Permit Roof 1455 Begonia St 2012 J�
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001503 Date 10/12/12
Property Address . . . . . . 1455 BEGONIA ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4375
----------------------------------------------------------------------------
Application desc
ReRoof
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
HUMPHREY ROY E ARTISTIC ROOF SYSTEM, INC.
1455 BEGONIA STREET 2146 ACACIA RD
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 233-8231
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . . RE ROOF
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4375
Expiration Date . . 4/10/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
---,-------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 9 � t�fgoyar %a S ve Permit Number:
Legal Description Parcel#
Floor Area o q. t. Sq.Ft
Valuation of Work$ y� ; 0 D Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/propoinstalled?
structure(s)(circle one): Commercial
If an existing structure,is a fire sprinkler system (Circle one): Yes No N/
Florida Product Approval # E Kvi�
For multiple products use product approval form
Describe in detail the type of work to be performed: �eoly o C�� ��ihct�2�3 (2 r)
L- 4AV" e- Owens, C_n\m� -xt sk' Q fes,
Property Owner Information:
Name: Address: S�A_V_Ir``k
City [ 4v�. State__Zip 3�a2 Phone 90q 616 1 -SA7
E-Mail or Fax#(Optional)
Contractor Information: n r t
Company �a�ne: Ar-44,-Lc c > _ C��'�n 2 Qualify' g Agent: �o r�.h jct'ajC S'r\
j� � _ Y5 T
Address: `�'�4 � CityJQtlCwo,l«- State r/ Zip 32-_:220
Office Phone 41 Le S''7(,&2 Job Site/Contact Number '701/ JW(7;? o2 Fax#_2'y'-5,-l- 02? )Y
State Certific'ation/Registration# 13P,P5'-3 o
Architect Naive&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 indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that ail work will 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 six(6)months, or if construction or work is suspended or abandoned for a eriod of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, urnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT 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.
I hereby certify that 1 have re d a d exam* a lic on and know the same to be true and correct. All provisions of laws and ordinances governing this
lupe o1 work will be comp/i her er eci ted in or not e gra 'ng of a permit does not presume to e authority to violate or cancel the
provisions of any other fede or c t c or ie performance of construction.
Signature of Owner Signature of Contract
Print Name Print Name ®`CGL S'O
. ..yy ...... ................. . . .... .. . ................. ............................................................... ......a...........................�.....................
Sworn to and subscribgTbbfore me Sworn to and subscribed efore me
this -3 Day of 2 this /2- Day of 20
Notary Public ,� DEDOpAHJAWON otary lic
. MY COMMISSION#DG 895007
FxPIRNO July ,20���� ,G JOSHUA A X11'01 6.10
Thy Ne�Y _� Notary Public,State of Florida
Commission#EE 97401
'Au n - a ne AAa OR OA1H
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No
State of Ic,ter;d► County of L., v QJ
To whom It may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information Is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: L
3
Address of property being improved: "/ '^ /� t'Ck
n wC
General description of improvements: 2 rC?0
Owner L 1',,)fJ (7, � r�
Address 7 47 (2 V'-Pe.\ 841ao -e-az ' 2k�5,,
yt,, o
Owner's interest in site of the improvement !X,) Zo
Fee Simple Titleholder(if other than owner)
Name
Address 1 , 1�
Contractor s L K & / � S rn
Address (G C>a e o o t)(,P 322 Do
Phone No. 9�L1 435= 76 Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
ne No. Fax No.
Nameofperson,, therthanhmself,
designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone 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):
THIS SPACE FOR RECORDER'S USE ONLY ;OWN R
Signe : a'
Before ay of / in the
Doc 9'201221795-i,OR BK 16094 Page 1563, Coun of D 1.State of id , as ona(I red
L—A/ANherein by
NUmber Pages 1 him 91V he that all rations ein
are true and ti
Recorded U 0512012 at 12:35 PM. ,: ., MY COMMISSION#DUAW
jIM FULL ER CLERK CIRCUIT CCURT: DU AL EXPIRES:July 24,2014
C C U IU TY Ther Notary Public Unlerwritarc
RECORDING$10.00
oe
Notary Public at Large,State of County of ,
My commission expires: 4 of �rn k f
Personally Known �— or
Produced Identification