765 Amberjack Ln 2013 roof CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
s)
-777777"'7 ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . 13-00003544 Date 10/18/13
Property Address . . . . . . 765 AMBERJACK LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12500
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Application desc
reroof
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Owner Contractor
-
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LEROUZ DENNIS & JUDITH BOHEMIA ROOFING INC
1745 SELVA MARINA DR 3950 ST ISABEL DR E
ATLANTIC BEACH FL 322335638 JACKSONVILLE FL 32277
(904) 859-3539
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Permit . . . . . . ROOF PERMIT
Additional desc .
Permit Fee 115 . 00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 12500
Expiration Date . . 4/16/14
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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 115 . 00 115 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 119 . 00 119 . 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)247-5326 Fax(904)247=5845
Job Address: 765 AMBERJACK L_NAATLANTIC BEACH,FL 32233 Permit Number:
Legal Description 30-M W-2S-29E ROYAL PALMS L"T1 LAT 14 BLACK 5 Parcel# 171199-OOW
Floor Area o q, t. q, t
Valuation of VHork$ Proposed Work heated/cooled non-heatedlcooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of g4tln%p ved siructure(s} circle one): Commer�cialn z /
If an existing re, a t"rm s�3tem installed?(Circle ene)k es Nfl N IA t eA4 k Ae o'�7deA
Florida Product Approval# 1 /6 L 4•/ ,�,y-� 7, cry St c� Ht) ! L
For multiple products use pr ct apnoma form
Describe in detail the type of w)orl:to be performed:COMPLETE RE-ROOF
Nam;LEROUX DENNlS,JUDITH Addrrss:1745 SELVA MARINA DR
Citv ATLANTIC BEACH,FL State Zip 3"33 Phone 9O Ll- d/V- ,5[)9 7
E-Mail or Fax#(Op6onal)
Contractor Information:
Compam Name; BOHEMIA ROOFING CO.,INC. Qualifying Agent: IVANA HODULOVA
Address:3950 ST ISABEL DR E City JACKSONVILLE State FL Zip 322T7
Office Phone 9134-859-3539 Job Site/Contact Number 904-982-2114 Fav# 904-353-2700
State CeYtificatiowRegistration#CCC1328464
Architect Name&Phone#
Engineer's Name&Phone it
Fee Simple Tide Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Appkarkm is hereby mask tv obom a permit io do the work med invaikairms as hidlcated 1 cerrif,that m work or hwallwkm has commenced prior io the
lssamx+ a permit agri 1hw ul!wok utl!be Pcrfvn j 10 me tv the skatdurdc of au kru.s re+gedaltng"<'vtutrwet3cet 6t dris fttrlu�c tl.va 7JtLs pcvmit becwnus tt�tll
and raid wm*is ruu tmrmtertcrd Rittsn sir tf1 mmuizz m tf rr»utrurticm rrri rs n .e1x}rric r ahwdmrifor%V of�.r M)mmvh<at arty
tm .firer
work is crmanenced J understmrd Hurt separate perndts mrst be secured EleaYri f!ark,A1a�iiag Si yrs, r3/a,Paels.Pwiwuc�t,Boitna.h ers,
r"ks and Air Cirwdiliantts,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 W-Mi NOTICE OF
COAUKENCEPdFAT.
I hetrby rrrNfv Arwt i Jxrve rrrxirmc!raxrraobtrd tJds� tirut7oat mrd bxnr dwamwe to be tntr mrd emmw AB pmvlaimas of laws or <
al wvtf iv1111 c: Ye�1 p e
type ynplttd waft�rfiadter sir lteteLt yr rut. 7fie of a p does mi .sr~to give ry t e yr cancel the
P-4ji ru of mtv other federal,state. a!knv regulalmg conanrctiml or the performmrce Consin etion,
Signature of[honer Signature of Contractor
Print Name _ t t)C' 136 l/L r)U A P,� ,V+
Sworn and subscn efore me worn to and subscri d re
this Day of 2£/L .2011 ay f 0 S
Pu iic FuM
sed .26.10
SHIRLEY L GRAHAM
FFWY COMMISSION M DD 957760
'g EXPIRES:February 14 2014
pF f Bonded Thru Nnhry Public Underwriters
CIDALL%low*
MOAMy P1fi-we til MIN
Illy Cam&ON AP 18,
G�IIIMMiiii 1 R low
Doc#2013267576,OR 8K 16565 Page 2057,
NOTICE OF COMMENCEMENT Number Pages:1
Recorded 10/18/2013 at 08:24 AM,
Ronnie Fussell CLERK CIRCUIT COURT LIUVAL
COUNTY
Permit No.
RECORDING$10.00
Tax Folio No.
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.
1.Description of property(legal description): REIN 171195.00W LEGAL:30-W 38-:: ROYAL PALMS t;N1Ti LQT14 BLOCK 5
a)Street(job)Address: 7WAMB c LNATLANM BEae>i.FL s2=
2.General description of improvcmcorn c4mKE7
RE ROOF
3.0wner information
a)Name and address: 1-EROUX DENNIS AND JUDITH,765 AMBERJACK LN,ATLANTIC BEACH,Fl X33
b)Name and address of fee simple titleholder(if other than owner)
c)Interest in property O*wm ts;
4.Contractor Information
BOIiI�A 1I{3t11�1G CO.,NaC. 3950 ST.iSABEL DR f,,sACiCSONYI.L£,Ft Mn G+;RC1 X8164
r a)Name and address:
b)Telephone No.: � Fax No:(Opt.) 904-3 z7ao
5.Surety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.: Fax No_(Opt.)
6.Lender
a)Name and address:
Plwne 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 Na-(Lx.)
i�or
8.In addition to himself,owner designates the following person to receive a copy of the 's Notice as provided in Section
713.13(l)(b),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax Na.(Opt.)
(the expiration date is one year from the date of recording unless a different date
9.Expiration date of Notice of Commencement
is specii'red):
WARNING TO OWNER-. ANY-PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDEI,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 30B SITE BEFORE THE FIRST
INSPECTION. IF YOU INTENT)TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMEJW
•c>tQ B1 C? Dll+t 3 R Q'i'- 'E OF COMMENCEMENT,
,� �� —
rATE OF t ILL W.MANKIN
COUNTY a �Pu08c-State of f10rWa 1 C.
My Comm.Eq*"Apr 10,MIS Signa:.i {ho o -:�ner's f�u±hcari�ed{�`n rii�i�Rai lMt f
Cm nolle oe I EE�4
going}f str urent u a3 stilziur cd cue file this 1�days of 0 C-4-0 43 f 2 X01
n5
(type of authorityt '.
otliceu,trustee,
on behalf 9f whommiin :-rument was executed)
3ttcsrney in fact)for Inane of part-
-
Personally Known ZOR Produced Identification ` ,t fsiple
V �
Type of Identification Produced OR Name(print) Vl NLA A� ;N
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.
F1�R94Si28DC:,t+sd1IID
P�.rsoai Sigiziugt #lo.)A'ova