161 MAGNOLIA ST - ROOF , 01--1-11-trie
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CITY OF ATLANTIC BEACH
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;-. mi, sl 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247-5814
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ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1615
Job Type: ROOF PERMIT
Description: reroof fl 1956.1
Estimated Value: $5,220.00
Issue Date: 7/7/2015
Expiration Date: 1/3/2016
PROPERTY ADDRESS:
Address: 161 MAGNOLIA ST
RE Number: 170625-0510
PROPERTY OWNER:
Name: FOSTER, WILLIAM C
Address: 1862 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: SHORE ROOFING COMPANY
Address: 914 7TH AVENUE S QA THOMAS LOUIS SHORE
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
BUILDING PERMIT FEE $76.10
STATE DBPR SURCHARGE $2.00
Total Payments: $80.10
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: /C f //1!5 it/a/t0 5
Permit Number:
Legal Description O- 6 6-off .S4/t,fi'r StL 3 pf�a
Parcel# 764;16
Valuation of Work$ oor A ea o q. t. t
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®(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# ifrc.Z
For multiple products use product approval -
Describe in detail the type of work to be performed: Pc Poc-
Property Owner Information:
Name: Dew r ru s f-ci Address: (,
City M ,,L t�rti� 1 Sl /'j Co /I rh UP'.
► " StatqaZip,72�GC Phone a v - ys-v
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: _Sl�o r- (200 F (��, Qualifying Agent: '� 4.5"40/
Address: 30 vt lly. vtr4,a Z-) _ ! meat e / (
Office Phone 96c/s.yl -fill 2- Job Site/Contact Number i��� - 4 �'� State �=( lip 3Lo t�Y
State Certification/Registration# CC,C Gcyq i f a�6-.2 9 SS Fax#
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 cert5 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 zf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for apperiod ofsix_(6)months at any time after
work is commenced I understand that separate permits must be secured for Electrical'York,Plumbing,Signs, Wells,Pools,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 FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certity that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordina
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to vi, to or cane: this
provisions of any other federal, .tate, or local law regulating construction or the performance ofconstruction.
.it i o
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Signature of Owner Z,..��� `���% Signature of Contractor - s o
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?rint Name pi y re) �',"'.. v C — — // o
Print Name -7-n'►I¢S cAd✓C— c m °a
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U *e-5 7 a J) - 6 ,.? lb Revised 01.2
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No. 170C� -d. 0
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property
(legal description of property nd address if available):
JO -16 l r -a5 -ot cm- +w riz s e t 61 fn S N� , st- +4yAG 6„L 4 F(3
2. General laescriptisof improvements:
3. Owner Information: w lll/Yh Cr 2 Ne/Ati�-/;,<G I-1 3 Z2(o‘
• a)Name and Address: Pt t y Fbs•c✓ 6/6 'L
b)Interest in property:
c)Name and address of simple titleholder(if other than owner):
Contractor Information: D lie 1I1 vU �� CO-.05�,S f, % 3,20T11
A
a)Name and Address: _j)o(C. i2vo r-v`l 041/ a3 Ur
'' b)Phone Number: 9,a`-( aZ Li
15. Surety Information: Doc#2015154385,OR BK 17224 Page 1259,
Number Pages:1
a)Name and Address: Recorded 07/0712015 at 11:02 AM,
b)Phone Number: Ronnie Fussell CLERK CIRCUIT COURT DUVAL
c) Amount of Bond: $ COUNTY
RECORDING$10.00
6. Lender Information:
i a)Name and Address:
b) Phone Number:
'1. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates
of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1) (b),Florida Statutes.
a)Name and Address: - —.
b) Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1) year from the date of recording unless a different date is
specified:
{ WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1,
SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
a IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPE BEFORE COMMENCING WORK OR RECORDING
CONSULT WITH YOUR LENDER OR AN ATTORNEY
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief.
k Pew/5 [ .,'o r-
Si: a ure of 0 re o i�iwner's Authorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me this / day of
l7-6 1, ,20 ,?S
by j) l v1� l f vs r ell as for
(Name of PersoM (Type of Authority,i.e.Officer/Attorney) (Name of Party Instrument was Executed for)
ai 0
- - - - - - - - _ _ TARP PUBLIC, ST p� LDAs/�/)�,
�"µ"'`,t; PAMELA JEAN SHORE Print Name: fit //1/
�a�
Notary Public•State of Florida ■
I ,y Se T= My Comm.Expires Dec 4,2017 ■
1 ?t, ;, ' Commission x FF 074537 1 ❑Personally Known
CI Identification'Type: o
(Affix Notary Seal Above)
Revised 3/15/1