287 S NAUTICAL BLVD - ROOF , i; LIL`I rJ J�
,,,,.,..___________.,,,,2
\mod ', ' 's, CITY OF ATLANTIC BEACH
r. 4 s 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-2601
Job Type: ROOF PERMIT
Description: RE - ROOF
Estimated Value: $6,886.00
Issue Date: 11/3/2015
Expiration Date: 5/1/2016
PROPERTY ADDRESS:
Address: 287 S NAUTICAL BLVD
RE Number: 170703-0371
PROPERTY OWNER:
Name: BRUGGEMAN OLIVE H & TOM, *
Address: 275 S NAUTICAL BLVD
GENERAL CONTRACTOR INFORMATION:
Name: RELIANT ROOFING INC RYAN SHOUPPE
Address: 528 Millhouse Lane Orange PARK
Phone: - -
FEES:
BUILDING PERMIT FEE $84.43
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $88.43
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 Seminole Road..Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 t _.O O f .y 44 Z�d t
Job Address: a21 J033\C)' N i J. Permit Number.
Legal Desert/hon. its 3. 1l—. J aKht . i1. 4, '1:. , , 16 `.-01+•!
,M Floor Area of Sq.Ft. Sq.Ft
Valuation of Work S (9 d,,pLQ Proposed Work beated/cooled f1rd non-heated/cooled 1-50(.4
Class of Work(circle one): New Addition Alterar . Repair Move Demolition pool/spa window/door
___
Use of existing/proposed Oro clarets)(circle one): Coirurercial ( fi,.3Ri. ,flab
If an existing structure,is a fire sprirrldcr system installed'(Circle one): Yes No MallIP
,`�.',�'B^�'}'
Florida Product Approval# 1� •\ 0(16���
For multiple products use product approval form slid e1� t �tt 1 L. it�l2 i . 2-1 �'
Describe in detail the type of work to be performed:
Pnnerty Owner i_uft t 1 ,(,�
Name..•L�1k At1dn s ,,, OtVA f iil� �1137.'3
City Ak Cr f)tQh State ip_J?i 'hone f 7j 9 ' 1 t
E-Mail or Fax t!(Optional)
Contractor Iaformatiso
Company Name: 1C2& ¢, (' Qua virr Agent: OA
Address:i31.2. kilt t Q Cityyt t"O State Zip
Of ioe lot U c I C o n i t es g�tt Number%if' Z 8-b 3 r 5 Fex t i fall—.74"7.
State Certification/Registration ii k?.?0 4Ol4T�
Architect Name&Phone#
Engineer's Name&Phone rr
Fee Simple Title Holder Name and Address
Bonding Company Name and Addresc__Mortgage Lender Name and Address
Application Is hereby trade!CO obtain a pernnl to elan ern•work CUL1 hrwaltrwnwtt ON 1IMhCOIet1 l rtr'.)t Mai on work or o,.tlallaiko,Iva coor,o,w,eal perr,r to the
issuance of o perm f m,d that ail w•3nt rill be performed to mod/ra:..tamaut/r of a.'1 loins rt aita!' crnWr.diom o,till..h n.mlic inn. TM<pert/!herarw,
raiu:wed void,f wont it rah commenced withal.,ix(,$)monrM.w I enaerdenon or wine it,n. or Myatt/ led for a period ot.ux 65)months ar o?y How
Veda;,work u•commenced 1 an,krstan/Mai separate.pen.,t•worst be.orcared for Wont,Prrndllnn.Sleur. We/h,Pooh, For./err.N.fkI
JJmkr;Tanks and Air Cw, owero,dc.
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 Serceyerfrey lisq!lm+e Ira mil examined hots oynl/colon and know rtes AVOW 10 be trot and correct A'I pru••�.,,am aflm s and urdromme r poknnng dm:
type o work phi be complied with Wittier.stppeeee cd litres,or not T e g,a w og of n peon..'doe not p a,ow a la gm a iJF,,1n A vrolar;w wren/the
pre visloos ofemy other federal,state,orlo,.ullow reg:dolingeon lino or ore pe,;rwmanre seconarurlr•rw. [._1-..k
Signature of Owner K Signature of Contractor
Print LArI ��o3C.l Prim Name Co .
Sworn to and srtMgs3 before tae SWonr to and subsc� fore me
tbis.3ClDay of ( r C iL;y if 20 1 tits U Day of OC fie 10P c _201
C� `-
Nr r YI:E CONWAY Nogry P11 is 1 ,,,s r„ JO E CONWAY
MY COMMISSION#FF921647 ;Co Cq�y�p1�l Q #Ff921647
���_ EXPIRES:SEP 24,2019tEza•2019
flooded through 1st State Insurance ^ Banded through 1st State Insurance
11/02/2015 at 08:56 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
NOTICE OF COMMENCEMENT
State of FIc.6 %. To Folio No. 11o1C73-11A-11
Coemty '13UxitA
y
To Whom It May Concern:
The undersigned healthy informs you that Improvements will be made to certain coal property,and in accordance with Section 713 of
the Florida Swags,the following information is stated i this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: 3°a-tau 1'1 Wig-21 - t'1 Q ysrgen1
Address of property being unproved: (-Mk
Not► teal t�vcl .ae S' rch ° 3
General descriptive of improvements:CL-ccthi
Owner Jttn1-14.f ck A 1pcx vcr�,l Addresx 'e7 Ea. t*Iuk P9t1 3AV 4 •
rX r imerest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Naaw
Contractor 2.osnn4- •01:1PtIA�lne� �,,,tr
Addrosc $rte 1.1 h%rl tti1!�yp�A)Ce�(' G.3w \i't�^ia Ft S7Q8a
Telephone No.:�O Y -f a 83 Fax No:
Surety OfanY) --
Address: • —-_ Amount of Bad f
Telephone No: Fax No _
Name and address of 8e0'person mating a loan for die cornotsllon of the impruverimms
Name
Address —_
Phone No: Fax No:
• Name of paean within the State of Florida,other than himself,deed by owner upon whom miens or odor documents may he
nerved Name: _
Address •
Telephone No: Fax No:
in addition to himself owner designee the following person to receive a copy of the Limes Notice as provided in Section
713.06(2)(b),Florida Statues.(Fill to at Owner's option)
Name:
Addrser
Tekpliate Rro: Fax Nor
Expiration date of Notice of Commencement(the expiration data is one(I)year from die date of recording unless a diflerent date is
specified):
ThIS SPACE FOR RECORDER'S USE ONLY OWNER
10 SC)1 be.
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Bane me tin 10 of . it the COMM(etXaaL Sore •
Of Florid*.boo penaWly weed. l nC O
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My commission=MIT I 4
Peneneny Known: V __ or
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