996 HIBISCUS ST - ROOF ,�
S, CITY OF ATLANTIC BEACH
J ," 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-2774
Job Type: ROOF PERMIT
Description: ROOF - SHINGLES
Estimated Value: $4,898.00
Issue Date: 12/1/2015
Expiration Date: 5/29/2016
PROPERTY ADDRESS:
Address: 996 HIBISCUS ST
RE Number: 170948-0600
PROPERTY OWNER:
Name: PISCHLY, DENNIS C
Address: 411 ASHCROFT LANDING DR
GENERAL CONTRACTOR INFORMATION:
Name: QUALITY DISCOUNT ROOFING LLC
Address: 1794 ROGERO RD QA RICHARD BRIGGS
Phone: - -
FEES:
BUILDING PERMIT FEE $74.49
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $78.49
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND "I IE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 S ROOF –Z-7-74—
Job Address: qq(1 -b i Hi i n'Ic ee0e1) 0. :3-3 Permit Number:
Legal Description Ii3- , i-aS-a9E.sec to q1-10,‘■C. pacer Parcel# 1 7191 -
Floor Area of Sq.Ft. Sq. t
Valuation of Work$ teq8 Proposed Work heated/cooled I I Z non-heated/cooled I I (oC)
"Re-Re:o
Class of Work(circle one): New Addition QtheratiOnD Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/
Florida Product Approval # FL-1(X) .
For multiple products use product approval form
Describe in detail the type of work to be performed:`QeM- ►c yec a own •'. t'oc cAer2le . -ilaf I ()cc"
e u / lie,v tt O Rref.lec c cct( 54N;n3te fl5(tua.ne. FL- 5-I '` 1-C,i..
Property Owner Information:
Name:Lance ;5c1�\ Address:gRCe b b�5c1-tS S. . AkKcna-tC &c rtel Fl cfl,a.33
City Ar\Cu'**-�C �3e "` State aZip 39V33 Phone cif —551- 3�
E-Mail or Fax# (Optional)
Contractor Information:
Company Name:(k..a1i �;5�cc �n� -mss 'n LL(.- Qualifying Agent: e-r 2e; 1e r
Address:,=31-e1 S*. �v15}-∎M_ (4 . n City Ji(, +nwd•�1 4 State PL Zip '51
Office Phone 1rX1-�((0-�0GC) Job Site/Contact Number 3�3(jt-.S( Fax# s -5aq.w(ce0,
State Certification/Registration# COO a:qcip.,85
Architect Name& Phone#
Engineer's Name& Phone# P(
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. 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 1 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 thisplication 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 authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name .1_.? '1 C i 1'5 C- e Ze ``e Q�
Print Name �1
Sworn hand subscribed befgr�e me Sworn to and subscribed before me
this /5 Day of NO 4)1 Yer- ,2015 this �G�Day of NO�P.n i ( • 2015
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otary Public , A 610Z'S Aew saJldx3•wo3 kw .•, -
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Doc # 2015266759, OR BK 17375 Page 2, Number Pages: 1, Recorded 11/20/2015
at 01 :07 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
pREPRR%psi D 3 ATt
Pen t NG. Tax Patio No. %1O 9 ,-CADC.C:
$late of Firmua County of
To whom It may concern:
The undersigned hereby informs you that imprnvements wilt 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: 12j- C. ; ,'
_
1.11-011+1C. r.616"t • _..._
A£sdress o!property being improved:
Genen'ri rescrtption of tmpto.e=nerds:Re-Roof
Owner t £*�
Address >}C l- ?t ;. >
Owner's;'Merest in site of the improvement
Fee Simple Titleholder of other than owner)
Name
Address
caata.,{or Quality Discount Roofing L.L.C.
Address 3499 St.Augustine Rd.Jacksonville.FL.32207
Phone No.904-3.904000 _•..._ ,_.Fax i`{o.866-329-6692
Sura'y(f any) k s
.,_.,..,
Address An aunt ofird
Phone No. —._ Fax No.
Name and address of any person making a loan for the construction of the Improvements.
Nome € f --
Address — Y»
Phone No, Fax No. ._..
Name of person within the Siete of Florida,other titan r:imself,designated by owner upon whom notices or ether
documents may be served:
Name
Andress
Phone No. Fax No
In addition to himself.owner designates the lowing person to receive a raj,y of the Lienot's Notice as provided in
Section 713.0E i2i(b),Florida Statutes.(Fill In at Qwner'S option;.
Name
Address _.»...._...._._._. ..�...._...
Phone No �-_ Fax No
Exp iration date of Notice of Convr;eai ement the exp;ration date is one(1,year from the date of recording unless a
different date is specified):
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