73 W 10TH ST 2015 ROOF \�s `i� CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r�JJ,1 9r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-169
Job Type: ROOF PERMIT
Description: fl 1956
Estimated Value: $4,500.00
Issue Date: 1/23/2015
Expiration Date: 7/22/2015
PROPERTY ADDRESS:
Address: 73 W 10TH ST
RE Number: 170811-0003
PROPERTY OWNER:
Name: SALTER, DONALD B ET AL
Address: 1957 IBIS POINT LN
GENERAL CONTRACTOR INFORMATION:
Name: EMPIRE ROOFING SALES & SERVICE
Address: 2806 -1 GI GIBSON RD QA PEDRO R NUNEZ
Phone: - -
FEES:
BUILDING PERMIT FEE $72.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $76.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904)247-5845
Job Address: 73 lot* 54 W Permit Number:
Legal Description — Parcel#
A Floor Area o q. t. Sq.Et
Valuation of Work$ tl r6l`0 Proposed Work heated/cooled non-heated/cooledr
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osedstructure(s)(circle one):iCommercial Residential
i
If an existing structure, s a fire sprinkler system nstalled? (Circle one): Yes No N/A
Florida Product Approval# l /ksb
For multiple products use product approval form
Describe in detail the type of work to be performed: Tear &ff d/d f CIA-VA alr�k• /�e,A/iK gra rly ,
K A
Property Owner Information:
rh
Name: &rnck LA/ a t ff Address: 7
City �(�>°� State fl Zip Phone 3`J`1 - 6 61 9'
E-Mail or Fax#(Optional) —
Contractor Information: CONT,RACTOR,ENSAIL ADDRESS:
Company Name: ''mn f,* Roo FAA Qualifying Agent: loedro IVUNi
Address: A906-1 ad City J Z/tsovv,'lle- State P/—Zip 3Wo 7
Office Phone Job Site/Contact Number /Ki/m DW7 Fax# 34/-/8/7
State Certification/Registration# GCC 1;124r007 —
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
:,Md
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
n:nd void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of sixA)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urn aces,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.
1 hereb certify that 1 have read and examined irds plication and know the same to be true and correct. All provisions s and ordinances governing this
type o work will be complied with whether sppeci:ed her
or not. The granting of a permit does not presume t giv authority to violate or cancel the
provisions of arty other federal,state, or local
re
regulating construction or the performance of construction.
Signature of Owner Signature of C or
y Print Name 1 cdv `� �- Z
PrintName ....:t........z.}' .1.. ................................. .............................................................................
Be ZBefo e ane
thDay of Pthis ?1 =o �otar o
;i°, %= any Pu c, I Florida ° c $� of
Notary P bl c "- •oma-` s Feb 201
Notary Pu Q,F��oP Com sion' � FF 086334
Commission 4< FF 086334 '���" Bonded Thr
"'° Bonded Through National Notary Assn. h Natio �s�
a " t
NOTICE OF CbMIKENCEMENT
(PREPARE INZ)UPLItATE)
Permit No. Tax Folio'No.
State of County of
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 73 le 5'/% i tw
/�'HanbL Jj2rg h �1..
Address of property being improved: 73 n
n/� n
General description of improvements: `I("
Owner Oer!'it z, IA,,iuo rl C t
Address )� e'G " 5�. W &b. 110'17G l3egL.,6 1i F1 ,
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor IFmiza- /C oWj.zlr
1" 1 Address'/ 6- bi•Qh2 61. Jody OA/yil f/
e-Ej 3,W)7
Phone No. 3�� /OO 7 Fax No. 7 7
Surety(if any)
Address Amount of bond$
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 i
Section 713.06(2)(b), Florida Statutes.(Fill in at Owner's option). oN Q Q
Name e
Address o w
Phone No. Fax No. ¢ �,
y 'O
Z
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unies a UX y ,
different date is specified): Wa.
E 'E
o E
THIS SPACE FOR RECORDER'S USE ONLY ` tOWNERSigv
Befned: of DATEin
O,'
Countyof u State of fFor' pers � ra •"'• bo
Doc#20150160667,OR BK i 7043 Page 526, Y ter—herein b
himself/herself and affirms that all statements Aqckdarations herein S1 • o`:
Number Pages:1 are true and accurate %oti"• ��:
Recorded 01%23/2015 at 12:01 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY X-14
RECORDING$10.00
Notary Pu a rg ,State
mmission of ounty of
My coaxI os:
Personally Known or
Produced identification