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2359 Seminole Rd roof 2013 v , CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 it Application Number . . . . . 13-00002341 Date 3/21/13 Property Address . . . . . . 2359 SEMINOLE RD Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 15000 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ JACOBSON, SAMUEL S . BURGER ROOFING CO. 2359 SEMINOLE ROAD 134-1 ERNEST STREET ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32204 (904) 355-2756 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 125 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 15000 Expiration Date . . 9/17/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 125 . 00 125 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 129 . 00 129 . 00 . 00 . 00 PERMIT IS APPROVED ONLV 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: 2359 SEMINOLE ROAD,ATLANTIC BEACH, FL 32233 Permit Number: Legal Description AG-212 37-2S-29E .984 DEWEES GRANT S/DAParcel# 168349-0000 15,000.00 mor Area oT—Sq. t. q. t Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New AdditionAlteration Repair Move Demolition pooUspa window/door Use of existing/proposed structure(s)(circle one): Commercial aside intimi If an existing structure,is a fire sprinkler system installed?(Circle one): a Nn Florida Product Approval#FL10674.1 For multiple products use product approva arm Describe in detail the type of work to be performed:REMOVE AND REPLACE SHINGLE ROOF Property Owner Information: Name:SAMUEL S.JACOBSON Address:2359 SEMINOLE ROAD City ATLANTIC BEACH State_Zip 32233 Phone 398-1818 E-Mail or Fax#(Optional) Contractor Information: Company Name: BURGER ROOFING CO Qualifying Agent: GARY BURGER Address: 134 ERNEST ST City JACKSONVILLE State FL Zip 32204 Office Phone 904-355-2756 Job Site/Contact Number 904-237-9664 Fax# 904-358-0733 State Certification/Registration# CCC032514 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 1 certify that no work or installation has commenced prior to the issuance ofa 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 rf work is not commenced within six(6)months,or if construction or work rs suspended or abandoned for a period of six/6)months at any time after work is commenced. I understand that separate permits must be.secured for Electrics!Work,Plumbing,Signs, Weis,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 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this type o1 work will be complied with whether specrjred herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions ofany other feder state,�Iocalfaring construct on or the performance of construction. Signature of Owner ( Signature of Con actor wlot Print Name .?Y ......,r�...,................. .. l.fa'L................. Print Name .... ...... G..................._._. Swo o and subscribe before me d su c ore e this Day of �_ t.-�. 20 �� th ay of 2Gj Q� r Notary Publ' T//, ay5.\\Q��NwoN•••.••*!iii Revised 01.26.10 •�y�� ` • 1pRY Pu 4t H.MEREDITH o:r- * MY COMMISSION tDO9002&1 EXPIRES:July 14,2013 ~�q'.• b l�Z��S��i•y N{''eoF nrR'iOe Bon*Thru BjAW Nagy SemcEs 5, *••s�HIdX3N •��y tlilrl�l�tti��•. Doc#2013071551,OR BK 16298 Page 1377, NOTICE OF COMMENCEMENT Number Pages:1 Recorded 03/2112013 at 10:02 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL Permit No. COUNTY RECORDING$10.00 Tax Folio No.168349-0000 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section 713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT. LDescription of property(legal description): AG-212 37-2S-29E.984 DEWEES GRANT SID PT LOT 1 DIV 3 RECD O/R 5765-1184 a)Street(job)Address: 2359 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 2.General description of improvements: REMOVE AND REPLACE SHINGLE ROOF 3.Owner Information a)Name and address: SAMUEL S. JACOBSON,2359 SEMINOLE ROAD,ATLANTIC BEACH, FL 32233 b)Name and address of fee simple titleholder(if other than owner) c)Interest in property FEE SIMPLE 4.Contractor Information a)Name and address: BURGER ROOFING CO, 134-1 ERNEST ST, JACKSONVILLE, FL 32204 b)TelephoneNo.: 904.355.2756 FaxNo.(Opt.) 904.358.0733 5-.Surety Information `�--3- a)Name and address: b)Amount of Bond: c)Telephone No.: Fax No.(Opt.) 6.Lender a)Name and address: Phone No. 7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a)Name and address: b)Telephone No.: Fax No.(Opt.) 8.In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(l)(b),Florida Statutes: a)Name and address: b)Telephone No.: Fax No.(Opt.) 9.Expiration date of Notice of Commencement(the expiration date is one 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 I,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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA \e\\`iti41 Nlll J/1��, COUNTY OF PINELLAS �`C\hJ d�tl1oN�•*• ` ,•�� .• l Signature of Olwner or Own ' Authorized Officer/Director/Partner/Manager s�� ` =•Z' =.M= Print Name �� / •�'y•-~ice. The foregoing instrument was ackrfoi,*'edged bet��r{eday of .-. ,201 by �s i •. S3H1 .• �� as / + e`� (type of authority,e.g.officer,trustee, attorney in fact)for \ 0. (name of party on hebalf of whom instrument was execut,4,4 Personally Known VOR Produced Identification Notary Signature Type of Identification Produced Name(print) (,L,�,r< OR Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. FORMS1N0C,rvsd2010 Signature of Natural Person Signing(in line#10.)Above