92 W 5th St 2014 roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-10
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $4,180.00
Issue Date: 1/6/2015
Expiration Date: 7/5/2015
PROPERTY ADDRESS:
Address: 92 W 5TH ST
RE Number: 170822-9895
PROPERTY OWNER:
Name: MANSEN, BRIAN D
Address: 92 W 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: EMPIRE ROOFING SALES & SERVICE
Address: 2806 -1 GI GIBSON RD QA PEDRO R NUNEZ
Phone: - -
FEES:
BUILDING PERMIT FEE $70.90
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $74.90
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: -1 o� 61. ldes+ Afl4 7'c (j)<, 11 rj _Permit Number:
Legal Description Parcel#
Floor Area of S .Ft. S .1,1
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration a ai D Move Demolition pool/spa window/door
Use of existing/pro osed structures)(circle one): Commercial Residential
If an existing structure ,is a fire 4prinlcler system installed? (Circle one): Yes No N/A
Florida Product Approval# 1 I0a - I
For multiple products use product approval form
Describe in detailthetype /of work to be performed: Remove cz I 1 �►f.s f-c ds,ln 4-u d,-c k
10.1G wyJ Re-A i r k 61PV'-ih wn .r (iiiqj4-0� Ctv/t
Property Owner Information:
Name: 1'c ICS r s Address: tvls�-
city_ fi 1,.,_}iy. 64a L,14 State t,`1 Zip Phone 3!V f - 666 F
E-Mail or Fax#(Optional)
Contractor Information: C UZACTORZMA]E L ADDRESS:
Company Name: ir e Qualifying Agent: Pedro A vivfL.
Address: ad l�~ N�snu A - City J ,,_k_fo1Vk I ie State F - Zip 3
Office Phone 321- 100 7 Job Site/Contact Numbernkc, Fax#
State Certification/Registration# C c.C. i�:t j�fi -o^ay
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 this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aWeriod of six_(6)months at any time a,Jte•
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, ells,Pools,Furnaces,Boilers,Reaters..
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 YOVIi 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 ofYwork will be complied with whether sppeci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of arty other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contract
Print Name /C G Y. s Print Name . ....... ....................lIze-
,7Z7 /P✓. _........................... ......................................... f'c Y
Before map Befo
f `&, ; MELISS '
S�L Y orida this ,?• • SLS K 20
• na
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NO „`• Bonded Through Naiional Notary Assn. No Bonded Thr National Notary Assn.
evise 1. 6.10
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NOTICE OF CO iS�ENCEMEN'r
(PREFIARE ItwDuPL&TE)
Permit No. - Tax FolioNo.
State of County of -
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:
T K« 0—T
Address of property being improved: "7 7, A 4,.4- iwee
General description of improvements: Q
Owner
Address i {
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor t-Fvtn;r� fi0 All
Address �t�t en/ ISO. JA&1246/vs I I e-
C1. 3�.Z
Phone No._ /fJ(J 7 31' � �Z Z
Fax No._ �2
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
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 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
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unlall'
different date is specified): Z
o
O C-) E;THIS SPACE FOR RECORDER'S USE ONLY ;1 OWNER 3
9
Signe -• m
Before me H m c r
° - / In . �. y
County of uviii,State of Floritla, pens a N a
7L-ierein by `^
DOC#2015002686,OR BK 17026 Page 712, himself,'herserr and affirms that all statements and. tions herein d T T
Number Pages:1 are true and accurateo S! o
Recorded 01/06/2015 at 12:28 PM,
N
Ronnie Fussell CLERK CIRCUIT COURT DUVAL o n
COUNTY / /�� r P Z. °
RECORDING$10.00 Natary Pu at to of u or Z
My comrrA�sion xpir s:
Personally Knawn or
Produced Identification