64 13th Street West ROOF j Lyf 6.
t.-51 rte'
I , CITY OF ATLANTIC BEACH
` ii, J 800 SEMINOLE ROAD
m- -- r:
�� y ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'.-t0.319`'
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2376
Job Type: ROOF PERMIT
Description: REROOF 10124.10
Estimated Value: $5,550.00
Issue Date: 10/7/2015
Expiration Date: 4/4/2016
PROPERTY ADDRESS:
Address: 64 W 13TH ST
RE Number: 170805-0010
PROPERTY OWNER:
Name: LANG, MARY E
Address: 64 W 13TH ST
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: - -
FEES:
BUILDING PERMIT FEE $77.75
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $81.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH O / - g
800 Seminole Road,Atlantic B h, FL 32233 7 i D
Office (904)247-58 ax(904)247-5845 .-----------'
i
Job Address: 6'71 L✓ /37X St, Art A Air/ 'A 1/, Ft 1Z13-1 Permit Number:
Legal Description /3 W 3Y Z S Z 9 c 0093 3 C T(ON 1-f• A.6 Parcel#la/0 rr v F I D r �l �T it'ZOf
Floor Area of Sq.Ft. Sq.Ft ek
Valuation of Work$ 515 SO.00 Proposed Work heated/cooled non-heated/cooled, Se
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial
If an existing strucure ,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# 1012. i•1 D
For multiple products use product approval form
Describe in detail the type of work to be performed: fZ c- -"goo F , 2 S Sf 5A.•,ej/t S, a f!Z Ps1 c
-1103glili
Property Owner Information:
Name:L S F A+Astc7)- /Peenrte:AZ,crrio•✓ T7tuJt Address: /6i5 con sitatJ Ace_ Ste 2o
City 't<«Ay 23L'cAl StateFLZip 31119,5- Phone Q''Y ' 25 9 -o 277-
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:%N `/ LJsr`LL 120 c., F:a f t 1 C Qualifying Agent: /`o") 7241JJ C(/
Address: Y`1/ 9 /4415NAf/ id. City %5 ' /t'( State FL Zip 22,1°7
Office Phone 90'? - 7/`/—l 907 Job Site/Contact Number Fax#
State Certification/Registration# C C C /3 2.7'iI e 1
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 a_period of six(6)months at any time alter
work is commenced. I understand that separate permits must be secured for Electricar 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.
I hereby certify that 1 have read and• amined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied ' ithl ther specified herein
construction not.
ructions ograntingfofinapcee permit construction.s not
tresume to give authority to violate or cancel the
provisions of any other federal,fiat/ local law
/ AO' /
Signature of Owner i Signature of Contractor Ailt` iaasdir
Print Name fil/e I 6 1 C-1V-A,S Print Name Ron Or!q I c..l 3 55e......‘
Sworn to and subscribed before me Sworn to and subscribed before me
I • 1 Day of 0(,11 ,20 this bay of f,r ■1 ' •20/s
��i JIt . ., �=�==_. 11..
lAiri � No ,, '
(., "UoIiC = >"' °•�;••; n N FF 111385 - ?i ii_., NOTARY PUBLIC v�sed 01.26.1U
i- Com ommi .r STATEOFFLORI�
'" '- My Commission Expires '� _ e
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•April 09, 2018
�,,_;''", .' Expires 5/8/2017
NOTICE OF COMMENCEMENT
;PREPARE IN DU=LICATE;
Permit No. Tax Folio No.
State of Florida County of Duval
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: /f'3 y } -2S ` 2-95-. 093
SEC 770,v // Arc/Jn.'r'ie f/ A' /UF'r of Lc,7 /� Lor7-
( ex La 7_o Fr) $04 sI
Address of property being improved: 6.17( /3 r'. Sr-
/ 7-z"vriC 9 P-ochi pe. 32233
General description of Improvements: C -2700
Owner L SF MAi rev Pig jt-n7 c i p®n row T7Li,.,rr
Address 7563 Phillips Highway Suite 109,Jacksonville, FL 32256
Owner's interest in site of the improvement Fee Simple
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor'ROu /mot Lt3Ss CL {y F'Ai G Z C
Address 'ill/ 9 HLib/v.44 3LA TAckSo.Jv'jl/e FL J1.2O7
Phone No. v^ 7/ / 'i 7 Fax No. 51 G 3 tS 9 PO 9
Surety(if any)
Address Amount of bond$
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 addittion 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 Nc. A
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 I / 4— OWNER
Signed: DATE 7 ('
Before me this day of �� h yte
Doc#20152 camtp of Du� �da h , ..14., red
30675,OR BK 17328 Page 629, ��y''hh herein by
Number Pages: 1 nhrwlr/hors rx! that all m :s a claratlons rwrair
Recorded 10/07/2015 at 01:52 PM, are' �d accurato
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY I
RECORDING$10.00
Notary •lc at Large.Stara of • Cant;of .m/OV fj L/
My commission expires: ✓
Personally Known or
Produced ldendf ton
*„”", JAMIE FENNELL
A �V Commission II FF 111385
I = *c
■yi 14, I14op�`; My Commission Expires
April 09, 2018