128 CAMELIA ST 16-ROOF-1047 r ,ALyr1 � �
`s CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
! y X 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 -1047
Job Type: ROOF PERMIT
Description: ROOF REPLACEMENT
Estimated Value: $8,000.00
Issue Date: 5/4/2016
Expiration Date: 10/31/2016
PROPERTY ADDRESS:
Address: 128 CAMELIA ST
RE Number: 170847 -0000
PROPERTY OWNER:
Name: JAMES, GARY DONALD
Address: 128 CAMELIA
GENERAL CONTRACTOR INFORMATION:
Name: STONEBRIDGE CONSTRUCTION
Address: 12550 AGATITE RD QA BRIAN HARDING VICK
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $90.00
Total Payments: $94.00
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
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 66 ,ClA i A Q Ol Ar , 0 Q &Yl Permit Number:
Legal Description X • g ' NE Sot u 0. 1111 c. &...80,11 � Parcel # I l i t ( l 1O
\ - t0
M Floor Area of y.kt. g. t �J
Valuation of Work SS (Mt). ()( ‘
) Proposed Work heated /cooled \ \ non - heated /cooled rc�
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing/proposed structure(s) circle one): Commercial
If an existing structure, is a fire sprin el system installed? (Circle one): Yes /A
Florida Product Approval irn..,I PI l`1
For multiple products use product approval form (�
Describe in detail the type of work to be performed: S) 9104)A0-0110)1.--
C "
Property Owner Information: 1 /� ,�,, \
Name: • / s : �� U -0,r1�
� r
Cit "�i`�� trZ!t�rL�1l Ste ip Phone
E -Mail or Fax • (Optional)
Contractor Information:
Company N: i e• �sr ► iX ! .I i b 1 ■ �� Qualif ing ent:U r 1 1
Address: l �1111:iIl(+lart . City F:, t11 tYt t Stale t .. • .T�LQ
Office P h o n e J contact Number *11164V7 Fax # , l0' •
State Certification /Registration # .1 f`
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 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 iJ work is not commenced within six (6) months, or if construction or work is suspended or abandoned far a period of six (6) months at any time alter
work is commenced. I understand that separate permits must he secured for Electrical" WW'ork, Plumbing, Signs, Wells, Pools, Furnaces, Bo Beaters,
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.
1 hereby certi f r 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 specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of anv other federal. state, or Local law regulating construction or the performance of construction.
Signature of Owner ,4
Signature of Contractor
Print Name C2C1i--6 . o (5 Print Name R5Yi elW .t
Sworn to and subscribed before me Sworn to and subscribed before me
this 1 4� Day of G , 201 l4 ti 1s _ Da of / i . 20 Co
1
r 6 r
� rlA
Notary Public 7 Public
ANDY ADEN � � ;y ";y;, JEFF MCCAR / Y Revised 01.26.10
, t ,,,y Commission # EE : 3942
,- NOTARY PUBLIC ,� !I .
MY Commission Expires 09-10-2016
STATE OF FLORIDA q .■ It pa Bonded Through Western surety
irxpires 1115/241 d
rage 1 of 1
Doc # 2016098254, OR BK 17547 Page 549, Number Pages: 1, Recorded 05/02/2016
at 03:02 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE w OUPUCATE?
Permit No. Tax Folio No. 1708470000
State of County of ttwa
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: 18-34 3 8 -2 5 2 9 E SEC H ATLANTIC BEACH
LOT 4 BLK $7
Address of property being imprwed: 1 28 Cam cliaSt.A Oat tic Beach ,FL 32233
General description of improvements: Re
owner Gary Jam es
Ackness 12$ Cam a lie St.A dim tic Besch,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder pr other than owner)
Nance
Andress
Contractor ` tone ;" -rigs Can;;trveiian Scn^.;c,i.:.r
Address 1 1 3 2 3 Ph illy: Parkw ay Dr.E,5i nc 1 jacks= vile ,F1. 32250
Phone No. 9°4462463e Fax No.
Surety (ir any)
Address Amount of bond $
Phone No Fax No.
Name end address of any person making a ban for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within Inc State of Florida. other than himself. designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In adcEton to himself. owner designates the following person to receive a copy of the Uenor•s Notice as provided in
Section 713.06 (2) (b). Florida Statutes. (FI1 in at Owners option).
Name
Address
Phone No Fax No.
Expiration data of Nobce of Commencement (the expiration date rs one (1) year from the date of recording unless a
different date is specified):
•
THIS SPACE FOR RECORDER'S USE ONLY OWNER
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