Permit ReRoof 234 Ocean Blvd 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001793 Date 12/07/12
Property Address . . . . . . 234 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 8000
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Application desc
RE-ROOF FL-10124 . 1
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Owner Contractor
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GAUSLOW, NORMAN DS KILLIAN ROOFING
234 OCEAN BLVD. 3898 DUPONT CIRCLE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32254
-- Structure Information 000 000 RE-ROOF FL-10124 . 1
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Permit . . . . . . ROOF PERMIT
Additional desc . . RE-ROOF FL 10124 1
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 8000
Expiration Date . . 6/05/13
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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.
Doc # 2012280325, OR BK 16173 Page 2163, Number Pages: 1, Recorded
12/07/2012 at 12:01 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
r NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio N0.
State of Florida County of DUVAL
To whom it may concern:
The undersigned hereby informs you that Improvements will be made to Certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 234 2nd St 16-2S-29E Atlantic Beach Lot 2 ]SLK
ELK 29
Address of property being Improved: 234 OCean Blvd., Atlantic Beach, FL 32233
General description of improvements: Re roof
owner Norman Gauslow
Address 4338 Swift Circle, Valrico, FL 33596
Owner's interest In site of the improvement
Fee Simple Titleholder(if other than owner) NLA
Name
Address
Contractor DS Killian Roofing & General Contractors Inc.
Address3948 S. Third st Suite 122 Jacksonville Beach F1 32250
PhoneNo.904 246 7663 FaxNo904 339 9233
Surety(if any) N/A
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 N/A
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 N/A
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 1�� _!�L_,
Signed: 11. DATE
Before me this Zl day of in the
S . C unty of➢rwgf,State of onds,has ra=appeared
herein by
-Wm!Wwsetr end affirms that an statements and declarations herein
alrins and accurate
RiE
tam.a Fterldis
cDonNdn EE1153512016 Notary Public at Large,State of Courdy M
My commission ewes:
Personally Known or
Produced Idemittcation
/ �Mwv CIfYIw�.III'l1/JI,.i �'
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
,e2
Job Address: 234 Ocean Blvd., Atlantic Beach FL 32233 Permit Number:
Legal Description 234 2"d St 16-2S-29E Lot 2 BLK 29 Parcel#
Floor Area o q. t. q. t
Valuation of Work$ 8,000.00 Proposed Work heated/cooledC� non-heated/cooled ��uU
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one): Commercial Residential
If an existing structure ,is a f re prmkler s s staled? (Circle one): Yes No N/A
Florida Product Approval # L l 9�t
For multiple products use product approval form
Describe in detail the type of work to be performe Re-Roof
Property Owner Information:
Name: Norman Gauslow Address: 4338 Swift Circle
City Valrico State FL Zip 32233 Phone 813 695-2717
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: D.S.Killian Roof& General ContractorsQualifying Agent: D0-5ki r`-un
Address: 3948 S. Third St., Suite 122 City Jacksonville Beach State FL Zip 32233
Office Phone 904 246-7663 Job_Site/Contact Number I k4(M Fax#
State Certification/Registratlon# C cC 06
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 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 period of sax(6)months at any time after
work is commenced. I understand that separate permits must be secured for E/ectrica Work, Plumbing, Signs, Wel/s,Pools, /'nrnaces, 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 I have read and examined this application and know the same to be true and correct. All provisions of laws rdinances governing this
d herein or not. The granting of a permit does not presume to gave thor o violate or cancel the
type o work will be complied with whether specified
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name / L ..................................................... Print Name I AA)
Sworn to and subsc ibed before me Sworn to and subscribp
,q before me 2,
Day of v 20 l2 this 71'*% Day of VOeayrywt- 20 1
_ �. ......._:. ...� fits
Notary Public . ,_ Nota u
Revised 01.26.10
Notary Public State o1 Florida
Teresa R MacDonald
pf My Commission EE115391
_:�_ K Ov 114. No1arY Publie Sh"Of FkWW8