197 Pine St 2014 Roof s ��1•L�l rfv�
s, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
N� ATLANTIC BEACH, FL 32233
J v INSPECTION PHONE LINE 247-5814
Jir
14-00000175 Date 2/06/14
Application Number . . 197 PINE ST
Property Address . . .
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3380
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Application desc
reroof f11956 . 3
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Owner Contractor
_ --------------
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RICHARD MASON SHORE ROOFING COMPANY
914 7TH AVENUE SOUTH
197 PINE ST
ATLANTIC BEACH FL 322334011 JACKILLE
(9045O241-8842EACH FL 32250
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Permit . . . . . . ROOF PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee . . . . 70 . 00 3380
Issue Date Valuation
Expiration Date . . 8/05/14
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- - - --- ------------
----------- - - - - -
Other Fees STATE DCA SURCHARGE 2 . 002 . 00
STATE DBPR SURCHARGE
Fee summary Charged
Paid Credited
_ -------.00
----- ----------
- . 00
Permit Fee Total 70 . 00 7000 . 00 . 00
.
Plan Check Total • 00 . 00
00 . 00 4 .
Other Fee Total 4 . 00 00 . 00
Grand Total 74 . 00 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
Job Address: 61 ?[N'L S Permit Number:
Legal Description 10-16 s hiy- Scc,3 Parcel#
Floor Area o q.l�t. Sq.
Valuation of Work$ DI 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):installed?
Residential
If an existing structure,is a fire sprinkler system nstalled? (Circle one): Yes No N/A
Florida Product Approval# /934. _75
For multiple products use product approvesform
Describe in detail the type of work to be performed: ",OF Soy 1"'Y.S'4 ' 'f b S
P,%,I +-S+•�k
Property Owner Information: _
Name: �Aed Sty ✓ Address:
City 13-r"ev State ftZip,� 223 Phone TO" 4Z 17
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: .SAOfL IwyF�c Cr Qualifying Agent: ,r c-
Address: 3 — v
A.(1 City ' 9,C&, c State i='/ Zip 32�d
Office Phone 1 ` $y Job Site/Contact Number��e- 21J 5 5 Fax# A 9/ -2:8y3
State Certification/Registration# t r 044 SFl I
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. I 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 tt hiis jurisdiction. This permit becomes null
and work void f work is not
otcom7 undmenced within six erstand that separate permits mor ust be secutred for Electrical Workon or work is ,
Plumbing,Sigor ns,aWells,Pools,x urnaces,Boilermonths at ys time after
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
BE OR ENTE RECORDING YOUR NOTICE OF
I hereb certify 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 of work will be complied with whetherspeci ted 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 local law regulating construction or the performance of construction.
w
Signature of OwnerSignature of Contractor
�, J� • ..l' S'�lorc
PrintName1f%I� -.................... Print NameYhl�'.........................................................................................
Before me Befo 201
this Da of 20 this ay of
' JEAN SHORE
y ���,."""�,,•, PAMEI I'm P11 Florida
Notary Pu 1 .• rtes Dee 4,2017 t , ;tlb t�EXPIRES:May 21,2015
My Comm.ExD 074537 �yy ThruNotalyPubficundeiw�ra
iSSion N FF +7 Bonded
Comm �q�,�r• vised 01.26.10
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. '76,'357
State of County of ,)L V N I
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: �� — sp �f G 3
t
Address of property being improved: `7 7 r itNt S F ✓Qt haw Ls des c 1— l
32
General description of improvements: �� /�GL'
Owner R,
2
Address IC17 �3'ivz S'II/►+y�rc /3rsc �l3S
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor k '�V
Address �� /�, v w vt y �►�t �l <<G 2 /'l Z 1 U
Phone No. �l/I — $�y� Fax No. 1241
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address h
Phone No. Fax No.
Name of person within the State of Florida,other than himself,de Doc#2014028385,OR BK 16682 Page 1729,
Number Pages: 1
documents may be served: Recorded 02/06/2014 at 12:43 PM,
Name Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Address RECORDING$10.00
Phone No. Fax No
In addition to himself,owner designates the following person to receive a copy of the Llenor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone 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 �'' QWNER 7 J/
Signed �;r1"l/ ATE
Before me this + day of .n the
Co`7rrrr�f �te gf Fioridn his ons ly�ppeared
_J1—P / LL J�( �� /r'`- horeln by
himself/herself and affirms that all statements and declarations herein
are true and accurate
PAMEIA JEAN SHORE
MOeary Pt101k-Ste*of FlotiOi
my Comm.EghM on 4.2017 �^
COIIMINf>it011 A FF 077 Notary Public at Large,Slete of County of
;F- My commission expires:
Personally Known or
Produced identification�l