2119 s faorway villas 2015 roof 'S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 15-ROOF-379
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $6,700.00
Issue Date: 2/20/2015
Expiration Date: 8/19/2015
PROPERTY ADDRESS:
Address: 2119 S FAIRWAY VILLAS LN
RE Number: 169398-1040
PROPERTY OWNER:
Name: DONDINA, SEVERINE
Address: 2119 S FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone• - -
FEES:
BUILDING PERMIT FEE $83.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $87.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i
NOTICE OF COMMENCEMENT
;PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:-aL PGV v a�0.s LQ
Address of property being improved: 9 raZ('w V71 as fin, S C, 5Z�3
3
General description of improvements: re-roof
Owner 5�=Herr w a ,964 e#1-q
Address _ — t S vr?
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
(� Contractor Ron Russell Roofing Inc
\ ) Address 4419 Hudnall Rd.Jacksonville,FL 32207
�( Phone No.904-714-1907 Fax No. 904-636-9909
Surety(if any)N/A
Address
Amount of bond$
Phone No, Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 N/A
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 N/A
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 ) DOWNER 9
Signed: DATE v� r J. I Z o)5 \J
Before' this day of iF 2O 1 S in the
Count of Der�al.State of Florida has pe 11 appeared
fS���t��v►t. II
Doc#2015040036,OR BK 17072 Page 1751, himself,herself and affirms that all statements and declarations herhet�n ln by
Number Pages: 1 are true and accurate
Recorded 02/20/2015 at 12:31 PM, TERRANCE SANTILLI
Ronnie Fussell CLERK CIRCUIT COURT DUVAL OTARYPUBLIC
COUNTY STATE OF FLORIDA
RECORDING$10.00 Nota blicatLarge,Stateof - County ON
m#FF016455
My commission expires_ � pires 532017
Personally Known or
Produced Ider+tification_ L
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 2 1 I Q Permit Number:
Legal Description F-a- fwu.�i U;, u 5 L0+ Z o Parcel#
n0__0__r_TFeao Sq.Ft. —SqTt
Valuation of Work$ Cc,_70y•o`' Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one)
New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed stru s)(circle one):. Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): es N/A
Florida Product Approval# l C>%Z_ ,1 b
For multiple products use product approval form
Describe in detail the type of work to be performed: �2_ - 1`0 of I ani n►t TQ, Shl r- QOlc_S
`441 2 A +c 2 7 le: 3
Property Owner Information:
Name: ��f� CJS Address: 2� I �.n
City State PUip U2, Phone d y
E-Mail or Fax#(Optional)
Contractor Information: ( i
Company Name: U S \k Y W\L Qualifying Agent:
Address: GM City _1C C`Y_SQ'1V 11 Lk State�_Zip 3 9.QU"1
Office Phone (5 - G 01 Job Site/Contact Number Fax#f10y)U_;U -G909
State Certification/Registration# C C C 13 q_ t- 2'
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 a period of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, rurnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc-
WARNING
tcWARNING 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 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 of work will be complied with whether specs ied 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 _j� Signature of Contractor
Print Name _...._._....................._Swv2<<n�...._ �.ti ._'...` ....._.......... Print Name ...................P� 5. .-1—................................_
Sworn to and subsr,,dbed before me Sworn to and subsc ' ed ANTILLI
this Fr�Day of G!!ll►�' TE �C�RIS this lat" Day o 20/5
STATF oF 9A 2z
NOTARY PUSUC _ TE GF FLCRIDA
No Pub CComm#FF01o,,,,; NotafyPubic 144jRW, Expires 5/8/2017
Expires 5/8/2017 Revised 01.26.10