143 S OCEANWALK DR - ROOF PERMIT j \Jv1
'� � CITY OF ATLANTIC BEACH
,, 800 SEMINOLE ROAD
- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
��J131l?
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1947
Job Type: ROOF PERMIT
Description: REROOF FL 1956.3
Estimated Value: $18.380.00
Issue Date: 8/24/2015
E piration Date: 2/20/2016
PROPERTY ADDRESS:
Address: 143 S OCEANWALK DR
RE Number: 169463-0182
PROPERTY OWNER:
Name: GILMORE JR. JAMES H
Address: 143 S OCEANWALK DR
GENERAL CONTRACTOR INFORMATION:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD QA HAROLD KERTIS VOSS
Phone: - -
FEES:
BUILDING PERMIT FEE $141.90
STATE DCA SURCHARGE $2.13
STATE DBPR SURCHARGE $2.13
Total Payments: $146.16
i
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
I
1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: � n«.nv ) � l�Q., • oh; J-3 Permit Number:
Legal Description-1 b%-AS"00" 'c. uI-�S- `C, Parcel# N:)C . �b?) . U1��,
w Floor Area of Sq.Ft. Sq. 't
Valuation of Work$ S �d Proposed Work heated/cooled non-heated/cooled
it.
Class of Work(circle one): 40100 Addition Alteration Repair Move—_DDnolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Retsislcntial%
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval # 1`ic- � 3 — IS LCO.` — 0 l lob, - - 1`i
For multiple products use product approval form ( w ,
Describe in detail the type of work to be performed: Pe1.t(L t M Luc Cf 1,J( 4U CI" p�
Property Owner Info��on: v
Name: 1 '14 S G,, hope Address: \i-k) CC 11Wtl's'VK , Q.- '
City StataZip - 'J Phone CI - L,31 - j A a
E-Mail or Fax#(Optional)
Contractor Information: ` ( e
Company Name: ►,�,v. .C. _____..1--i-
: . . 1 - Qualifyi g it ent: G\ �a-E �'$i�SJ
Address: t•__ _ ��aM 'k��� City State C V` Zip._s__ _:1_.
Office Phone' a 111214 , Job Site/Contact Number ��I— 514.1 Fax# �(}1, 54(, 1-la:)
State Certification/Registration# • " p 35f
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 if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(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,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 rea' and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied ith whet t r specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal tate,or l tl law regulating construction or the performance of construction.
/
Signature of Own / Signature of Contractor /47,,
Print Name 1/AO l.` ,6L _ ,at • ,f......,r�........... ...._... 1._...�c1 � __ Print Name V Q
Swo to and subscribed before me Sworn to and subscribed •-fore • e
this Day of 'r this H Day of .' ~ , 20(5
V%,,,,, CHRISTOPHER VOSS
�� �`�} Notary Public State of Florida I �,,,,.4',:s;
� ', ,S,. CHRISTOPHER VOSS
Notary Public i• • = My Comm.Expires Dec 3,2017 � Notary Public :�° Notary Public•State of Florida
.12 ��; °;` Commission#FF 044467 ,.�
+ � -• 5 M Corn x i e Q 3 2017
�'%FO;,;;d`'' Bonded Through National Notary Assn. "; ��� �fc Rein 4A44f 4. 0
A — — --■ — 4 ••,;"<f,, Bonded Through National Notary Assn.
NOTIC7 OF COMMENCEMENT
(PREPARE IN DUPLICATE) 11 �
Permit No. Tax Folio No. • `I�0) �'l"
State of •`,;.Q..t A,) J County of l �j.-,t
To whom It may concern:
•
The undersigned hereby informs y u that improvements will be made to certain real property,and In
accordance with Section 713 of the Flo da Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT. 1 �
Legal description of property being impro \Li D. - (N 1� —c) \
�� -�"t ..__Ci , 4
( L1 UCC�r.,v`1w 4\ 11 .*- ("):1_ rJ
Address of property being improved: 1 1 �( -�.(\W 4K J
MI ter VN -Vii.- `- - '53
General description of improvements: ( rf C
Owner t(Ult� C t- .rk:►2k
. u
Address �``t_� L Ce �-h WYt� v� • Mk (3,._k_A"�_-�?4=-33 •
Owner's interest in site of the improvemen `c,C-')f)
Fee Simple Titleholder(if other than owne )
Name JACK C.WILSO ROOFING
Address 4522 St Aug Stine Rd.,
Contractor Jacksonville, FL 32207 .
Address (904)39: 1546
Phone No. . Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
—"I.Phone No.
Fax No.
—g-1:- -1— 1S•
Name of person within the State of Florida.other than himself,designated by owner upon whom notices or other 1 S i
documents may be served:
Name =
Address o 3 W
Phone No. 'Fax No. U r
. �
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.(Fi I in at Owner's option). ..
Name F
Address i��
Phone No. Fax No. '�•.,�. �
Expiration date of Notice of Commencement(the expiration da is on (1) ar from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY f Ar OWNER j `
lVl )
. . BBefore meths Iilli• day.. ►'K_ 'i!.D1. E the
• County of• of Florida.ryas • • eppeareo
,I Ili 'Ow 4kw�^ herein by
hirnsalfi herself and affirms that all statements and aliens herein
are MA and accurate
Doc#2015190046,OR BK 17273 Page 863,
Number Pages: 1
Recorded 08;18,2015 at 03:33 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL "�Public at COUNTY n. .,/.
RECORDING$10.00 `�cormiissionex itss:_ i CO1f1ryOf-6�aL�
Personalty Known I Produced identltka on i� or
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