860 Hibiscus St 14-00000086 Roof CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�URI
Application Number . . . . . 14-00000086 Date 1/22/14
Property Address . . . . . . 860 HIBISCUS ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4700
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Application desc
REROOF ONLY 860 SIDE OF DUPLEX FL10124 . 16
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Owner Contractor
-
------------------------
-----------------------
KSN INVESTMENT CORP RON RUSSELL ROOFING INC
4419 HUDNALL RD
JACKSONVILLE FL 32256 JACKSONVILLE FL 32207
(904) 714-1907
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Permit ROOF PERMIT
Additional desc .
Permit Fee . . . . 75 . 00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 4700
Expiration Date . . 7/21/14
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Other Fees .
. STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
Fee summaryCharged 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
(PREPARE IN DUPLICATE)
Permit No. R_13- Tax Folio No.
State of Florida County of Duval
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:
18-34 17-2S-29E SEC H ATLANTIC BEACH S 5VI'LOT 2 N 35FI'LOT 3 BLK 154
Address of property being improved: 860 Hibiscus St Atlantic Beach Fl
General description of improvements: Reroof
Owner KSN Investment Corp,James Heffernan,Pres
Address 9191 RG Skinner Pkwy Ste 501
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Ron Russell Roofing,Inc.
Address 4419 Hudnall Road,Jacksonville,FL 32207
Phone No.904-714-1907 Fax No,904-636-9909
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 Ron Russell Roofing,Inc.
Address 4419 Hudnall Road, Jacksonville, FL 32207
Phone No.904'714-1907 Fax No.904-636-9909
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 Statutes.(Fill in at Owner's option).
Name N/A
Address _
Phone No. Fax No.
Expiration date of Notice of Commencement(theexp' 'on date is one( year from the date of recording unless a
different date is specified): /
THIS SPACE FOR RECORDER'S USE ONLY f WNER
r
Signed: --''i-- DATE /
Before me Is day of v in e
County of StatlpofFIZOa. persona ly appeared
C herein by
himself/ rsetf and affirms that all statements and declarations herein '
are true and accurate
TERRANICE SANTILLI
NOTARY PUBLIC
Notary Public at Large.State of County of_ L,'-;/ STATE OF FLORIDA
My commission expires: Canm#FFU16455
Personally KnOn or
Produced Identification • E)VrOS&8/2017
p 201 7
Doc#2014015587, OR BK 16667 Page 243, ^^MM�� W`
Number Pages: 1
Recorded 01/22/2014 at 12:51 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax(904) 247-5845
Job Address: �O d f-�'�sb'5 cy S s�- Permit NK m yer:
8ea<h S is zM 3s Par el# !7O 9 4 S - �0 2 0
Legal Description 1?-3117 Z 5-2 9 See ft'A>t 610 -,'c t
Floor Area of t non-heated/cooled
Valuation of Work$ ql 1� Proposed Work heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one):• Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes M N/A
Florida Product Approval#
For multiple products use product approval form
�_ f { ��o`
Describe in detail the type of work to be performed: R rv� ° Sade S Z
Property Owner Information:
Name:I�Sn �I1"t0 -"'°j!t C°�P Address: 9�9� "rtu pkwy Sf{ SOI
City J�bCsc,y.11e State Fl Zip :3Zz5G Phone 7/0 — 7 y 3
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: rpt ��f� � " Qualifying Agent: Z Zi 32 Zo 7
Address: 4111/9 /!a/ d City-rte K5vrtvifff- State�_ p
Office Phone 7/4-/9107 Job Site/Contact Number 60o-982,3 Fax# 436- 9969
State Certification/Registration# CC c 13 7 7e19c(
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
that no work or
ation has
the
Application is herebyn= nmade
dhat al work will be�pedbrmed toomee the rk and installations
of all regulating onstruction to this jurisldi tionn.. Th s permit becomesrior on
u I
issue p period
workss�If'work is menced.ot 1 understand that sesix(ate permits°must be secured for Electrical R' k,Planibing,Sigfns,aime after
WeUs,P°f°IsxFu)rnaces months at
Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YON YOUR PAYING FAILURE TO �TW I E FOR IMPROVEMENTS
A NOTICE OF
COMMENCEMENT MAY RESULTCONSULT
TO YOUR PROPERTY. IF YOU INTEND E ORE RECORDING YOO OBTAIN UR NOTICE OF H
YOUR LENDER OR AN ATTORNEYCOMMENCEMENT.
I hereb work y that
I�e rea a ex in lied with w thers t eciaedllherein or not.T he granting of a per does the same to be true and cnot prt. All esumes to ions vel authors°rdina attegor governingthisthe
type ojY
provisions of arty of r fe al state, 1 al regulating construction or the performance of construction.
Signature of Contractor
Signature of Own A ^
/fes, Name .....................o .� X11..................
Print K..S...SELL.........................
Print Name e� r 4'...✓lCt{�............................
....................... .....................
Swrn
o �j�,and-subscn ed before me Sworn to and subscri d before me ,201
this !I' Day of uc 20�'� this Day of ��
gAtMLLI
NOTARY PUBLIC
No ry Public 3 q•�OF FLORIDA No .� ,TATE OF FLORIDA
• Comm#FF016455 Comm#FFU18455 Revised 01.26.10
•
Expires&WW17 Expires 518/2017