359 19TH ST ROOF PERMIT 02" CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1 396
Job Type: ROOF PERMIT
Description: RE-ROOF SHINGLES
Estimated Value: $11,360.00
Issue Date: 6/20/2016
Expiration Date: 12/17/2016
PROPERTY ADDRESS:
Address: 359 19TH ST
RE Number: 172020-1324
PROPERTY OWNER:
Name: RICHARDS, STEPHEN D
Address: 359 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: COLLIS ROOFING INC
Address: 485 Commerce WAY
Phone: 321-441-2300
FEES:
BUILDING PERMIT FEE $106.80
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $110.80
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACII ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
ATLANTIC BEACH
PERMIT RECEIPT
r 1,69,
PERMIT DESCRIPTION: RE-ROOF SHINGLES PAID
PERMIT NUMBER: 16-ROOF-1396 JUN 20 2016
CITY OF ATLANTIC BEACH
ADDRESS: 359 19TH ST POSTED TC)COMPLITFR
OWNER: JUN 2 () 2016
DATE ISSUED: 13A
CITY OF ATLANTIC BEACH
FEES DUE: 800 SEMINOLE RD
BUILDING PERMIT FEE $106.80 ATLANTIC BEAC,Fl.32233
06/20�2016 09:15:50
CREDIT CARD
STATE DCA SURCHARGE $2.00 VISA SALE
Card WMXW3980
STATE DBPR SURCHARGE $2.00 SEQ#: 3
Batch P: 153
INVOICE 3
Approval Code: 800251
Entry Method: M&WI
Totals: $110.80 Mode: OnIhe
Tax Amunt: $0.00
Card Code: M
SALE AMOUNT $110m
CUSTOMER COPY
06-15-' 16 10:16 FROM- Collis Roofing 863-682-5757 T-2110.'_:)� F'1)OO''/01`1`12' F-47-3
DUILDING FERMIT APPLICATION
CITY OF ATLANTIC 13EACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 359 )9*hS4re-o-f /AeP7L7 r- 8,e4chl�rniit N
rber
rl;+
Legal Description 50--1 b 61-,25-AC Sel0a% Parce14 )*7a6A6)-3A4
zn JA.L-3uo C�� Floor Area of Sq.Ft. S q.Ft
Valuation of Work$j Proposed Work heated/cooled 4Z55" - non-heated/cooled
Class of Work(circle one)* New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)f�ircle one): Commercial 2e;sid:e:n�fial
es
If an existing structure,is a firg sprinkler system install&d? (Circle one�: e$ 0 N/A
Florida Product Approval 4 5
FL 101 V4.
For multiple products use—product approval Win
Describe in detail the type of work to be performed:
Property Owner Information;
Name: 3ii—Agn Address: -359 19 �2t-
City B40-ACk-1 State ip 3Ra?13hone
E-Mail or Fax 4(Optional)
Contractor Information-
Company Name: ?a Quali4ring Ag t: cc rl�c t-
Address.`_6_1� C ity mzrt-ts te Zip 0
Office Phone 111'
Job Site/Coni�ct Number
State Certificatio Neggistration 9 CC(,0- 5 9101a A
Architect Name&Phone 4
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 certiA,that no wor,k or installation ha.7 commenced prior to i
issuance�f'a permit'and that all work will be performed to meet t1w standards of all laws regulating construction in thisjurisdiction. This Permit becomes n
and void if work is not commenced within six(6f months, or if construction or work is suspended or abandoned f6r a Period ofs4x months at anv time at
work is commenced. I understand that separate permits mu.Tt be securedfor Electrica[Work, Plumbing,Sijns, Wells, Pools, rnac F,
Tanks and Air Conditioners,etc, 91, e, Boilek. Reate
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN VOU-R-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 here certify that.1 have read and e ined th' It t'on and know thesame to be true and correct. Allprovisions oflaws and ordinane ern.i t
4,pe ol�lwork-will be co�nplied wit wheth§131 'e"C',T11§1h19!11in or not. The granting of a permit does not presume to give authority to
p
,r)rovi��onsofanyotherj'ederal,,4at , r I Cal am,regulating construction or the peFformance ofconstruction,
0
Signature of Owne Signature of Contractor
PrintName LxAtl
..................................I..................... ---A/................VC.................. .
......... ... .................... ...............
Swor to and sub 'bed befo me Swort
'n Al 0 �jto and subs�c�bed before me a
this Day of 2WO this L 7_3 LAYl-C
nu u 9cr 0
1 s 13' e(I beToTe
'r lob ay of Day of,
A NEA,
b c A taryrubliv-
f;�6tary VU lio Not Notary Public-State of Florift
ComMj$r
.10T) # FF 1.0.6448
MP
Commission FF 196448
�,V �Ay Comm.ExPi(es V;ay ca
P
ilt� .1
My Comm.ExplreS Mag",
�j ,OF f Bonded throu0,Nr;'
Bonded throup Natioml Not Assn,
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE,
Permit No. Tax Folio No./ 7Qz1 ,Q,0/34z/
State of Florida County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:3,to—"?to 5e t()o-
Address of property being improved.
_;�5CA
A41o,"-VL,� �A , C-( , a
General description of improvements:
Owner
:��I
Address "O�,46� �Seac� ,E
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Collis Roofing Inc.
Address 5750 US 1 North St Augustine FL 32095
Phone No.904.810.9657 Fax No. 904.810.9663
Surety(if any)
Address Amount of bond$
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 owner 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 as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
4,,
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 E
Co
C,
to
Sig �, V
Before me this day'of C)
in the
County of Duval.STale of Florida.has personally appeared ;T
Doc#2016136020,OR 13K 17 599 Page 4-44. herein by
himself!herself and affirms that all statements and dec'arations herein
X Ff
Number Pages are true and accurate Z.
16 at 03�37 PIVI,
Recorded 06115120
onnie Fussell CLERK CIRCUIT COURT DU'xJAL
R 2i
M
COUNTY 3�
.00 CD
RECORDING$`10 9.
arge.State of rL, County of .16
ca
My commission expires: CL
Personally Kno�.-.,n r A� co so
Produced IdentificationP L 0 4,14 5 9PM