ROOF 1753 E PARK TER \Js V, , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ;r 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-572
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $4,165.00
Issue Date: 3/18/2015
Expiration Date: 9/14/2015
PROPERTY ADDRESS:
Address: 1753 E PARK TER
RE Number: 172020-0410
PROPERTY OWNER:
Name: HEFLIN, MICHAEL
Address: 1753 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD QA HAROLD KERTIS VOSS
Phone: - -
FEES:
BUILDING PERMIT FEE $70.83
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $74.83
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MAR-12-2015 15:31 JACK WILSON ROOFING 9043967700 P.01
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Job Address: ' '( VU Permit Number:
Legal Description fit .. � ,' Parcel#
Hoor Area oofFqTt. Sq.Ft
Valuation of Work Proposed Work heated/cooled non-heated/cooled
Mass of Work(circle one): (!e Addition Alteration Repair Move Demolition poollspa window/door
Jse of existing/proposed structure(s)(circle one):_ Commercial esidenti
[fan existing structure,is afire sprinkler system installed? (Circle one): s No N/A
Iorida Product Approval# 3 . 0� '-
Zor multiple products use product approveform
r
)escribe in detail the type of work to be performed:
'roperty Owner Information:
lame: tr 1. Address: �-
'ity State Zip L_,1 Phone v0) .
's-Mail or Fax#(Optional)
.ontractor Information:
r Ma
'ompany Name: . V�l� +n _ Quay g Agent: Mac\ �'Ss
,ddress: ity State "I ,—, Zip
Uiice Phone J b Site/Contact Number - Fax# _ b - -1-A b
tate Certification/Registration#
xchitect Name&Phone#
ngineer's Name&Phone#
ee Simple Title Holder Name and Address
onding Company Name and Address
tortgage Lender Name and Address
P
is hereby made to obtain a permit to do the work and installations as indicated 1 certify that no work or installation has commenced prior to the
ruonce 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
td void f work is not commenced within six(6)months, or if construction or work is sus dor abandoned for a�ppeenod of six l6)months at anytime after
irk is commenced 1 understand that separate permits must be secured for El�Plumbing,Slg►rs, Wtlls,Pools,t+urnaces,Boilers,Heaters,
rnks and Air Conditioners,etG
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
CONIldENCENIENT MAY RESULT IN YOUR PAYING TWICEFOR IMP VEMENTS
T YOU INTEND TO OBT T WITH
L� OY BEFORE ATTRNEn
T E OF
Notary Public.State m rt t CONP4ENCEW .= My Comm.Expires Dec 3.2017
A My Comm.Expires Dec 3.2017 � aa Commission*FF 044467
. ton FF 044457 dFr�
;ere j plication and know the same to be true AIDPOOtFlfslN►N slf&4I�Woo'Minances governing this
Ibe d herein or not. The granting of a tfly to violate or cancel the
�e w
ovi e,or oc aw regulating construction or the performance of construction.
gnature of Owner Signature of Contractor
cC
int Name Print Name ........................... .......
_ ........ _.. ._.... _ ._... __..__._� ....._.-.__....
vorq to and subscribe efo me Sworn and subscribed before me
:s Day of 20 this Day of h 20
Mary Public N - otaryPu lic
Revised 01.26.10
MAR-12-2015 15:32 JACK WILSON ROOFING _ 9043967700 F.02
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. ? ��; N-'
State of `r .ti 1- County of cATo whom R 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.
1 lit f..ti• � ti
Legal description of property being improved: `f
Address of property being improved: � Z.-
General description of improvements: `� i ( i k" �:+�t �� V" i•k
Owner
Address l ,1� n
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name JACK
Adtlress WILSON RO r!NG
Contractor 4522 St UguStine Pd,
Address
onvi a, 2201
(900 39b-1546
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the constriction 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 w U IS
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's option). y $
0
Name
L o c
Address O
Phone No. Fax No, ec a E E
U T EO C {<
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a z 1
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY __ - OWNER,
DATE
9
E3araden@ thls day or_ _in ow �Sy
County 01 Duval, of g rich. ly appeared p„qN
r,- 11 iu: tioreinby
himm"i herself and affirms that ail=mrr erns and eciarat:ons herein
are true and etcurote
Notary Pubik at Sts a Or l COtX1tY of ►.:�'t .
my commission @ res:
Personalty Knavn
Produced Ider0ka&M
MAR-18-2015 11 :37 JACK WILSON ROOFING Hi-
- db 9043967700 P.01/01
(PREPARE IN DLIPUCATE)
Permit No.
State of Tax Folio No.
County of t �
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain realproprty,and
accordance with Section 713 of the Florida Statutes,the following Information Is stated in this NOTICEIOF
COMMENCEMENT.
Legal description or property being improved:
Address of property being improved:
General description of improvements: '
Owner 4
Address >
Owner's interest in site of the improvement t ~�
Fee Simple Titleholder(if other than owner)
Name
Address 11
Contractor Ug"tIR6 ;?d•
Address sonYl er 2251
Phone No, Fax No.
Surety(if any)
Address
Phone No. Amount of bond$
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 foilowi ,•
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's opgon�Ve a COPY of the Lienors Notice as provided in "
Name H
> $
Address W '" a '_
Phone No. o % o
Fax No.
0. E
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a h `
different date is specified): " A v o
THIS SPACE FOR RECOROER'S USE ONLY OWNER, z
Sig
eoror6me this day pf DATE
Doc f 201500 38,OR SK 17099 Pae 1525. minty of Duval,
gt!of fa.twR paegonarty appeared §+.;
Number Pages: t ..m` r 1 _ \1k�- l 11 herein by
hi+nseltr herself and aMr s that ay statemerus am aclarations herein
Recorded 03,17.2015 at:i2'.f6 PM, J are true and accurate
Ronnie Fusseii CLERK!—';RCUIT COURT DUVAL
COUNTY
REC:,RDING$40.30
Notary PUNIC at stab of County of ,.7,-T,
My commissions
Personalty Known �—
Produced tdennecation or