126 15th St 2014 Roof CITY OF ATLANTIC BEACH
r) 800 SEMINOLE ROAD
+� ATLANTIC BEACH, FL 32233
ROOF PERMIT INSPECTION PHONE LINE 247-5814
CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-ROOF-414
Job
- -
Job Type: ROOF PERMIT
Description: reroof fI 10674.1
Estimated Value: $7,900.00
Issue Date: 11/12/2014
Expiration Date: 5/11/2015
PROPERTY ADDRESS:
Address: 126 15TH ST
RE Number: 171864-0000
PROPERTY OWNER:
Name: JONES LIFE ESTATE,MAE THOMPSON,
Address: 126 15TH ST
GENERAL CONTRACTOR INFORMATION:
Name: BURGER ROOFING CO.
Address: 134 -1 E ERNEST ST QA GARY G. BURGER
Phone: - -
FEES:
BUILDING PERMIT FEE $89.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $93.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc it 2014256107,OR BK 16974 Page 624,
NOTICE OF COMMENCEMENT Number Pages:t
Recorded 11/12/2014 at 11:00 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Permit No. RECORDING$10.00
Tax Folio No.171664-0000
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
LDescription of property(legal description): 10-11 16-2S-29E MANDALAY LOTS 10,11,12 BLK 60
a)Street(job)Address: 126 15TH STREET,ATLANTIC BEACH,FL 32233
2.General description of improvements: REMOVE AND REPLACE ROOF ON HOUSE AND FRONT OF GARAGE
3.Owner Information
a)Name and address: MAE THOMPSON JONES, 126 15TH STREET,ATLANTIC BEACH, FL 32233
b)Name and address of fee simple titleholder(if other than owner)
c)Interest in property FEE SIMPLE
4.Contractor Information
a)Name and address: BURGER ROOFING CO, 134-1 ERNEST ST, JACKSONVILLE, FL 32204
b)Telephone No.: 9 0 4 .3 5 5.2 7 5 6 Fax No.(Opt.) 9 0 4.3 5 8.0 7 3 3
5.Surety Information
t a)Name and address:
b)Amount of Bond:
6.Lender
c)Telephone No.: Fax No.(Opt.)
_
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
8.In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(Ixb),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date
is specified): 40.
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PINELLAS 1 Q
Signature of Oeror is Autho' Officer/Director/Partner/Manager
o (2 or 0 n e-s
Pnnt Name
The foregoing instrument was acknowledged before me this��day of �c1/e y+.�o/ ,20_1�_,by
�aGmns��— � as
(type of authority,e.g.officer,trustee,
attorney in fact)for (name of party on behalf of whom instrument was executed).
Personally Known�OR Produced Identification Notary SignatureC4:4 U ch
s,
Type of Identification Produced Name(print) ka 1 �g
OR �-
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
FORMS/N0C,rvsd2010 2�t 'Y PUe��c ALISHA D.DUGGER
* MY COMMISSION t FF 007054 Signature of Natural Person Sigcmg(in line# 10.)Above
EXPIRES;April 11,2017
r^JFOF FlOaw Bonded Thru Budget Notary Services i
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 126 15TH STREET Permit Number:
Legal Description 10-11 16-2S-29E MANDALAY LOTS 10,11,12 BLK 60 Parcel# 171864-0000
7,90000
Floor Area o q. t. Sq.Ft
.
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pooUspa 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#FL10674-1
For multiple products use product approval form
Describe in detail the type of work to be performed:REMOVE AND REPLACE ROOF ON HOUSE AND
FRONT OF GARAGE
Property Owner Information:
Name:MAE THOMPSON JONES Address:126 15TH STREET
City ATLANTIC BEACH State_Zip 32233 Phone (904)249-2644
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: BURGER ROOFING CO Qualifying Agent: GARY BURGER
Address: 134 ERNEST ST City JACKSONVILLE State FL Zip 32204
Office Phone 904-355-2756 Job Site/Contact Number 904-237-9664 Fax# 904-358-0733
State Certification/Registration# CCC032514
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[o 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 a!/work will be performed to meet the standards of al!laws regulating construction in this jurisdiction. This permit becomes nu!l
and void if work is not commenced within six(6)months,or tf construction or work is suspended or abandoned for a_penod of six(tiJ months at anytime after
work is commenced. 1 understand that separate permits must be secured for Electrical Work Plumbing,Signs, ells Pools Furnaces,Boilers Mit.,
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 hereby 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 o 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 otherfederal,state,or local law regulating construction or the performance of construction.
Signature of Owner )WZ,,p ( A J 0-/" lel 7 Signature of Contractor
0
Print Name.. ..._ QYk[ .�.f?..l'1......._s./b-12.L 5 Print Name e,,..................................
Sworn to and subscribed before me Sworn to and subscrib�
Efforeem
this" Day of A)s /r,,,,, 6A.L 20 I`{ this " Day of A c ls. 20 M
Notary Public Notary Public
Revised 01.26.10
MAN D.DUGGER
MY COMMISSION t FF 007054 �, ��r► AUSHA D.DUGGER
x EXPIRES:April 11,2017 MY COMMISSION I FF 007054
FOF Ide Bonded Thru Budget Notary Smices
EXPIRES:April 11,2017
Bended Thtu Budget Notary Services