Permit Roof 1076 Hibiscus St 2013 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002234 Date 2/27/13
Property Address . . . . . . 1076 HIBISCUS ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3870
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Application desc
REROOF
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Owner Contractor
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MILLAIRE JEFFREY S & ANNE R RON RUSSELL ROOFING INC
1076 HIBISCUS ST 4419 HUDNALL RD
ATLANTIC BEACH FL 322332652 JACKSONVILLE FL 32207
(904) 636-9909
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3870
Expiration Date . . 8/26/13
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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 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 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: 1076 q;b 5Cvs FL.2z3Permit Number:
Legal Description Parcel#
Floor Area of SO.Ft. Sq.Ft
Valuation of Work$31%70 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/proposed structure(s)(circle one):. Commercial e' ;es
R
If an existing structure,is a fire sprinkler system installed? (Circle one): No N/A
Florida Product Approval# 101 7.14.1 b
For multiple products use product approval orm
Describe in detail the type of work to be performed:_ - f O of
Property Owner Information:
Name: C.-z Address: 50*,�L c.,6 40vt
City State_Zip Phone 38(* -3 3N-?6 86
E-Mail or Fax#(Optional)
Contractor Information:
CompanyName: noir RtJscea 9bcr-jc n =dyC. Qualifying Agent: ijEelzv St44JrILL�
'7
Address: If 0 v .whu 910 City C IState F4 Zip-3 ZZC)
Office Phone q q--71 q-)907 Job Site/Contact Number qb -345 - 49 39 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
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 wall be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperaod of six(6)months at any time after
work is commenced. 1 understand that separate permits must be secured for E[ectrlcal Work,Plumbing,Signs, Wells,Pools,1�urnaces,Boilers,Heaters,
Tanks and Air Conditioners,etre
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 hereby certify that 1 have read and examined this a lication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether speci aed herein or not. The granting of a permit does not presume to gave authority to v' a or cancel the
provisions ofany other federal,state, or local law regulating construction or the performance of construction. `:::a
Signature of Owner 1� _ Signature of Contractor
Print Name .s 1 ¢.....' 1.A1Print Name1.......1 .S.E..t.L. .............................................
Sworn to and subsc�ribed before me Sworn to and subscribed before me
this 27'*" Day of}eh-u,,rj AMIA& w4ECAR m this 2111, )Day of 'br- n ,20/.�
1 NOTARY PUBLIC wCARL RIq W08M SR
STATE OF FLORQ4
'Notary Publicr Comm#EE018= Notary Public STATE OF FLOROA
EXPIres&12,2014W. ' (401.26.10
FEB-27-2013 15:49 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
NOTICE OF CCyMMNCEMENT
SPR5PARE IN bUPLICATE)
Permit No. Tax Fallo No.
State of Marida CwrIty of Dural - -- --
'ro whom it may concern:
Tr*UPdersigned hereby informs you that Improvements will be made tv Certain real property,and In
accordance with Section 713 of the Florida Statutes,the follovling information Is stated M this NOTICE OF
COMMENCEMENT.
Legal description of prop"being improved: i 17 1 5 cv$
Address of property being improved: f 07 q 4 6",, vS r_ A j j-�.c&4,tz t FL 37-11.-3 --
General description of Improvements-, re-roof --
owner LSA M 1kc:,;rF -
Address SO-Mf oS njln �,,.._,......, ..,
Owner's interest In site of the improvement Cwft,-r
Fee Simple Titleholder Cif Other than owner)
Name
Address -
Cantractor lion Russell Rnofing Inc
Address 4.4)9 Hudnall Rd.Jacksonville,FL 32207-
( Phone No.9D4-714-1907 _. Fax No.904,636.9909
Surety(if any)N/A
Address Amount of bond
Rhone No, Fax No.
Nam and address of any person making a loan for the constrixtion of the Improvements.
Name NIA
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-9 Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill In at Owners option).
Name NIA
Address
Phone No. Fax No. _ --
Expiration date of Notice of Commencement(the expfratlon date Is one(1)year from the date of recording unless a
different dote is specified):
THIS SPACE FOR RECORDER'S USE ONLY OYMER
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