TAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY DEFO RECORDING YOUR NOTICEOF
COMMENCEMENT.
1 hereby certify that I have read and examined this application and know the same to true and correct. All provisions of laws and or nces governing this
t)pe ojwork will be complied with whether spec;zed herein or not. The granting a permit does not presume to give author; violate or cancel the
provisions of any other federal,state, or local taw regulating construction or the perfo'mance of construction.
Signature of Owner)k,JAC, (� QV
S gnature of Contract
Print Name ........................................... R
`l
. ... . S� its�U[t U �.- P'int Name l v1
..........'... o.... ��.. . ............................... ............
Swor a 4scriefore me S orn subscri d or i •e
this ay 20 Z th, Da o 20Not ub11c*: *ToC9560Feb ary 4,2014
^� otary ters 17zS�7S�l �� Revised 01.26.10
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of�
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made t certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE F COMMENCEMENT.
Legal Description of property being improved:
Address of property being improved:
General description of improvements: c�cl
2
Owner: %� '"f' i�"� ?l-� � 7 Address:
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: . vvi,// ze-'i' 6e-1 L,-,
Address:5 W 25_.S l2l�) - J 11
x Telephone No.: 1�74) —.2 Y Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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, designate by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to recei ve a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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):
Doc#201 21 71 1 00,OR BK 16031 Page'i 189,
Number Pages: 1 OWNER
Recorded 08/13/2012 at 11:48 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL Signed: Date:
COUNTY Before me this day of in the County of Duval,State
RECORDING$10.00 Of Florida,has person' lyappeared
Notary Public at Large'State of Florida,County of Duval.
expire':
SHIRI.EY LPf P"lY K, H. or
W COW 5SIftodnaddde 1 to
5,XPIRFS:February 14,2014 j
"'untied Thri Notary Public Underwrite*
.kms
7