273 Pine St - Roof Permit r I ,_1..J.\.1,.„...,
fr
. s z CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
�, J "` ATLANTIC BEACH, FL 32233
INSPECTION PHONE L
,� � LINE 247 -5814
\ J.Ffl9r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- ROOF -86
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $14,780.00
Issue Date: 1/12/2016
Expiration Date: 7/10/2016
PROPERTY ADDRESS:
Address: 273 PINE ST
RE Number: 170561 -0000
PROPERTY OWNER:
Name: FRANK JR, RAYMOND D
Address: 273 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: JAMES SHELTON ROOFING
Address: 252 SANTA BARBARA AVE QA JAMES W SHELTON, III
Phone: - -
FEES:
BUILDING PERMIT FEE $123.90
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $127.90
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
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 3 SY 7`�• f� 3�.�
Permit Number:
Legal Description — /G /(p - OS' - a Sc f r J / S � y
F oor A rea o q Ft Parcel # D S, -0000
Valuation of Work $ 4 ?p, y/ Proposed Work heated /cooled / S'O 0 non-heated/cooled . t
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 .
Florida Product Approval # ,....L. 1 - b 0 , o N /A
For multiple products use product approval �~ � �-
P pproval form
Describe in detail the type of work to be performed:
�°.. d 41 . ` et, '.a .s - mod
° ,Z...4-N Iii, _ ›1e —, ii p ,
Property Owner Information:
Name: " ,iA.61.u/1
City ,c�,,� Address �, --=
State Zip 3 3 Phone �l�
E -Mail or Fax # (Optional) Y - '-� -lo��
Contractor Information: CONTRACTOR EMAIL ADDRESS:
W140,44 - -s sotrE,4Y 4, tam: r s cam
Company Name: -4.4/V _SW 23 oA,413, Qualifying Agent: v,� e � o �
Address: 1' .4 City 7,¢,{e,
Office Phone `10y- may. 92o < --- Job Site/ Contact Number �� State JAL, Zip s
State Certification/Registration # - -C /330 / V3 y Z � « Fax # y� ..28',.. ?a,
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 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, 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 hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of la nd ordin •s governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to guv- ority to - „te or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner e ft, . L t _ J • I 1 �' Signature of Contractor —�4..� ”
'rint Name 'r `0.- 14 , F W Print Name ' '-/" She
3efor me Before me
his Day of el , 20 I (n this 1 b . ,
i n i 20
'I'
lotar` ublic
III 111 I r n IFIN2
Nota -y Public .
Revised 01.26.10
NOTICE OF COMMENCEMENT
State of EL , County of
tY ,bye �� Tax Folio No.
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: / () — / / (� ._ -` _
� � 1/4.S'q /tU r S'-0c
Address of property being improved: , 2.g
General description of improvements: ,ma , „,e
—
Owner: S �� 4 /`if�/ii/t
` % Address: ' ; • .— L . $1 , #---Z_ 3c' 33
Owner's interest in site of the improvement:
Fee Simple Titleholder (if other than owner): --
Nance:
Contractor: ^/ F - c. oKv /ZvvV:::•-c.,r
Address: .S 3.j' ..- ,■ • /4 , jam. " 32c i —
Telephone No.: 70V- 3 7y ge _� s-- Fax No: Y
��,y._ 3 ?d � Qzo4.0
Surety (if any)
Address:
Amount of Bond $
Telephone No:
Fax No:
Name and address of any person making a loan for the construction of the improvements
'6 Name:
0 Address:
0
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
7 served: Name:
D 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
1 - 713.06(2)(b), 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 (1) year from the date of recording unless a different date is
' specified):
1
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed:
Before Q / lioi Date: , J(.1() , I 1 ; c , r e
me this 1 day of
� the County of Duval, State
Jac # 2016006843, OR BK 17425 Page 406, Florida, has personally appeared plY”) L, CI in r ray, I(,�
Number Pages: 1 sonally Known: Ni C —
Recorded 01:122016 at 12:37 PM, duced Identi s n: °r
DUVAL ary Public. *sir
` .Vi�wyaN� � � �
2vUNTY , &t/t�(TAIr a1 /Vi s '
Bonnie Fussell CLERK CIRCUIT COURT DUV
commission expires:..) / 27 4
RECORDING $10.00 lor/ — — _ - - - -- —
44 KIMBERLY OLMO
', MY COMMISSION tt FF199330 • ' EXPIRES February 12, 2019
;,, 9
/�!` / 14113 l 17 fin,staNe»arwSarnra COT