1290 - 1292 ROSE ST - ROOF r e, � CITY OF ATLANTIC BEACH
�< 5,-) 800 SEMINOLE ROAD
\L) =r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'�J 33319'r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2813
Job Type: ROOF PERMIT
Description: RE - ROOF
Estimated Value: $10,000.00
Issue Date: 12/4/2015
Expiration Date: 6/1/2016
PROPERTY ADDRESS:
Address: 1290 ROSE ST
RE Number: 171006-0000
PROPERTY OWNER:
Name: CLINE EL AL, WILSON D
Address: 9310 -802 S OLD KINGS RD 9310-802 OLD KINGS RD S
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: - -
FEES:
BUILDING PERMIT FEE $100.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Rose. (904)247-5826 Fax(904)247-5845
Job Address: 1292//?9 2. RO1xf. JT_ Permit Number:
Legal Description skit;�I-�IA Sec. }( �-1 Z to- P l#
P l Floor Area 5f Sti Ft. arse Sq.Ft
Valuation of Work$I(�)/t7D(T) 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 Residential
if an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A /
Florida Product Approval# /Q[uct approval stt n,Y,e, (----e_ k RL t6 Z (6d
For multiple products use product approval form �1
Describe in detail the type of work to be performed:Re:eobc 110 s?lare, 1 Z Qi�vi
Dowi
Property Owner Information: Q
Name:Do .i ..` Rts.\ky Address: 9310 Old V.:nt,S Zci..vi6k, 902
City za)C State4Zip VZZS7 Phone 90q-3(e 7-77k#
E-Mail or Fax#(Optional)
Contractor Information: -�
Company Nam :R till R1k15C/l�{ars!-r4 1 Quali in Agent: Trey
Address:5 f� Nti Alit/ L City "C-X State 1%t- Zip_3ZZO7
Office Phone 90Y-7/Y-/90'7' Job Site/Contact Number 90 it 7/y 1947 Fax#
State Certification/Registration#
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 a of 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(6f months,or if construction or work is suspended or abandoned for as period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Healers,
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 read and examined this laws application and know the same to be true and correct. All provisions of ws and ordinances governing this
type of work will he 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,star• ,r local law regulating construction or the performance of construction.
Signature of Owrder eaWIZ`1 A' ' fr ✓i: Signature of Contractor „A
Print N:a r ��A�r / ,,/
-..... .l.f.. i .,, .._....._... ....__. Print Name goo tCl... U.SS /.._....._...
worn I and s • .bed before me Sworn to and subscribed before me
Vs % " •• o k- - i ..-.. 20 45 this �. Day of Dee-c. ,20 if
._ �%//1,i _ A
No- s,'lie o blic
Revised 01.26.10
„.t►µ�P's,,� PATRICIA A.MALLARD l
>� �`o- Notary Public State of Florida ` TERRANCE SANTiLLI
1 •. •E My Comm.Expires Dec 25,2015 = NOTARY PUBLIC( '��� 1f � Commission•EE 143482 : STATE OF FLORIDA I �aiii,,,� Bonded Through National Notary Assn. Comm#FF016455
' AO' Expires 51812017
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. R-15-
State of Florida Tax Folio No.
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. e
Legal description of property being improved: I$'3 LI I !-7-Z
/F'Iut4-c Brach Se C 1-1
Lot- 1 N 36Fr 404 2 211 19Z
Address of property being improved: I
1290/1292 Rose Street, Atlantic Beach, FL 32233
General description of improvements: Reroof
Owner Wilson D. Cline Revocable Trust do Duval Realty, Inc.
Address 9310-902 Old Kings Rd.S..,Jacksonville, FL 32257
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Ron Russell Roofing, Inc.
Address 4419 Hudnall Road, Jacksonville, FL 32207
Phone No. 904-714-1907 Fax No. 904-636-9909
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 Ron Russell Roofing,Inc.
Address 4419 Hudnall Road, Jacksonville, FL 32207
Phone No. 904-714-1907 Fax No.904-636-9909
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 N/A
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 'W ER,,
Signed ��f// i/_ /� "`;• TE
Before 1•i}�.�y of I� .r`L ' in he
Co),0 • a e • Florid, a • rsonally appeared
Doc#2015274507,OR BK 17385 Page 1630, �2� ' 'A/4- herein by
Number Pages:1 himself.T hersel - d affirms th . •ts and declarations herein
Recorded 12/02/2015 at 03:15 PM, ar a and a rate
Ronnie Fussell CLERK CIRCUIT COURT DUVAL ••,Y P a, PAT' CIA A.MALLARD
COUNTY ;a° `2'; Notary Pu lic-State of Florida
RECORDING$10.00 i'•� 1, •3 My Corn I..Expires Dec 25,2015
i1. • mission#EE 143482
Notary Fr•is at Large.S ate• ! '`�.I' :T(gral
• • • mission expires: _ f• 42.111//:
Personally Known or
Produced Identification