28 FORRESTAL CIR ROOF Will 1
?;; CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
'c Opl�r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1337
Job Type: ROOF PERMIT
Description: FL 1046.R2
Estimated Value: $9,000.00
Issue Date: 6/8/2015
Expiration Date: 12/5/2015
PROPERTY ADDRESS:
Address: 28 FORRESTAL CIR
RE Number: 171759-0000
PROPERTY OWNER:
Name: SHUDA, MARY E
Address: 28 FORRESTAL CIR
GENERAL CONTRACTOR INFORMATION: .
Name: DIBBLE ROOFING COMPANY
Address: 3518 MORROW ST QA JOHN R. DIBBLE
Phone: -
FEES:
BUILDING PERMIT FEE $95.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $99.00
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
('+IWfPS Office(904)2147-5826 Fax(904)247-5845
Job Address: aP
A CAY-O.IP NQVr Permit Number:
Hgq,,nnt�Co1' 9 LlV�
Legal Description 30- 510 �R-a5�`) rAt}I I K aLIPn
Parcel#
—F oor of q. t. �"
Valuation of Work S 9610,aO Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration &;t Move Demolition pool/spa window/door
Use of eaisting/proposedstruMure(s)((aide one): Commercial sial
If an existing structure,is a fire sprlaWer sya em installed?(Circle one): es No
Florida Product Approval# I
For multiple products use pro uct app—m--val torm
Describe in detail the type of work to be perforated: e4
Prooerty Owner Information: /� "'
Name: Address: 900 ° S�Ir uk Klor (/l
City State Zip Phone Ryl 1 LaU'1
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualif ng ggent:
lyP
Address: �`;I IY'Vf)f.tom � Ci Qf IC
)V"—State— L I
Office Phone 4-I - BR 35 lob Site/Contact Number Fax#.-133- as SS
State Cenification/Registretion# GCE- 0S-P/4 9
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. l certify that no work or installation has commenced prior to the
issuance ofapermit and that all work will hope arnced to meet the standards ofall laws regulating construction in this-howdiction. Thispermitbecomeanall
and void f work is nm commenced within six(6Imonths,or ijcomhuctian ar work is suspended or ahandoned jos a period ofsix/6)momhs at any time amor
work is commenced I understand that separate permits must be secured jor Eledrl Work,Plumblog,Signs, Wdhr Pools, FLmueq Rollers,Heaters,
Tanks andAlr Connsdommi,de.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPBRTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDE4 OR AN ATTORNEY BEFORE RECORDING YO'OR NOTICE OF
COMMENCEMENT.
/hereby certjy Iha[Ihave read and esamirwd this applicationandkno thesametobetreeandcorrecl. A//provisioru oflaws and ordinances governing this
type q work will be complied with whether speci. id herein or not. The gmsaft of a permit does not presume to give authority to violate w cancel the
provisions ofany otherfederal,state,w localnl in regulating construction w the pedormanre ofcomaruction.
Signature of Owner I' %' Signature of Contractor
Print NameMari Shu a Print Name
....._........
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wo to yyrsn subscribed f more Swo?�to and subscribed before me
lDa of end 201 this k! ply of 'fi®mt• .2015
bkc ? 6? Notary Public-State of Florida ES
E•: : My Comm.Expires May 26,207' t`�:� ����_�.f� My COMMIS ON#PPoaaTo Revised01.26.10
W Commission#EE 9]646 `p EXPIRES Polar 18.2018
Bonded Through National Notary Assn
Part yaa,a] FbriaaNd Servimmm
r NOTICE OF COMMENCEMENT
State of 7� I Ly-, A C,i Tax Folio No.
County of -DL,-Va
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: ', 55 io 3^,Z 9q E J1-HnvtkC �PQC� Vi 11Q
uni+ i lo+ q 1.3tx d
Address ofproperty being improved: DR �.Y,lox-re6bf l IYY11P kl(�1 Gdanko,�r)In
General description of improvements: Rip Y f JLT
Owner:m/h Yt A —sy),vin, Address: r
Owner's interest in site of the improvement: 2e Yfce
Fee Simple Titleholder(if other than owner):
Name 1
Contractor. 1 V ik le_ 1(1Q bIYY l 1
Address: -�I,Sq� R n-cKrob)
/o Telephone No.: Fax No: —7 3'�— DD Igs-
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the imp------
Name: Doc#2015129821,OR BK 17191 Page 2453,
Number Pagas:1
Address: Recomed O&O812015 x111:24 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Phone No: Fax No: COUNTY
RECORDING$1000
Name of person within the State of Florida,other than himself, designated bl
served: Name:
Address:
Telephone No: Fax No:
in addition to himself, owner designates the following person On receive a copy of the Lienor's Notice as provided in Section
713.06(2x6),Florida Statues. (Fill in m Owner's option)
Name
Address:
Telephone No: Frac No:
" ALBERT MORENO
Expiration date of Notice of Commencement(the expiration date is one(])year from the da " raNgsr�matifRmabrhMda
specified): ,.`'My Comm.Expires May 26,201E
`;?£ Cmnmission a EE 97846
THIS SPACE FOR RECORDER'S USE ONLY OWNER ' Bonded Through Nafenal Pelery Assn.
Signed: Date: J
Bctmena,tlis F I11 day of ' in the Cc of Duval,State _
Of Floridahwpmonallyappeared ✓nAax pPENou
Notary Public at Large,State of FI ride. 7ountyof D .;�.:
My commission expires: !9$ '� x+1 14 Notary Public-Slate of Red,
Pall Known: I U.7k1' y Pnea MaY 28,
Pr6Qaced)demi FY.U1'.. TJL. IN=X e wt al ouryA
'C��,\IYaJQ1�IL ,I�Q ,$7,1I^�aepN'ihmu011'Nelional llolarY A'
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