318 8TH ST ROOF 2015 rL`I
` , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2286
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $7,175.00
Issue Date: 9/29/2015
Expiration Date: 3/27/2016
PROPERTY ADDRESS:
Address: 318 8TH ST A
RE Number: 169920-0000
PROPERTY OWNER:
Name: ROTH JR ET AL, CHARLES B
Address: 66 S ROSCOE BLVD 66 ROSCOE BLVD S
GENERAL CONTRACTOR INFORMATION:
Name: J & M ROOFING SERVICES INC
Address: 2021 ART MUSEUM DR STE 115 MICHAEL ANTHONY
LOEHLER
Phone: - -
FEES:
BUILDING PERMIT FEE $85.88
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $89.88
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
03UILDING PERMIT APPLICAJN
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845 ROO F
Job Address: Vis F)Paa', -Permit Number:
a kycq
Legal Description lQ ( 5 ' Serer Parcel#
oor ea o q. t. q. t
Valuation of Work$_10I75 •aD 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(s)(circle one):. Commercial esidenti
If an existing structure,is a fire sprinkler system instaped? (Circle one): es N /A
Florida Product Approval# 5r L 101:ky 7 R g (= L
For multiple products use product approval form
Describe in detail the type of work to be performed:
Property Owner Information:
Name: May 1A Q0� Address:�n(a Ra 5 C o�'
City, gn-.G ve V.A beEcI State kZlp j�?CIR�Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Namej 1' ro aiva( Qualifying Agent:
1 n C f,0v%0!U•� State�Zip 33 aO-I
Address: a(Oaye� �'P ke a City Fax#
Office Phone qt4• Job Site/Contact Number
State Certification/Registration# 3 q
Architect Name& Phone# �-
U
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. /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 t��hiis jurisdiction. months at This permit becomes null
or and work id iis menced.otl understan
within s�d that separate permits muor st be secured for Electrical construction or work is pWork numbing,Sigended or ns,aWells,Period o ls,XFurnaces, Boilers,tHeat rs,
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 BEFR ENTCORDING YOUR NOTICE OF
his
type 7worktw that I will be clomplied with whether this
eciaedlherein or not.' ton and icat Theegranting of a permit same to be true adoescnotprt. All esumetto give authority toons of laws and roiolatences gor canc�ltthe
provisions of any other federal,state, or local w regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name �f..y. ... ..........................................................................................
Print Name MeK
....... oeW e ..............................................................................
Sworn to and subscribed before me Sworp to and subscribed before me
c� a ,. 2015 this I I Day of 6P441-k.1� ��✓ a, ,,,, BSA.'Mccauley
�_Da of f`~ 4?r• �s
this y ;,�^�i 7b �__.__A
�cCOMMISSiON#EE 872533
.% grynn A. McCauley ( ` ` y^
�' 1 �: 2533
Nota Public
"EXPIRES: FEe.c7,2o1�
Notary ublic -` ' ��EXPIRES: FEB.07,2017 1y ',;,,O °�° y wW.AARONNOTARY.corr
�,,��oF�* WWW.AARONNOTARY.-M Revised 01.26.10
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. `� "_001C"�,Z10 Tax Folio No.
State of Florida County of
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:_n—(A
O�-LaVAn �L heap
Address of property being improved: '319)
General description of improvements: Re-Roof
Owner M al
ttn
Address �, o Cl CJg�
Owners interest in site of the improvement Re-Roof
Fee Simple Titleholder(if other than owner)
Name
Address
t. Contractor J&M Roofing Services,Inc
((�1
{I Address 2604 Powers Ave Suite 2 Jacksonville Florida 32207
tl Phone No.904.399.5546 Fax No. 904.399.5023
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
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 o� a1� c
Signed: DATE t 1 1,V ul v
Before me th s El dayof In the
Cp�p�y of Dpvol.S of Flgncfa.has onaliy appeared
Doc#2015212806,OR BK i 7317 Page 303, �W 1 herein by
Number Pages:1 himseel herself and affirms that a i statements and declarations herein ynn A.MCC�u'�
""21nq
Recorded 09/29/2015 at 12:38 PM, are true and accurate z?S` PG.B011MISSION#EE 872533
Ronnie Fussell CLERK CIRCUIT COURT DUVAL ;fit q EXPIRES: FEB.0712017
COUNTY ,
An
RECORDING$10.00 r WWW.MRONNOTARY.wm
A/ `
Notary Public at Large,State of County of
My commission expires:
Personally Known or
Produced Identification
I