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109 Pine St 2014 roof CITY OF ATLANTIC BEACH Ij 800 SEMINOLE ROAD N� ATLANTIC BEACH, FL 32233 =� INSPECTION PHONE LINE 247-5814 jilt Application Number . . . . . 14-00000696 Date 5/01/14 Property Address . . . . . . 109 PINE ST Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 3580 ----------------------------------------- Application desc reroof ----------------------------------------- Owner Contractor ------------- ------------------------ SALZER, JOHN & RON RUSSELL ROOFING INC FERNANDEZ GEORGINA D 4419 HUDNALL RD 109 PINE ST JACKSONVILLE FL 32207 ATLANTIC BEACH FL 32233 (904) 714-1907 ---------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . . 00 Permit Fee . . . . 70 . 00 Plan Check Fee Issue Date . . . . Valuation . . . . 3580 Expiration Date 10/28/14 --------------------- ---------- Other Fees STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ---------- ----- ---------- - Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 74 . 00 74 . 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) 247-5826 Fax(904) 247-5845 Job Address•' 109 Rn.e � Af1 C �!h, �� 3 z 733 Permit Number: Legal Descri tion C 3 9- o� 3 Parcel# � p oor Area of Sq. q•1"t Valuation of Work$3,990. 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): Commercial Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# to l2 .lo For multiple products use product approval form l Describe in detail the type of work to be performed: Jqe—COQ ,. �l�Z I! tom' �,�g��es C3 fu6 2 so Tar�hl��__•��r; Zso ell Q�d - Property Owner Information: Name:�Il I,. StA I7'e� Address: &6Q e_ a_5 above— - City State_Zip Phone SG 0-JOO h E-Mail or Fax#(Optional) Contractor Information: Company Name: Qualifying Agent: Address: City_: 4 State�—Zip 200 Office Phone 7/ – Job Site/Contact Number (z06Q0=9R23— Fax# (QU�lJ �,_ _Qop State Certificatio egistration# 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. 1 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 this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a-period of si%)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells,Pools, urnaces,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 RNEY BEFORE RECORDING YOND TO OBTAIN UR NOTICE F CONSULT H YOUR LENDER OR ANA COMMENCEMENT. 1 hereffb certify that 1 have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this ryrovisioYns o a 111 obe the epedlral,state, or locallawre specified lat'ng construction oke pe orherein or not. The granting mance of constructermit does ion. to :ve authority to violate or cancel the p .f n3 f Signature of Owner Signature of Contra LL C r Punt Name .�.......... .. .......�.:....�`.�.....�..................._........................................ Print Name ,�eti......14�.ltlr/...`..-"....................................... Sworn to and subsc *bed fore me Sworn to�e�nnd subscri be ffo-re me 20 this�k Day of .201 k this 28''"°Day of .4ha ARY PU13UC ota Pub is sAHrnu Notary Public STATE OF FLORIDA ry ��RY LIC SDA ` COMM#FF018455 Comm#FF016455 S ires l8/2017 Exphn 5/&2017 E* LV 1-f GV VJ '�� Gl'l/ 1\V•I��l Y� 1UJJC11 \.Iy✓1\l\ \ill\VVli \. 0l\1 ✓VYlIJ.J \.iV VlY11 RECORDING $10 .00 NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. R-14 Tax Folio No. State Of Fbrida County of Duval To whom It may concern: The undersigned hereby informs you that Improvements will be made to lain real property,and In accordance with Section 713 of the Florida Statutes,the following Informatle ;stated In this NOTICE OF COMMENCEMENT. Legal description of property being improved: t �� 6 /S7 43,S Address of property being improved: Reroof General description of improvements: 4 Owner Address Owner's interest in site of the improvement Fee Simple Titleholder(it other than owner) sr Name Address Contractor Ron Russell Roofing,Inc. Address 4419 Hudnall Road,Jacksonville,FL 32207 Phone No.904-714-1907Fax No. 904-83E9909 Surety(if any) Amount of bond$ Address 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. 714 1907 Fax No. 4-6 9036-9909 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 NIA ` 7 Address Fax No. Phone No. ! Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a 4' different date is specified): ER THIS SPACE FOR RECORDERS USE ONLY DATE %�z4/jy Signed.Beforday of _` in the CountyW�0stag of Fbrtda.has PAY appaand twit 4j!, hereto by hl n"M hWW and atflrnla tltar as atetsrrwMAs&MW declarations herein WUkk NM �L) ars true and accuraw 1 C�'r�� RY PUB M STATE OF FLORIDA Comn*FF016W Notary Pubuc at I".Starve Of , county� � 6f 8 17 My co n nissbn Wk": or nrr \ ir dtu { Prod kantlfkatlon e es i R:$ "' r ,:,d,... "' ` .i6c:• .i�*R:.'".\`" i+,l;-.fFY�d.+.»;•'.": ri.- "tali3�aRiz «.. 'a:,��...1. _.._.