760 Triton Rd 2014 Roof ��t•U`1 f'
SS CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�JF3 SA
Application Number . . . . . 14-00000805 Date 5/22/14
Property Address . . . . . . 760 TRITON RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 8000
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Application desc
REROOF
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Owner Contractor
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NARKIEWICZ, JOSEPH A.J. WELLS ROOFING
105 END AVE W 5432 WELLER PL
LITITZ PA 17543 JACKSONVILLE FL 32211
(904) 553-0069
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 90 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 8000
Expiration Date . . 11/18/14
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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 90 . 00 90 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 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: Ito o +'(�tl Pd- Dp�__+�'�� 8C 3�i�Permit Number:
Legal Description s�� �J RS "at9 E 1 al 100dnS 1 -X14 Parcel#/ r]l 3 3 —0 000
Floor Arege o q. t. �q.Ft
Valuation of Work$ Proposed Work heated/cooled non-hented/cooled 1, 7tg
Class of Work(circle one): New Additionlte Repair Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial
If an existing strucure, is a fire sprinkler system installed? (Circle one): No N/
Florida Product Approval# - RJ
For multiple products use product approval form
Describe in detail the type of work to be performed: 04 W
Property Owner Information: �-
Nam h t I C2- Address: �� L'Ul A � {�
City i State_Zip t S� Phone 35-2,- a8,3__-__3 138
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 60Qualifying Agent:
Address: City _GUC _ State E- Zi —
Office Phon S-Sqno Job Site/Contact Number CJ64 s5300Fax# `f 0-913
State Certification/Registration# CC-C- ►3IT91 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 herebpy de to obtain a permit to do the work and installations as in�cated. I certify that no work or installation has commenced prior to the
issuance of a permit athat all work will be performed to meet the standards of all thisjurisdiction. This permit becomes nulland void f work is noommenced within six(6)months, or if constrcon or wok uspended or abandoned for a_perrod ofsix 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 INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether speci 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-7 or local law regulating construction or the performance of construction.
Signature of Owne Signature of Con a.ct
Print Name OSp�l ! ar-k,.P_wICZ. Print Name
.................................. .................................................................................................. 4011-114-r-- S
..............................................................
Swo and subscribed before me Swo to and subscri before me J`�
thi of 20 j this ay of 20
Notary Pu is Nata Public State of Florida Nota
ry
Kimberly Baker $ Y i Notary Public State of Florida
,ts
My commission FF 012533 . . Kimberly Baker Revise 1.26.10
L4Expires 04128/2017 „n My Commission FF 012533
10Expires 04/28/2017
-�( NOTICE OF COMMENCEMENT
State of Tax Folio No. //I 3 ""000c)
County of �,P. ayaA
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 NOTI E OF CONCE NT.
Legal Description of property being improved: . — -aZ 'aq C-
Address of property being improved: C
General description of improvements: "✓
Owner: &Y-KI'f U,9 I'e-- ttom�, Address:��J� C►'t:7 4") j � '7 .
Owner's interest in site of the improvement: Alen�C
Fee Simple Titleholder(if other than owner):
Name: `
Contractor: 1- s
Address: A I AcfeAO {,d 4V,0-
Telephone
V2.Telephone No.: O' 5-6--goo(p� Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: 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,
Signe . Date:
Doc#2014"1'1430,Ott BK e 85 Page 13- B orida thas personally appeared in the County of Duval, State
Number Pages: z.
Recorded 0522/2014 at 10:28 AM, Notary Public at Large,State of Florida,County of Duval.
Ronnie Fussell CLERK CIRCUIT COURT DUVAL My commission expires:Q —
COUNTY Personally Known:
RECORDING$10 00 Produced Identification: • L--
Kimberly Baker
c� My Commission FF 012533
�opp�o'F Expires 04/28/2017
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