355 PLAZA ROOF2015 CITY OF ATLANTIC BEACH
r, s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
r 13 �
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1020
Job Type: ROOF PERMIT
Description: REROOF FL 9792.1
Estimated Value: $6,000.00
Issue Date: 4/30/2015
Expiration Date: 10/27/2015
PROPERTY ADDRESS:
Address: 355 Plaza
RE Number: 170008-0000
PROPERTY OWNER:
Name: BLEDSOE JR, JAMES A
Address: 4653 EMPIRE AVE
GENERAL CONTRACTOR INFORMATION:
Name: NORTHEAST FLORIDA ROOFING INC
Address: 178 PINECREST CIR KYLE JAY KRISER
Phone: - -
FEES:
BUILDING PERMIT FEE $80.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $84.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904) 247-5845
Job Address: 3 rJ S Plaza 5`� Permit Number: 10-2,C)
Legal Description *4 fo 11 Qklj bd ;o ^� ^��`R�pa c
Lel# oo® _ ag
Floor Area of - Sq.Ff. Nq Ft
Valuation of Work$ 6 ooa!� Proposed Work heated/cooled lay non-heated/cooled
Class of Work(circle one): New Addition Alteratione�D Move Demolition pool/spa window/door
Use of existing/proposed structure(s) ((circle one): Commercial Residenti
If an existing structure,is afire sprinkler system installed? (Circle one : No N/A
Florida Product Approval# `�� a.
For multiple products use product approva orm
Describe in detail the type of work to be performed: ee saC-r -,kNle5 w2sAl"g fe 5
Property Owner Information:
Name:1-7,w e-S RIPAsae Address: SSS pkza S4
City Aafkj,-kc. FS,eac,k StateT:LZipPhone qo1-1-66`t-Bkoo
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: 1�. , Qooff n q T nC. Qualifying Agent: k%41c- kr se-
Address:_V71 ;�e cm-,-F Cr City Sa t khfco State FZ- Zip 117
Office Phone Job Site/Contact Number Fax#
State Certification/Registration# CCC I g� r- 7 fs?�e
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 ttbandoned for a_pertod of six 6)months at any time after
work is commenced. I understand that separate per
must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,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.
I hereby 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
type o1 work will be complied with whether speci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of arty other federal,state, or local law regulating construction or the perf�a' n'c`e of
_construction. /�
S10'— (�- ZS1- 0
Signature of Owner A-A_VkT Signature of Contractor
Or
Print Name ...... .,..........8........ Print NameI�.�E........ ' .5 .............................................._.....................
Before a . . KRISTINA x�+sEA 20 I
this Day of commission R EE 86,201 Befg e
a 17,2017 this+Day of r`-1
�??;p;;;s�•`� gondeBT�rnT Fainlmuonte
N ary Publicubl11
M�COMMISSION#FF 011480
EXPIRES:AP6124,2017
ftf Bonded Thai Notary Public Undewrlers evised 01.26.10
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 1 'f
State of County of �-..yul
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: Lot 26, Block 11 , Plat 1,
Subdivision "A" , Atlantic Beach, Duval County, F ori a
Address of property being improved: 355 Plaza St. , Atlantic Beach, Fla. 32233
General description of improvements: Roof work - frcnt house
ry
Owner James A. Bledsoe, Jr. , and Debra C. Bledsoe,his wife
Address 4653 Empire Avenue, Jacksonville, Florida
Owner's interest In site of the improvement Fee S imp 1 e
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor North~Florida Roofing
�f Address f-74', C_117e-Sf 61.[-• SC-,A W' CL
Phone No.3�t�-`l 37 , 5 j<t
Fax No.
Surety(if any) Not Applicable
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name Not Applicable
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
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
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 OWNER
Signed: R DATE �V-?
Before meWs day of In the
County of Duval,State of Flod has personalty gippe d
.?'A.►� �5 14 %- Lbs v✓ STT\ herein by
himself/herself and affirms that all statements and declarations herein
Doc#2015097741,OR SK 17149 Page 109, are true and accurate
Number Pages:1 os"AY'�8�, VICKIE S.BARNES
Recorded 04/29/2015 at 03:41 PM, � ' o
* * MY COMMISSION#EE 220079
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY � � EXPIRES:August 7,2016
� `" "
RECORDING$10.00 Notary Public at Large,State of CobhPI br 'i edgetNotary Services
My commission expires:
rsona or
uce dentlfleation