250 Seminole Rd 2014 Roof �� � � �'• CITY OF ATLANTIC BEACH
s j 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
14-00000056 Date 1/16/14
Application Number 250 SEMINOLE RD
Property Address . .
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4000
-----------------------
-- --------------------------------------------------
Application desc
REROOF
------------------------------
Contractor
Owner
_ ________________ ------------------------
JUSTIN LARSEN CONSTRUCTION INC
ASL LLC
PO BOX 1942
1820 SHERRY DR N
ATLANTIC BEACH FL 32233 4784 CATTAIL ST
MIDDLEBURG FL 32068
(904) 241-0320
---------- -----------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee . . . . 70 . 00 4000
Issue Date Valuation
Expiration Date . . 7/15/14
------------
-------------------------------------------- 2 . 00
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE
________ ------
Due
Fee summary Charged
Paid--- Credited
_ _ -----7 ------- . 00
----- ----------
- . 00
Permit Fee Total 70 . 00 70 . 00 . 00 . 00
Plan Check Total • 00 . 00
4 . 00 . 00
Other Fee Total 4 . 00 74 . 00 . 00 . 00
Grand Total 74 . 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
s
Job Address: r St'VI� k ko _ Permit Number:
Legal Description 1 g 1 - �' J� .� Parcely4i I #
oor rea o q. t. q. t
Valuation of Work $ Gp Proposed Work heated/cooled 14 non-heated/cooled N A
-Class of Work (circle one): New Addition Alteratio e air Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial �esi,,,
If an existing structure, is a fire sprinkl r syst m in ailed? (C'rele one):
Florida Product Approval #
For multiple products use pro uct approva or I �f
Describe in detail the type of work to be performed: - —
Property Owner Information:
Name: �. Address: —
C i ty #qoA An 1& State Zi Phone _ -
E-Mail or Fax (Optional) _
Contractor Information:
A
Company Name: Qualifyin A _
Address: City State Zip
Office Phone - - Job Site/Qontact Number—Q%4-RZ.7- 311 _Fax#
State Certification/Registration # _
Architect Name & Phone #
Engineer's Name & Phone#
Fee Simple Title Holder Name and Address Z Y7
Bonding Company Name and Address
Mortgage Lender Name and Address
Applicution 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 o permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes 1r11l/
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six((6)months at any time a%ter
work is commenced. I understand that separate permits must be secured for Electrical-Work, Plumbing, Signs, Wells, 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.
I hereby certify that I have read and examined this application and know the some to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give a tthori violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner _ Signature of Contractor
Print Name )rlrl ( a I (,�,( Print Dame �Q,/
................................. .................. _
Sworn to and bscri d efore me Swo subsc - C
his �� D of _ this o MARIA PIMIij
• loss,
MARIA PIMIENTA .' Notary Public-$tate of Flori r
_. '•• ' ry Public-State of Florida Comm.Expires Jan 28,2L t
1 u �1 c My Comm.Expires Jan 26,2015 a lc 10ommisslon#EE 59080
'•.',%p,.f�dCommission N EE 59080
' Revised Ol.26.10
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of � a
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: /0-$ `6-125- 121E a Q,¢ AiA
Address of property being improved: 5V'1?1A),0 LC /ZQACA -
General description of improvements: �Q- ►��
c ,J
Owner: Address: R - 4'6
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner): NN
Name: T7
Contractor:
Address: 2 1!!S8 - FL
Telephone No.: Q 2 - Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: 71f 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: Date: IL/ •/
Doc#2014012411,OR BK 16662 Page 2224, Before me this ay of in the County of Duval,State
Number Pages:1 Of Florida,has personally appeared
Recorded 01%16/2014 at 02:33 PM, Notary Public at Large,State of Florida,County of
Ronnie Fussell CLERK CIRCUIT COURT DUVAL My commission expires: TA
COUNTY Personally Known: Wof Florida
RECORDING$10.00 Produced Identification: I>Kt EX J.1-My Comm.Expires Jan 26,2015
'�%.'E ov«d;•` Commission#EE 59080
�•mnu�.