1757 Seminole Rd 2014 roof nl CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r i3
Application Number . . . . . 14-00001441 Date 9/02/14
Property Address . . . . . . 1757 SEMINOLE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES GEN 2F DISTRICT
Application valuation . . . . 4700
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Application desc
reroof
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Contractor
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WELLS, HAROLD D ROMANO BROTHERS ROOFING, INC
1757 SEMINOLE ROAD 1188 12TH ST N
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 246-5649
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4700
Expiration Date . . 3/01/15
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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.
1, BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1 75'7 Sn.r► ,.✓e/� DA2. Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled Z-, non-heated/cooled
Class of Work(circle one): New AdditionIter x= Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial P�;�IPnr
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No
Florida Product Approval# .161141.4-61 .3 :ZZd,"
For multiple products use product approval form
Describe in detail the type of work to be performed:I I r-e;IAZ fy�s��PY
./44�4 • rse s
Property Owner Information:
,I i
Name:1}2 Address:la m S�.�L�✓a��
City3ge*aft Stat�Zip Phone 27G- //f
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: PN .J Qualifying Agent: D �/`--e�r+ 0
Address:l'S City r � is�ol� Stated Zip 331 3
Office Phone Job Site/Contact Number 2A, 5v/- Fax#
State Certification/Registration# 01 0-e-
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 in 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 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 six6)months at any time after
work is commenced. 1 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 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 will 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 Owners � Signature of Contractor
Print Name .... ...._..., Print Name
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Before e Be a „�' ��POW L.$we of �
thisDay of 2 thi ay
PVy011 L.P1IAE%TEL •EE MIT
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Notary blic 5 N ry lic
' MY��1Wn•EE tA/2-aA Revised 10.24.12
(PREPARE IN DUPLICATE)
Permit No Tax F o,
State o County of
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To whom it may concern:
The undersigned hereby informs you that improvements will be made to certifff real property,and in
accordance with Section 713 of the Florida Statutes,the following information
COMMENCEMENT. in this NOTICE OF
Legal descd tion of property being improved: 0 1
Address of property being improved. -
3�a33
General description of improvements:
Owner -—
Address ?
Owner's interest in site of the improvement J Q
m
Fee Simple Titleholder(if other than owner) 0
p
Name Im-
Address ti 0
Contractorco
' in
Address I N U
Phone No. --— l�r!�= Fax No- 0 V
iL'
Surety(if any) m
0 v o
Address iv w 4
-r o
Amount of bond$ CO ..cd 0 Z;
Phone No_ Fax No. �n q-)a�
m o uoi Z
Name and address of an _a
y person making a loan for the construction of the improvements. ` (1)w t rr
Name =x a 0E)z 0
Address
OO uj
ZoY ra
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
Phone No. Fax No.
In addition to himself,owner designates the following
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option),�tve a copy of the Li:,nor's Notice as provided in
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 / OWNER
Signed; DATE
Before a
this' day of
County of Duval.state of Flodd, s Personally appeared In th
r IAL I t f hereinm dab
himself{herself and aft that a statements and declarations herein �way��i
1"Tare true an ccurate prfM L. MEN11a
Notaty pWic- tate of FtorWa
My COIMII.Eupif Jun 13,2015'
Comamwon EE MIT
Notary Pu61ic f Large,State
its
MY
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County of
y commission expires:
Personally Known (.7"-- -
Produced Identscat on "' or