1641 W Park Terrace - Roof Permit - Shingles , CITY OF ATLANTIC BEACH
= r) 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: 16- ROOF -126
Job Type: ROOF PERMIT
Description: RE ROOF - SHINGLES
Estimated Value: $13,100.00
Issue Date: 1/19/2016
Expiration Date: 7/17/2016
PROPERTY ADDRESS:
Address: 1641 W PARK TER
RE Number: 172020 -0322
PROPERTY OWNER:
Name: GREEN JR, WALLACE M
Address: 1641 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: DUBO ROOFING
Address: 5300 EMERSON ST QA NONE
Phone: - -
FEES:
BUILDING PERMIT FEE $115.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $119.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rs K _� CITY OF ATLANTIC BEACH
r ROOFING PERMIT APPLICATION
Date:
Job Address: t/ k errL c ' t .. c. . ' _ ._ 3a-
Owner of Property: J C Ere en .
Address: (/pt{ ( wet- prAr k ¶e r7Le, /I ($wt+(c lx f7 - 32l33Felephone:
Contractor: D a P--)0 (Zt)O 1 114rry CO State License Number: CCCO S a IL,
Contractor's Address: *! l 12' S k a v• r• • 3
Telephone: q 0 4 - 3 c j , ; I S 3 C I Fax: CO -.3G Co 157 44 2
Scope of Work: RI- roof 3h 1 Y10l t -• . S �e) 1 r t -€ .
Deck Slope: y f 1.A. Greater than 2:12 ,/ Less than 2:12
Valuation of work: 41 \ \t:0 , C O
J
Florida Product Approval # (or NOA# from Miami -Dade) . 17_ 5 EL /6 S i /
Product Name (Example: Timberline): L't vc1 ! no_r L Pr p D ('G'"` o 1 cI D e c Is
Manufacturer (Example: GAF): C.e rtin c =_d
ASTM Designation(s):
Required Inspections: Sheathing and Final
Signature of Owner: ) Ge't.e( --- , Date: / y (
AS TO OWNER:
Sworn to and subscribed before me this / 8 day of 9.2c , 20 1(0 ammo
State of Florida. County
k . JANET SHELTON Notary's Signature: 04,7Q J Ot.Q ( - , c )
MY COMMISSION # EE224596
-- e , EXPIRES August 13, 2018 Personally known E
(♦m)s %�1 F ,,,,y,�,gcom ® Produced identification
Type of identifi - : , I produced
Signature of Contractor: �► /Ai`` /' Date: ///4 / /6,
1 111.
AS TO CONTRACTOR:
Sworn to and subscribed before me this ,7 day of , 20 / (p .
State of Florida, County of Duval
Notary's Signature: C j 4112A1119-7)
;; iiNt JANET SHELTON ,_,/
li
•'c MY COMMISSION # EE224596 I �1 Personally known
�« 4, EXPIRES August 13, 2018 El Produced identification
(4 '' i!s&o153 Fbnewoswys.twceoom Type of identification produced
800 Seminole Road • Atlantic Beach, Florida 32233 -5445
Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic - beach.fl.us
Page 1 Revised 11/06 DH
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of a Florid
County of Duval
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. LEGAL DESCRIPTION OF PROPERTY being improved: RE # 1.7.2020 -0322
34-62.09-2S-29E / Selva Marina / Unit 7 / Lot 10 / Blk 12
Address of property being improved: 1641 West Park Terrace. Atlantic Beach Florida 32233
2. GENERAL DESCRIPTION OF IMPROVEMENT: re -roof shingle to shingle
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name: Wallace Green
Address: 1641 ParkTerrace West, Atlantic Beach, Florida 32233
Owner's interest in ro ert
P P Y FeeSimple
Fee Simple Titleholder (if other than owner)
Address:
4. CONTRACTOR'S NAME: DUBO Roofing Co.
Address P_O. Box 10252 ,Fleming Island __ FL 32006 -
Phone: (904) 396 -1889 ----
_ Email: duboroofing@dubo,net
5. SURETY Of applicable, a copy of the payment bond is attached)
Name:
Address
Phone No. Amount
- - -- -- ount of Bond: $
6. LENDER'S NAME:
Address
Phone No.
- -- Fax No.
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7 Florida Statutes:
Name
Address
Phone No-
- Fax No
8. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as provided in
Section 713 13(1)(b), Florida Statutes.
Name
Address
Phone No
- Fax No.
9. Expiration date of Notice of Commencement (the expiration date will be one (1) year from the date of recording unless a
different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA
SATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT,
r OWNER
i - - I1f
THIS SPACE FOR RECORDER'S USE ONLY Signed: / i
{ Owner/Lessee's signature, Autlruriz wet/Director/Partner/Manager wet/Director/Partner/Manager ^
DATE: [ (&
f , , � y
!fore me this la *Jay of 1
Doc # 2016011639, OR BK 17430 Page 2207, ,4,y'4r `� - , 20 � In the County O U 14 V&A
Number Pages: 1 ate of Florida, has personally appeared, W Q`. at:+tt 7 re 42
Recorded 01/15/2016 at 03:30 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL rein b himsetf/he If and affirms that all statements and declarations herein are true and accurate
COUNTY rL � * /J itt / i _
RECORDING $10.00 tom/ (,/a Of/L1Ll.A
, � ELISEFERNANDEZ CASHMAN
Lary Public at Large, State of Florida, County of : ; + � r MY COMMISSION N FF 120872
My Commission expires. ;,��.�. o? EXPIRES: July 17, 2018
Y
Bonded Thru Notary Public Underwr8ers
_ Personally known 'y or Produced Identification