267 Jasmine St roof 2014 f �i yL`1,rJv�
=a , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
±� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000860 Date 5/28/14
Property Address . . . . . . 267 JASMINE ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4300
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Application desc
reroof
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Owner Contractor
-
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CONNELLY, GLENN EMPIRE ROOFING SALES & SERVICE
267 JASMINE ST 2806-1 GIBSON RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 334-1661
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Permit . . . . . . ROOF PERMIT
Additional desc .
Permit Fee 75 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 4300
Expiration Date . . 11/24/14
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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 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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
h
Job Address: QA33 Permit Number:O`
Legal DescriptionParcel#
ff Floor Area o q. t. q t
Valuation of Work S 1i 300 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteratio . Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commerciales' nt'
If an existing structure,is a fire sprinkler system installed? (Circle one): ll
es No N A
Florida Product Approval# f:�-1 15 51. . .
For multiple products use product pprova orm
Describe in detail the type of work to-be performed: 904 6Uf1^
Property Owner Information: *�k 6`7
Name: Address: ;W J q!rin t h P- S f'
City eicA State Zip 3p)X31 Phone
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: &V 90411-heQualifying Agent: Ped iro
Address: -1 C M _ City - wck�jt& State 8_Zip_��°
Office Phone 39' -100)! Job Site/Contact Number 121 -d,)el Fax# 341 - 1977
State Certification/Registration# CCC j3;2 Eno j
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 thpis jurisdiction. This permit becomes null
and work er
is commenced.work is otcommenced within six I understand that separate permits muor st be secured for ElectricaCWork,Plumbing,Sigconstruction or work is suspended or ns,or awells,poeriod ols, FsixF rnacemons,Boilers,hs at time
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
BE OR ERECORDING YOUR NOTICE OF
COMME1 hereb certify that 1 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 well be complied with whether specified 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.
Signature of Owner zLen�—�
Signature of Contractor
Print l/'�v U <.�-:...........................
Print Name Ur. _e.t► .............. ..N.�tl �l..s�/.............................................. �.......
Before Befo
thi � ay of this y of 20
�• .a I COOK ..1u,, C006 laic of Florida '°"
n ar
Nota P = is My Comm.Expi eb 21, O1 g My Comm.Ex s Feb 21,2018
• Commission N FF 086334 ?s, 'd: Commission # 26.10
Bonded Thrnugr National Thro.:ar
al Notary Assn. p l? V y sR.
"
NO rICE OF COMMENCEMENT
(PREPARE Ih-DUPLILATE)
Permit No. Tax Foiio'No.
State of County of
To whom it may concern:
The undersigned hereby int)rms you that Improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information t: stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: it 7 A A111 `
Address of property being improve f: �b JOI.SMittP, S
General description of improvemer is: Oyfy—
Owner Con 1t
Address 2A
Owner's interest in site of the imprc✓ement _
Fee Simple Titleholder(if other that owner)
Name _
Address
Contractor Qt
Address A9012-1 (41Y,3W v
Phone No. Jq — l UD: _Fax No.
Surety(if any)
Address _ Amount of bond$
Phone No. Fax No.
Name and address of any person m iking a loan for the construction of the improvemen,s.
Name
Address _
Phone No. _Fax No.
Name of person within the State of F orida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. _Fax No._
In addition to himself,owner designai;s the following person to receive a copy of the Lienors Notice as provided in '
Section 713.06(2)(b),Florida Statute s.(Fill in at Owner's option).
Name
Address -�-----_— — ---- - � CO �
Phone No. Fax No.
Expiration date of Notice of Commenc,ment(the expiration date is one(1)year from the Gate of recording unless a " o
different date is specified): ,� 4
THIS SPACE FOR RECORDER'S U ;E ONLY OWNERr�ii y T It '
co W H
Signed: j�t _ TE ly .
Before me this of— �}Y�L e a E
Coun of al.Siaie a has s IIS ap' peered �u N
by .
herein
Page 7,
himself/herself affirms that a I stat nts and tleclarations herein ��` ;r`••,
Doc 4 20141176^88,OR BK 16793 Pa e 83. are true and accurate
�
Number Pages: 1 �O�. ,
Recorded 05/28/2014 at 09:52 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL - '� '
COUNTY =� 1'�nr
RECORDING$10.00 Notary ubl L rge,State of a:ountyof ,
my corrmissior pires: _
Personally KnaAn or
Produced Identification --- .�_('�_�