1758 W Park Ter 2012 Roof CITI( OF ATLANTIC BEACH
Is) 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-(10001152 Date 8/31/12
Property Address . . . . . . 1758 W PARK TER
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12000
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Application desc
reroof
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Owner Contractor
BELL RICHARD W SR TRUST AAA ROOFMASTERS INC
1758 PARK TER W 5355 LENOX AVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 713-7663
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Permit . .
. ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 110 . 00 Plan Check Fee .
Issue Date . . . . Valuation . . . . 12000
Expiration Date . . 2/27/13
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-----------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
_____ _ _____ ---------------------------
Fee summary Charged Paid Credited ---Due
---
----------------- ---------- --
_ ------ ---------- - ---
Permit Fee Total 110 . 00 110 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 114 . 00 114 . 00 . 00 . 00
I
�I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY 01 ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CI'T'Y OF ATLANTIC BEACH
800 Seminole Road, Atlantic,Beach, FL 32233
Office (904) 247-5826 F'ix(904) 247-5845
Job Address: 7
ocPermit Number:
` L cZr c��-'��
Legal Description 54yV,0 4)A,40 iT A07-/ 1 40 Parcel#
.Floor Area ot Sq.Yt. Sq.11t
Valuation of Work$1&000 Proposed Work heats /cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circleone): o N /A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: o
ProveProvertv Owner Information: _
s$ 1t
Name: 1G. oa o �\� Address.
City o — Stat _Zip 3 2133 Phon Soq-1
E-Mail or Fax#(Optional)
F_
Contractor Information: ® y� `
Company Name: \ M� �40yy�Qs 5 11,�� Qual Eying Agent: �`��
Address: _ 1ta...oa� k VP-- City S •-t" _State
Office Phone ojo�(� $O 5=`z(,6 -Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
i
.9pplication is hereby made to obtain a permit to do the work and installations as indt ated. 1 cert 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 la s regulating construction in this jurisdiction. This permit becomes mull
and void if work is not commenced within six(6)months, or if construction or work is uspended or abandoned for apertod of six((6)months at env time after
work is commenced. 1 understand that separate permits must be secured for Elecir al Work, Plumbing,Signs, Wells, Pools, Furnaces, Boilers,Healers,
Tanks and Air Conditioners,eta
WARNING TO OWNER: YOUR FAIL E TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TOO 3TAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY DEFO RECORDING YOUW NOTICE OF
COMMENCEMENT.
I hereby certify that 1 have read and examined this application and know the same to b true and correct. All provisions of law and ordinances governing this
1)pe of work wit/be complied with whether speci ted herein or not. The granting a permit does not presume to give fit iry to violate or cancel the
provisions ofany other federal,s e, or local law regulating construction or the perfo mance ofconstruction.
Signature of Owne �� �-�'�- Signature of Contr ctor
Print Name41lC- }t1�1] �� .......................................... P int Name �.�.. ....... `�
...........................
Sworn to and subscribed before to S otn to and subscri ed of
thisolls�Day of�A,_S 1` 20 1 �---, th s 20
•�. 14
Notary Public f;o,�Y°�a;, N tary P IDWI14M mum"ft
;ro Notary Public-State of Floridan
•= My Comm.Expires Feb 9,2013 �� �...
evised ed 0 01.26.10
Nr,�F OF f4�o-o�` Commission#DD 831667
Bonded Through National Notary Assn.
NOTICE OF COMMENCEMENT
State of " �` Tax Folio No.
County of 4-�\A
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made t q 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:
i
Tr L
Address of property being improved:
General description of improvements:
Owner: °��-, .� <i P, Address: � �+ ~��C J QS
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: \
Address:
z
Telephone No.: 0 tQ' $-O�;— C�,; Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of th improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designs ed 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 re ive 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 on (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: G" (y . — rr%''.�' Date:
Before me this S 1 day of ?v i the County of Duval,State
Of Florida,has personally appeared
Doc#2012188905,OR BK 16055 Page 113, Notary Public at Lar e,State of Florid County of Duval.
Number Pages: 1 My commissi — ' 4' 4
Recorded 08/31/2012 at 03:42 PM, PersonallyKn or
JIM FULLER CLERK CIRCUIT COURT DUVAL Produced Ideo *•. 111y �-
COUNTY Commission# DD i1 7
RECORDING$10.00 ,F4 0?.' �
'4�+++++++ Bonded Through Nalionai Notary Assn. E