128 Pine St 2013 roof CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003878 Date 12/27/13
Property Address . . . . . . 128 PINE ST
Tenant nbr, name . . . . . . 122 AND 128
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5000
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Application desc
reroof
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Owner Contractor
------------------------ ------------------------
HENRY, KATHLEEN ROSS K & D ROOFING & CONSTRUCTION
12906 BIGGIN CHURCH RD S 2758 DAWN RD SUITE 1NE
JACKSONVILLE FL 32224 JACKSONVILLE FL 32207
(904) 553-1381
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5000
Expiration Date . . 6/25/14
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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 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
Tic:+F�IiO\v.
State of Florida.Countv of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
I. Descripti�l o rooem�(legal desc lotionl nronery and.ad ss if availabieri ,
Z
_. G neral Description of improvements: `3
�-,P,t GGr LtSi f1Lt ��lti j11�5
=.
Owner information:
aj:Name ana Address:ef/k' � - /. y/
b)Interest in oronerty: /gem CC
c)Name and address of simple titleholder(if other than owner): 3
" 33
Contractor Information:
a)Name and AddresspoCpiJ1Q ��5r✓ ��CIIN 11 t�S�l r JFe � UQX•
b)Phone Number:C_I_..5L4j—11e�7
5. Surety Information:
a)Name and Address:
b)Phone Number:
Amount of Bond:S
6. Lender Information:
a)Name and Addresb:
b)Phone Number:
'. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herself,Owner designates of to receive
a copy of the Lienor's Notice as provided in Section 713.13(I)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity,designated by owner:
9 Expiration date of Notice of Commencement(The expiration date is one(1)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
1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMEIN'TS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST NSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR .AIN' ATTOR'I >ZYIBEFORE CONIMENCNG WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
t '
Signature of Owner or Owner's Authorized Officer/Director/PartnefiManager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me this-.11 day of ';c. 20/ = y
as for
{Name of Person) (Authority Type:i.e.Officer/Attomev) (Name of Pam Instrument was Executed fof)
DATHA A. DEUBLER
NOTARY PUBLIC.STATE OF FL RIDA
Notary Public, State of Ohio Print �
vmmission Exalres Sepr 13, ? 'CrSonally Known
Identification'Type:
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read die
foregoing and that the facts stated in it are true to the best of my knowledge and belief.
Doc#2013329119,OR BK 16644 Page 1597, Signature of Natural Person Signing Above
Number Pages:1
Recorded 12/27/2013 at 03:24 PM, Revised 10/1/2009
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
M11101
moo,
10-
CITY OF ATLANTIC BEACH
Date:
ROOFING PERMIT APPLICATION
��—�(/�_,�
Job Address:
Owner of Property: '
Address: Telephone: _110
f
Roof Contractor: ���,� (� State License Number: cfCC cj--_
Contractor's Address:
Telephone: `jai`'_/W —/ ?GY/ Fax:
7 Email:
Scope of Work: Via,n
i ,nRoofing Material
FL Product Approval# j ,
PP J ( Valuation of Work:
Required Inspections: Sheathing/In Progress-Dry In /Final
If re-roof: Assessed Value of Structure:—<$300,000/_>$300,000;Roof-to-wall improvements required?
(Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY 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 WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE 0, MENCEMENT"
SIGNATURE OF OWNER:
Z %A
AS TO OWNER: /
DAT rrAto plj�1t4sCcRed before me this�_day of C, 20�.
t to
of o i of Duval ��
Notary Public, State of Ohio Notary's Signature: // ✓ ��
�Rersonally known
f'v Commission Expires Sept 13,2C, ❑ Produced identification
Type of identification produced
SIGNATURE OF CONTRACTOR: Date: /cam
AS TO CONTRACTOR: �C� ,
Sworn to and subscribed before me this--�— day of 2L—�, 201 .
State of Florida,County of Duval _
Notary's Signature: DJ �
personally known
/�J Produced identification
DATHA A. DEUBLER Type of identification produced
Notary Public, State of Ohio 800 Seminole Road•Atlantic Beach,Florida 32233-5445
My Commission Expires Sept 13,20' Telephone: (904)247-5800 Fax:(904)247-5845
F:\roof permit applicaton 2010