680 PALM AVE - ROOF PERMIT l' �r,
i
' �tijl� CITY OF ATLANTIC BEACH
�, - 800 SEMINOLE ROAD
j t ��r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�OJai r,f.
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1943
Job Type: ROOF PERMIT
Description: RE ROOF - GAF SHINGLES
Estimated Value: $5,000.00
Issue Date: 8/14/2015
Expiration Date: 2/10/2016
PROPERTY ADDRESS:
Address: 680 PALM AVE
RE Number: 170432-0000
PROPERTY OWNER:
Name: GILPIN JR, SAMUEL A & JANICE M. *
Address: 680 PALM AVE
GENERAL CONTRACTOR INFORMATION:
Name: AAA ROOFMASTERS INC
Address: 5991 CHESTER AVE APT 110 DAVID MATTHEW IRVIN
Phone: - -
FEES:
BUILDING PERMIT FEE $75.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $79.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 ( --R 00 r 3
i 9 4
Job Address: (42' 0 0.1 in A ven v Permit Number:
•cri tion —ZS' LJ &C� Fa-1-1-fk I f Parcel# 4 32 - 00 0 0
Legal Des p F oor Area of Ft. 'q.rt
Valuation of Work$ 5'00 0 Proposed Work heated/cooled 2J. _ non-heated/cooled_
Class of Work(circle one): New Addition Itei:atic_4 Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial
Han existing structure,is a ti A r u��y tcin installed?( cle o ): , es No N i Sl.l 7
Florida Product Approval# ` �)
For multiple products use product approva orm D_ 11fat //f j t
Desc ' e in detail the type of work to be performed: -ReC.ari W/ W7 F " ' '/f19 le•J
1
Property Owner Information:
Name: .)u rit.dt \ O' ii,n Address: ten P2,1',' kvc
City State f-.Zip 'Vitt 3 Phone S-`t 601 -4 i Si
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 4d A 4o/'cif) in c Qualifying Agent: �j
Address: 5991 clle.)J••v nut City 7`' State L (. Zip 521/7 I�0!
Office Phone 7 I -76C) Job Site/Contact Number Fax# • ' ' 5
State Certification/Registration# 1.17,1631/ NA
Architect Name&Phone# r
Engineer's Name&Phone# i 4 oN,
Fee Simple Title Holder Name and Address r d
Bonding Company Name and Address J I _
Mortgage Lender Name and Address �� I tr
Application 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 \
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 if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. l understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,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.
1 hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give a rity to violate or cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner / 0 ` Signature of Co ractor
Print Name _...%/ . ._. .. _. :/.._p..........._._..._..._.__._._.._..... Print Name �./.. .......... ......_/1. ................................_......_..._
Sworn to and subscri. • ••fore - Sworn : and subsc' • befo - me
this Day of Ca". .201S this Nay of ...,L,LA 20
I
C &4— !� / Mt."'
Notary Public / `ot. 'i•tc '�"
y MY COMMISSION#EE828014
RITA R DYSON '';. i:l(PIRE3 August 98,tot
,�r s
PAY COMMISSION#EE82801d toT►:teo.otss Flamm.. .,,.w
:*.e.: ce.com
EXPIRES Auger 19,2016
• ^ ,..'tom FAN., . •..coin
t • 398-0
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No
State of ri County of G, a_
(Vj f't\ 'p`-)r To whom It may concern:
O`a-N;onS I"'r ` * The undersigned hereby Informs you that Improvements will be made to certain real prorty,and
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE In
COMMENCEMENT. //,,,, r- ' I
• Legal description of property being improved: / Io—ZS ' bib e C 7 .c i-i Gl i r
4 Address of property being Improved: Gig.0 ife/zt) Qv-4— , /h 1rc c 7-1-1.Z (r
TaA•
*- General description of Improvements: (idea f i+ I eX +
may. { _+ +
T Owner 1a Mr1'f f tin, Alt'4a `,/e}n /5 .1- 6
' Address /. • ,• G(.^e— CLT1CN , ''- ac,\7-1
LwS Fbr`0(C
Shingles?
Single Family I TownHome/Trailer
►ame- Amount? $
(-1/i9( Addrius H/0 phone number
Contractor AAA Roofmasters Inc
s-/,4100. . Address 5991 Chester Ave Suite 110 Jacksonville Florida 32217
Phone No.9047137683
Fax N0.8886329007
/ Surety(if any)
Address
•
Amount of bond$
)U/, Phone No. 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 following person to receive a copy of the Lienor's Notice as provided In
Section 713.06(2)(b),•Florlda 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
!Pi 4
Doc#2015187766,OR BK 17270 Page 458, co • this i Al l t F /� ���' I "'y .— S
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Number Pages: 1 n himself/heriaH and affirms that all sta mania and declarations herein herein by
Recorded 08/14/2015 at 01:39 PM, era true and accurate
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00 �' fA-y/y►p.,4
arm Public at expires:
Stst{pf U�/i` County of •
-1-'
My commission axplras: {{t///
Panonally Known / \'
Prodtxad Idantlricetiorl/ ]),.,- „r, ,
40' •
,;a. ° RITA R DYSON
��/� •'e MY COMMISSION#EE828014
. � � SXPIRES August 19,2016
r"r`r t (407)398-j 53 Flcrdallotaryeeerlee.com
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