363 ATLANTIC BLVD - ROOF S ��y7
`'' S, 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-2859
Job Type: ROOF PERMIT
Description: ROOF - REROOF
Estimated Value: $9,000.00
Issue Date: 12/9/2015
Expiration Date: 6/6/2016
PROPERTY ADDRESS:
Address: 363 ATLANTIC BLVD
RE Number: 169730-0000
PROPERTY OWNER:
Name: SHOPPES OF NORSHORE LLC
Address: P O BOX 330108
GENERAL CONTRACTOR INFORMATION:
Name: DS KILLIAN ROOFING
Address: 3898 DUPONT CIR QA DAVID S KILLIAN
Phone: - -
FEES:
BUILDING PERMIT FEE $95.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $99.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
f 1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
15 -RooF - Ze■ Sc)
Job Address: 363 Atlantic Blvd Atlantic beach FL 32233 Poe's Tavern
Permit Number: Parcel # 169730-0000
Legal Description 5-69 21-2S-29E 1.65 ATLANTIC BEACH LOTS 7 TO 18,PT LOT 19 RECD
OIR 14858-1893 BLK 1
Valuation of Work$ 9.000 Proposed Work heated/cooled N/A 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 # F "�
For multiple products use product approval form
Describe in detail the type of work to be performed: Apply Gaco-Flex ro frating to flat area behind parapet wall.
Property Owner Information:
Name:\AO,ndO.rr i(\ Empty i um :t-c . Address:-9.O. Y Yc 33(-1 .18
City N*\O nti C- t CSC'cl Statca_Z i p Phone 40.1 21-41- 1 151
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: DS Killian Roof&GC Qualifying Agent: David S Killian
Address: 3948 S 3rd St Suite 122 City Jacksonville Beach State FL Zip 32250
Office Phone 904 246 7663 Job Site/Contact Number 904 246 7663 Fax#
State Certification/Registration# CCC 1328203
Architect Name&Phone#N/A
Engineer's Name&Phone#N/A
Fee Simple Title Holder Name and Address N/A
Bonding Company Name and Address N/A
Mortgage Lender Name and Address WA
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 aperiod 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,Heaters,
Tanks and Air Conditioners,eta
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 cert fy that I have read and examined this application 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 speci iedherein or not. The granting ofa 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.
•
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Signature of Owner
` Signature of Contractor,... ' ,a,.....fr sc-
Print Name C� i( 15 -- 1C)nit C\Q� Print Name David S Killian
Sworn to and subscribed before me Sw.r to an. ub.cribe. e-fore me
this I Day of �.01" in DA( , 20 l5-' this 'rt D.4: A� , 20 ) S
1 (L.Q_AN Notary Public 4:.. �_ Notary Public
ill: - ' -. 01.26.10
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� i 1`�. Notary Public-State of Florida 0
Commission•FF 229545
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°"4;'a t'`'� Bonded through National Notary Assn.
NOTICE OF COMMENCEMENT
State of Florida Tax Folio No. 169730-0000
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: 5-69 21-2S-29E 1.65 ATLANTIC BEACH LOTS 7 TO 18.PT LOT 19 RECD
O/R 14858-1893 BLK 1
Address of property being improved:363 Atlantic Blvsl Minnie f}e c .J t L 322.
General description of improvements: _ Apply Gaco-flex roof cojpg to flat roof
Owner:Max laY t_►1 C Y i_. _l),_,C0_. _. Address: O '4C C�..M Po �3 % Jkl�?C-Y)
Owner's interest in site of the improvement:.Q �41 __..___.. _ 3.
Fee Simple Titleholder(if other than owner):_ ____. .__ __.. _
Name:
Contractor:DS Killian Roof&GC
Address:394$S Third St Suite 1n2 Jacksonville Beach F 3L 2233
Telephone No.:904 246 7663 Fax No:None
Surety(if any)WA
Address: � _.... . ... ._ .. . .__- Amount of Bond$.-
Telephone No: ._._._ Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: Doc#2015278600,OR BK 17391 Page 368,
Address:
Number Pages:2
Recorded 12'08!2015 at 12:01 P
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Phone No: .._.----------._ ---- Fax No: COUNTY
Name of person within the State of Florida,other than himself,designate RECORDING$18.50 r
served: Name:
Address:
Telephone 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(2Xb),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: _...____- Fax No:
Expiration date of Notice of Commencement(the expiration date is one(I)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
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Signed: — __ _-_... Date: 121 �.E
Before me this , ` _day of _ , ' .'• the County o Duval,State
B SALCAN Of Florida,has personally appeared_ �..\ ■ ,
;; .PG;�.,, Not Public at I,ar ge.State of Florida,Count of Duval.
• - 0•. Notary Public-State of Florida " b _ y
4. Commission N FF 229545 My commission expirtts:l L2-i5y�
Personally Known: 1.....
=: o'c My Comm.Expires May 11,2019 .... or
1"--;',„,_:1--.4„4/ Produced Identification:
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