1536 OCEAN BLVD ROOF /r
' W CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
�*-
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- ROOF -1091
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $10,200.00
Issue Date: 5/10/2016
Expiration Date: 11/6/2016
PROPERTY ADDRESS:
Address: 1536 OCEAN BLVD
RE Number: 171883 -0000
PROPERTY OWNER:
Name: CAMPBELL, DONALD
Address: 1536 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: SHORE ROOFING COMPANY
Address: 914 7TH AVENUE S QA THOMAS LOUIS SHORE
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $101.00
Total Payments: $105.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
State of 1` ( County of pv u.t* 1 Tax Folio No. 11 40.3 —000
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: /0 -// /G "as —aciE 44.)0141)4y 1.o1'o. /3 /KGil
Address of property being improved: /.53C 0 C,C t,1 13I Ulit t 44/3{ L . I 2'' i h - L j'' 1 3.22 35
General description of improvements: Rt.. /boo }—
Owner: of4ticl eAmpbe/I Address: 1 53 2 OCen• Blvd . 44I04,L &t'1
Owner's interest in site of the improvement: PV -, c U33
Fee Simple Titleholder (if other than owner):
Name:
uC) u u `;
{," m 0 , i , c- i
C ontractor: S I�dv F, in ca c) (__ .D -) _ ,,
� � Address: S l f¢v,vs+i,' - /� ( ,2. U 0 0
N ;
c, y u
Telephone N�i" ' - $6H Z— Fax No: , ' N " _...
G
Surety (if any) __ 0 r.) 6 ( ;
:n
Address: Amount of Bond $ c, v•
Ai .>
Telephone No: Fax No: (' 1 ,
Name and address of any person making a loan for the construction of the improvements (7''
C) O
C::
Name: ;o
a
Address:
Phone No: Fax No: `_
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documeiuis may uc
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(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):
THIS SPACE FOR RECORDER'S USE ONLY OWNER // ,. /
Signed:X b 2-) r • . Date: 7 ii� .2 a'i
Before me this 1 0 day of , i ` :j L/ in the County of Duval, State
— — — _ _ Of Florida, has personally appeared
e ��•u"r ck Personally Known: or
e e l ��"` , E.s PAMELA JEAN SHORE I L�� ° m — 3 • U
` Produced Identific tt m:
�� s Notary Public - State o1 Florida 1 Notary Public: r(✓r` L t% 7/
y J� g.5 M Comm. Expires Dec 4, 2017 I My commission expires: d 6, ZG2/
Azo Commission # FF 074537
•aura.
- BUILDING PERMIT APPLICATION -
- A: iii;
CITY OF ATLANTIC BEACH
j 800 Seminole Road, Atlantic Beach FL 32233
Office: (904)247 -5826 • Fax: (904) 247 -5845
Job Address: 1S 36 0 Cecinl i3 I vo( Permit Number:
Legal Description 1 D - l I I 6 3 ' ` d p i C /hp.,.1h A-4/ Llif" a/31 KG 1 1 RE#
Valuation of Work (Replacement Cost) $ /0, a00. t "" Heated/Cooled SF Non- Heated /Cooled
• Class of Work (Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial • - , - • .
• If an existing structure, is a fire sprinkler system installed? (Circle one): Yes 0 N /A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal •46
Describe in detail the type of work to be performed: Re (OD F' &A h ' t ""' ty 1 3 tVt 444 �n7.) I -i lex , f
Florida Product Approval # j- I ..S 6 gc) A L5 for multiple products use product approval form
Property Owner Information
Name: o m Pt to 14- C CA- k Ft..2.l 1 Address: ) 53 6 o(-eaiJ 1l....0 O
City GkA-lo.rvt- Z,, -C--k StateaZip 3 Z 3 Phone ' Ct — 81 Ctt - 77 q c
E -Mail 1
Owner or Agent (If Agent, Power of Attomey or Agency Letter Required) 0 k.)•) A. en._
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.
Contractor Information:
Name of Co mpany: _Ow fC- l.ao l� " , vj CO Qualifying Agent: � 1?'ylrkl 5 C
Address: g30 v. II f. viva* ;4I City f t II-vs v41`,"-.1 State Zip 3 20 to
Office Phone Xi/ • fg` 2- Job Site /Contact Number 22 G- a ys
State Certification/Registration # CCC o 51 811 E -Mail
Architect Name & Phone #
Engineer's Name & Phone #
Worker's Compensation
xempt nsurer ease Emp oyees xptration a ate
Application is hereby made to obtain a permit to do the work and installations as indicated. I certf that no work or installation has commenced
T or 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. 1 understand that separate permits must be secured for Electrical Work, Plumbing,
Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc.
Signature of Property Owner: . Signature of Contractor:
Before gie
this Day of yi i l , / - Before me this Day of
Notary Public: 0 A.' S ,l r�' : ±� / ' Notary Public:
iie ,
M Y C . Expires Dec 4.2
I hereby certify th. " 7t azgoffiellialm iU ptic. ''on and know the same to be true and correct. All provisions of laws and
ordinances gove - - - • - • - • ' . - • u • - e ith whether specified herein or not. The granting of a permit does not
presume to give authority to vzo ate or a e - p • • s of any other federal, state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16