275 Beach Ave Roof 2013 cc,� � CITY OF ATLANTIC BEACH
, J 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
J
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003099 Date 7/19/13
Property Address . . . . . . 275 BEACH AVE
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 15600
-------------------------------------------------------------
Application desc
reroof
----------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
HOLMES MARK H LIVING TRUST DAVID MERRITT CONST. CO. (ROOF)
275 BEACH AVE 108 FLORIDA BLVD
ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266
(904) 993-1697
----------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc .
Permit Fee 130 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 15600
Expiration Date . . 1/15/14
----------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
---------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- --------
Permit Fee Total 130 . 00 130 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 134 . 00 134 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
/ � NOTICE OF COMMENCEMENT
AState of 0 rl u�a - Tax Folio No.
County of 10 U-I/0—!
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: Bf -c
Zj:jYa:,a 47('-.
Address of property being improved: C 7 P-)ea(' ftirf �jcC d 33
General description of improvements: eKct-41,
Owner: %�c /m es Address: 75- &0) Xf
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Con�ctor: OaV I•Ct M t V( t C� rS-) Cc / r
U,410 (f 1
Address: -7 09' K v c 1'1
by Telephone No.: Fax No: ;00-3-7
l�
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan 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: te: 1 Ig-1-3
Doc#2013186527,OR BK 16459 Page 480, Before me this day of i e C my of uval,Sta
Number Pages:1 Of Florida,has personally appeared �
Recorded 07/18!2013 at 03:26 PM, No Public at Large,State of Florida,County of Duv
Ronnie Fussell CLERK CIRCUIT COURT DUVAL No co mission La ges:
COUNTY
RECORDING$10.00 Personally Known: or
Produced Identification: =+R'
DD926677
M ,
:Pi2ES Septsmlmr 20,2013
39t!41W Fw:aaNetaryEx�,W
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: �� ALJAPermit Number:
Legal Description Parcel#
oorArea of Sq.Ft. Sq.kt
Valuation of Work$-JI,5 "' 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 W=ti9f
If an existing structure,is a fiirrelsprinklers stye installed? (Circle one): Yes No N/A
Florida Product Approval# f x0 `l
For multiple products use product approva form
Describe in detail the type of work to be performed:reroof �-'T-
Property Owner Information:
M
/
Name: '"`0-(k M01MC5 Address: z4r&
City t-Uh State I- ZipTZ2- 3 Phone LOW'ail 'p3y3 —
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: ViN l P-t' ` U Qualifyin} Agent:
M d t Sic Perls 1l4
Address: ( 0 V %/ r 3—< 9 City �J State r�`� Zip-
0'
i Z 2
Office Phone 6 y- f 4 06 Job Site/Contact Number Fax# � D 37//
State Certification/Registration# 7-
Architect
C,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 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 work er
void if
ommenced.of Icommenced within six understand that separate permitsomust be secuconstructred for n or Electrk jricual Works Plumb ng,S gior ns,aWells,period ols,XFurnaces Boilerys time
Heaters,
Tanks 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.
1 herecertify 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
type Vspecified will be complied with whether speied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or to a law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor X_"A
Print Name 4\-1 ul � Print Name ..... ....`. ..... /�I„'�'!�l j .................................
Swort} n subscri ed eore me Sw and s crib d f r
this / Day of (.i .20 /3is Day 20
.: L
: 957760
Notary liC '+�' #DD926677 Nary 20'14
MY coMPJ flF, Mded7AruN
September 20,2013 °� "denvriters Revised 01.26.10
Fr,..; Interyservice.com