Permit Reroof 374 11th St 2012 � CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r
Application Number . . . . . 12-00001528 Date 10/17/12
Property Address . . . . . . 374 11TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 9265
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Application desc
reroof
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Owner Contractor
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OSTERGREN KAREN A DAVID MERRITT CONST. CO. (ROOF)
374 11TH ST 108 FLORIDA BLVD
ATLANTIC BEACH FL 322335532 NEPTUNE BEACH FL 32266
(904) 993-1697
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 9265
Expiration Date . . 4/15/13
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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 100 . 00 100 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 104 . 00 104 . 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: 37� 11'1 S-J— Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. Nq.kt
Valuation of Work$ 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/proosed structure(s)(circle one): Commercial identia
If an existing structure,is a fire sprinkler system installed?(Circle one): es" No N/A
Florida Product Approval# ;0)JZq L
For multiple products use pro uct approval form
Describe in detail the type of work to be performed: CC�
Property Owner Information:
Name: ., / �I`� ��� ) Address: +_r7 Lr
City Stater_Zip•?7_-.213 Phone
E-Mail or Fax#(Optional)
Contractor Information: �/� �
Company Na e: V (�( ���e✓111rf�C�Cst �0�l�� Q g I► K C1 1 ��� ' i`' /
p Y uali m Agent:
Address: 1v 2C City � r C'�4 6 tt State Flk- Zip Z�l
Office Phone0' `7 / I Job Site/Contact Number_`�y?–/�`�"7 Fax# -:)c)G _-1-7 1
State Certification/Registration#_ c'C1'_ 13, cl 1 `fi
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 indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work wrll be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void rf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for Melts,
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, Furnaces, 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.
1 herebycertify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of ork will be complied wit Nether speci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,s e, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name K . � ......................_........ Print Name
............................................
Sworn to and subscrit�d before me Swo a nd s scri o e me
this Day of VL- - ' `____._.. _ 20 this 6 Day 20ZZ—
Notary ublic ;*11",
N 1414 TT HMmiss LN S' ��
NAM,IF 10N#DD926677F r 9 ,7e�itS:F bruary 4,2014
Fk. Bnn ed Thru Not k rr?ber 20,2013 "'' P unde-Ke sed01.26.10
ar . .. _ r ,�9 Gq� -
NOTICE OF COMMENCEMENT
State of
County of Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,
the Florida Statutes,the following information is state in this BOTICE OF COMMENCE ENT.d in accordance with Section 713 of
Legal Description of property being improved: 7 P-
t �3 l� 3Zz33
Address of property being improved:�37 SJ- 14-g R L57-Z,3
General description of improvements: AC,.,EW
Owner: X*ai r 7 j �S'f �,,
Address: A-6 4'�..(� 3z-z33
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
n Contractor: a 17A t is
to (L„wl fo Address: S-Z-(pR. 3 2-2Y0
wP
Telephone No.: �l 3 405 .D Fax No: a JO
Surety(if any)
Address:
Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a to for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated 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 receive 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):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed:
Date:
Doc#2012228486, OR BK 16107 Page 799, Before me this day of O in the County of Duval,State
Number Pages: 1 Of Florida,has personally appeared aul/2yl
Recorded I OY17/2012 at 10:35 AM, Notary Public at Large,State of Florida,County of val.
JIM FULLER CLERK CIRCUIT COURT DUVAL MY commission expires:
COUNTY Personally Known: L--
RECORDING$10.00 Produced Identification: r,,, or
AMID E
001,,•!!;BION#DD926677
w . :�rnber 20,2013