2112 FAIRWAY VILLAS LN - RE ROOF r
Jas .
`, CITY OF ATLANTIC BEACH
\It,
f 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-537
Job Type: ROOF PERMIT
Description: RE - ROOF
Estimated Value: $8,943.00
Issue Date: 3/3/2016
Expiration Date: 8/30/2016
PROPERTY ADDRESS:
Address: 2112 S FAIRWAY VILLAS LN
RE Number: 169398-1028
PROPERTY OWNER:
Name: LEFT, FRANK
Address: 2112 S FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: GREAT WHITE CONSTRUCTION INC
Address: 4320 DEERWOOD TRAVIS SLAUGHTER
Phone: - -
FEES:
BUILDING PERMIT FEE $94.72
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $98.72
I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AM) THE FLORIDA
BUILDING CODES.
1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845 1 (0 - Roo r- S37
Job Address: 21k'L �Q,�. V��(tiS \GWI�� pt.
S ' .GtP,1/1 373 33 Permit Number:
Legal Description 3‘t-la 08-75-246 F V \\Ct5
ki-.4 Parcel#
Valuation of Work$ 9'2.25 Floor Area o 23 Sq.Ft. i Sq.Ft
t Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Rep r Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial R
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No
Florida Product Approval# 0 2c - — L(Z 3 Z8•-RS
For multiple products use pr uct approva o
Describe in detail the type of work to be performed: \ ia4. Q)� 'l s9 (fill Z
Property Owner Information:
City e' Address: '' '2(l 2 F' \)\�,�5 Ln
StateZip 32233 Phone 4• S(nk • 432't
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: , !A ()1\ 1 • &\ it ..V
Address: ' _ • �t,t _ _� � , i1�� Qualifying Agent: ���\S 5�0� �y2,
Office Phone City Jw State Zip 32'2\(O
(On•-11ZS Job Site/Contact Number $3s• itoccl Fax#
State Certification/Registration# Ocek 32x041 l$'
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 1 cert,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 tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six l6)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 certi that I have read and examined this a plication 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 A,dir , / / `��
A Signature of Contractor J9t2
Print Name
• I , _
•
Print Name irat
Sworn to and subsc -. before me _
I ! ! 20 Sworn to an• _
—L this
17,191 1r., '~'! °'%` ANKE B DE I 'r94 ?�s •. bi -State of Florida
DEASON 1 ` = .i a. 0-°
No .i• i irf'. ;. TGi MY COMMISSION#FF085842 Notary 'U, '%"',-)'.s'Nrs~�4 oafs.# i!1 2966,2017
�? �P' EXPIRES January 23,2018 cF` mission# 1. 29966
a1, `!302 5b5-5 D 6._)398-01 b3 FloridaNOtaryService.com -• 1 •• 1
Doc # 2016047784, OR BK 17479 Page 1065, Number Pages: 1, Recorded
03/02/2016 at 03:07 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
NOTICE OF COMMENCEMENT
iPREPARE IN DUPI.ICATE)
Permit No. Tax Folio No.
State of Florida County of Duval
To whom it may concern:
The r!ndet-!gned hereby Informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 39-22 08-2S-29E Fairway Villas LOT 14
Address of property being improved: 2112 Fairway Villas Lane S Atlantic Beach FL 32233
General descffpfion of Improvements: Reroof
owner Frank Left
Address 2112 Fairway villas I ane S Atlantic Beach FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Great White Construction
Address 4320 Deerwood Lake Pkwy#403 Jacksonville FL 32216
Phone No 6.47-7775 Fax No. S66-746-1840
Surety Of any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself.designated by ov.ner upon whom notices or other
documents may be served:
Name
Address
•
Phone No._ Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice us provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No Fax No.
N {0
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a 0 N E
different date is specified): N
THIS SPACE FOR RECORDER'S USE ONLY �-, W - t
sWn.d 16.); , / DATE '(Ci �
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cowry or MGM !- . W r to•.)..C1 i _iF-3' h.r.In X w =
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