Permit Roof 74 W 5th St 2012 s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001622 Date 11/02/12
Property Address . . . . . . 74 W 5TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7560
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Application desc
RE-ROOF
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Owner Contractor
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FRY, JACK LOUIS SHORE ROOFING COMPANY
74 W 5TH ST 914 7TH AVENUE SOUTH
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 241-8842
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Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 7560
Expiration Date . . 5/01/13
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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 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERNHT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904) 247-5845
Job Address: Permit Number:
Legal Description Parcel#
a� Floor Area o q. t. q. t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition poolfspa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# / S�
For multiple products use product approval form
Describe in detail the type of work to be performed: 126 A.0a/r j d y ez r 74-4-i'Ka SA I�d- lfS
Property Owner Information:
I1ame:e: �O G — Address: 7'� ti/�S�' S�'�'►J
City
E-Mail or Fax#(Optional)
Contractor Information: ^� r
Company Name: .IlOYL I &d 9',! t (2D Qualifying Agent: sA or L
Address:q/� '71c1+ _ City u State — ZipD
office Phone 1.1 —$�W Z Job Site/Contact Number L- qS� Fax# �//— _
State Certification/Registration# ('CG Q;4
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 certafy that no work or installation has commenced prior to the
ssuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void of work is not commenced within six(6)months or if construction or work is susppended or abandoned for a penod ofsix(6)months at any time after
vork is commenced. I understand that separate permits must be secured for ElectricarWork,Plumbing,Signs, Bells,Pools, urnaces,Boilers,Seaters,
ranks and Air Conditioners,eta
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.
hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
ype o work will be complied with whether speci ed herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
wovisions of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner X
U"4��
Signature of Contractor
'rint Name X...l./.. ¢-_/.e-T.........�h. .................................................... Print Name ....�J....l..�....... l�`S
..- . ..................................................................
,worn to and subscribed before me Sworn to and subscribed before me
his L].Jay of 0 C��he { 20�� this �1 Day of(-)C ,rhe ( 20\6
lotaryPublic ,I YAs, IV". Not <, Tjl�,,1C MARJORIE.M.ADAMS-HARRUP
NOTARY PUBLIC ter. NOTARY PUBLIC
_STATE OF FLORIDA e—STATE OF FLORIDA Revised 01.26.10
Comm#DD0933778 a s '- Comm##OD0933778
'/roetaA® Expires 10/30/2013 Expires 10/30/2013
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.1 7 Q 154.6706
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description ofro erty(legal description of property and address if available):
.�lS
2. General Description of improvements:
3. Owner Information: _
a)Name and Address:
b) Interest in property: ,
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: 145oYt OU r,' 9A 7A /.yr,s rA e_- 3 -Lida
b) Phone Number: spy _a 4l `dr6 y2
5. Surety Information:
a)Name and Address:
b) Phone Number:
c)Amount of Bond: $
6. Lender Information:
a)Name and Address:
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a)Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of to receive a
copy of the Lienor's Notice as provided in Section. 713.13 (1) (h), Florida Statutes.
a)Name and Address:
b) Phone Number of person or entity designated by owner: _
9. Expiration date of Notice of Commencement (the expiration date may not be before the completion of construction
and final payment to the contractor, but will be one (1) year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1,
SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief
Viggnatuareof"Owner or Owner's Othorized Officer/Director/Partner/Manager Signatory's Printed N me& Title/Office