68 Jackson 2015 Roof �i"�vj�f
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-743
Job Type: ROOF PERMIT
Description: REROOF
Estimated Value: $8,484.00
Issue Date: 3/30/2015
Expiration Date: 9/26/2015
PROPERTY ADDRESS:
Address: 68 JACKSON RD
RE Number: 172041-0010
PROPERTY OWNER:
Name: CHURCH OF THE LIVING GOD
Address: 68 JACKSON RD 68 JACKSON ROAD
GENERAL CONTRACTOR INFORMATION:
Name: QUALITY DISCOUNT ROOFING LLC
Address: 1794 ROGERO RD QA RICHARD BRIGGS
Phone:
FEES:
BUILDING PERMIT FEE $92.42
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments, $96.42
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIc BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 0,cKsov)
Permit Number:
Legal Description 5L9 L- Parcel# IIQDq I E)o I C)
.coo 151 )111 Sq.Ft
Valuation of Work$ Proposed Work heated/cooled .2-1 �)O non-heated/cooled :;X��
Class of Work(circle one): New Addition o Repair Move Demolition pool/spa window/door
(!AM1 t��erat it
Use of existing/proposed structure(�) (circle one): i�Eo�jmmercia Residential
If an existing structure,is a fire sprinkler system
Florida P�oduct Approval# 7z)R(P. Lf installed? (Cfir-cTe one): Yes No
For multiple products use product approval form —
Describe in detail the type of work to be performed:124WoV P"( kL t-t2k-Aml dle U 4p 0 Adle
e I LO
-'VI 0 */)r2- akh
Property Owner Information:
Name:ChL���bui-
Address:(.09 -jt-jcX1q0r1 i]!1!'11. 11�, each. C-4- 3ZZA;;
City LE rL
!,4-rc f3ee (:i:l StateP-Zip -9�0
E-Mail or Fax#(Optional) __phone 11014- -7 4- (113
Contractor Information:
Company Name: au&b4-Riselo(LA4 eo6-%
� LLP-, Qualifying Agent: D. 2,Ie
Address:aj(61 64, & uAnLCd- —city��ori ii Ile j State Zip 32.2 33
Office Phone 4764-314--S-boo
Job Site/Contact Number I Q-f 9'1 Fax#
State Certification/Registration (4Lqg
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Ad�dress
Bonding Company Name and Address
Mortgage Lender Name and Address
A a hereb ma�e b�a a e m do he work and n8ta'ations as indica or installation has commenced prior to the
p 'y h "to f thisjurisdiction. This permit becomes null
r
or_ do (,t
P' 0�_ e n�.,the gandar("'0
n o n � �'mo�t , or, ,'t ct, 0 o
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0' 0" r- r (Weefllsioko' "k ... ....
0
b
om"�' it
P'�i'c' ii�
"ice Prii,Must c r f
T ark"c'-' C d i dersta d that eprate be e I ed or Electric, �rnaces, oilers, Heaters,
"k,,,dAir on t,."r"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.
Ihere,lb certify that I have read and examined this a h ,
_pp ication and know the same to be true and correct. All provisions oflaws and ordinances governing this
work will be complied with whether s
1 pecifi-ed 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 loca aw regulating construction or the performance ofconstruction.
Signature of Owner Signature of Contractor
PrintName ......................................................................................................................................... Print Name 01, - 11c,
....... ...w () 14.k..........................................
Sworn to and subscribed before me Sworn to and subscribed before me V
this Day of 1A this -10 Day of dA a 4Ltj T
,20 IS
Notary Public
C
klotary-
SHEREE J.AMATO
N No .........
otary Public-State of Florida S�1EREE Jl�.AMATO Revised 0 1.26.10
M
MY Comm. Expires May 1,2015 NMary PLblic-state of Florida
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s ay 1 01
Commission#EE 89125 ',"Y Comm. Expires may 1,2015
#
Commission#EE 89125
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: &–"7 Permit Number:
Legal Description Floor Area of Sq.Ft. Parcel P Sq.Ft
Valuation of Work$ 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 structure(s) circle one): Commercial Residential
If an existing sfruciure,is a fire sprinMr system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:
Property Owner Information:
Name: Address:
city State—Zip Phone
E-Mail or Fax# (Optional
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax
State Certification/Registration
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication 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 thisjurisdiction. This permit becomes null
and void ff work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period ofsix 16)months at any time after
work is commenced I understand that separate permits must be securedfor Electrical—Work,Plunibing,Sikns, Wells,P6ols,Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,eta
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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Ihereb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
'ID
type o work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany otherfederal,state, or local law regulating construction or the peifi��mance of construction.
Signature of Owner Signature of Contractor
Print Name F:51�T, ihl�
Print Name
Befor Before me
this ay 4) ' 20/6 this Day of 20
No N a te F ida Notary Public
S irley L Gr a
.. in F 86990 Revised 01.26.10
M ommissi
or Ex Was 02/141
Doc # 2015063664, OR BK 17103 Page 1382, Number Pages: 1 , Recorded
03/20/2015 at 01 :09 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
NOTICE OF COACMXCEMENT
P R ERA�RE IN OW.LICAM:
0
permitNo. - .1�&,� Tax Folio No-
&ate of County of
To whom it rnay c*ncm,
The undersigned hereby,Informs you 2W by.qwavernants,w9l b
o.madeAd certain real prq*ftawin
accordance with Sect",713 of Me Florida StabOlas,the,Mowbvinforination is sta%d In this N*Tt=..cw
COMMENCEMEtM,
Legal descroon of propedy tong improved:
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Address o1property being Jmpraved- �VL
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OwnWs interest in sita of the 0-tproverrmit
Fee,Simpie Tik"',dw(IflOw than oswwr)
AddfM
Contractor Quality Discount LW,
Addtes,,3Q1 St.AuquOm Rd JacitsonvAWFL.32207
phone No, Felt No.8M-329-WQ2
Surety(if any)
Address
----Amount of bond.$,
phone No. . . .
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Address
Phuie No-
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0 is may.be served-,
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Address
phone 140. FaxNo.
In a4ftw to hirauff,a,�vner designates ft fbilkwingperson brooeft a copy ofthe Lienor's Notice as Provided in
Section 71&06 02)(b*-Florida Statutes-(Fift' in�at Owner's optlon)�
Name
AddrW
Phone No., Fax No
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Expiration daift of Notim of CAmvrowycernat,Me piration.date Is.aw-(1)year from the dste�of recording 1
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different date,Is srwncffied Y
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