640 PALM AVE - ROOF S \11\
/fr \s\ CITY OF ATLANTIC BEACH
r ",, J 800 SEMINOLE ROAD
J 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-1419
Job Type: ROOF PERMIT
Description: RE- ROOF
Estimated Value: $5,200.00
Issue Date: 6/21/2016
Expiration Date: 12/18/2016
PROPERTY ADDRESS:
Address: 640 PALM AVE
RE Number: 170439-0010
PROPERTY OWNER:
Name: WHALEN III ET AL, ALBERT G
Address: 640 PALM AVE 640 PALM AVE
GENERAL CONTRACTOR INFORMATION:
Name: LEAKBUSTERS LLC ROOF
Address: 6040 NW GEORGEWOOD L QA CHARLES KEVIN PEGRAM
Phone: - -
FEES:
BUILDING PERMIT FEE $76.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND TIIE 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 1 1 ( -Roo F - 14 ( 9
Job Address: 640 Palm Ave Permit Number.
Legal Description Parcel#
Floor Area of Sq.Ft.t. Sq.l't
Valuation of Work S 5200 Proposed Work heated/cooled non-heated/cooled
Class of Work(cirde one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro structure(s)(circle one): Commercial Residential x
If an existing stru sprinkler
re,is a fire system installed? 'rclee,: Yes No N/A
Florida Product Approval# fl 1956.3 L 'e e
For multiple products use product approval form
Describe in detail the type of work to be performed: reroof
Property Owner Information: /
Name: SA-1-1- AIR 1-1
AIOU`'� S 1 N4- Address: )-2-6 TAIA-1,Ntee4 ¢✓J
City i 41 3a. Elm StateeeZiP-52.1.52Phme 90 L/ -333 -4 k?7
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Leakbusters 1k Qualifying Agent:Charles K Pegram
Address: 6040 George wood Ln.W City Jacksonville State Fl Zip 32244
Office Phone 904-778-4377 Job Site/Contact Number _ 904-334-5559 Fax#904-772-6682
State Certification/Registration# ccc1328512
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 I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be pe onned to meet the standards of all laws regulating construction in this jurisdiction_ This permit becomes null
and void IT work is not commenced within six(6)months,or if construction or work is suspended or abandoned for ape nod of six f6)months at any time after
work is commenced I understand that separate permits must be secured for Elect,wat Work,Plumbing,.gni,Wells,Pools,turnacrr,Boilers,Heaters
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 FINANCINGCONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO1JR NOTICE OF
COMMENCEMENT.
I herebycertify 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 ofworkwill be compli . 'di whether specified herein or not The granting of a permit does not presume to gyve authority to violate or cancel the
provisions of any other fed . "Ie.or local law regu 'g constructs n or the performance of construction.
0111
3
Signature of Owner Signature of Contractor
Pri Name O(o r e c-IS Q() '
S« Print Name hUr le V �j Cci!`u r✓\
cad sur c r are me
Sw, rand ubsc y �� .r�y e
thi Day of Iaki` �v 20 1 this I of 20
o ry Public � No : •••.n:
Revised III 6.10
+'. 70NI GINDLESPERGER .
a'e',t` ru = MY COMMISSION t FF 924951
- EXPIRES:October 6,2019 _
r•,'�dr' Bonded Thru Nosy Pubic Underwriters TONT GINDLESPERGER
f*: .+ t4 MY COMMISSION a FF 924951
t-,%,.,°2-.,ie EXPIRES:October 6,2019
.''f f3,', / Bonded Thu Notary Pubic Underwriters
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of County of
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: 56c". �Ct V See Z e I/2 �� ,:i ;�3 1 QQ``/L/
Address of property bung improved: "1 O :A.L At/
NLS C
General description of improvements: ' I,.-,. / F1,,��
00
N Gw F-
Owner S/kl,t At R- 14014,4
Address 7-2 6 •al ter tvoc ( .�A X gcL' -32-2g0
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor L C
Address 60 itU WcTvJ W /�}`A 322E ff f
Phone No. 76L(- Fax No. 901i�— '772 66 S-2--
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 1)0J A
•
Address `J/,LL
Phone No. Fax No.
In addition to himself,owner designates the following person to rece Doc#2016117893,OR BK 17574 Page 522,
Number Pages:1
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Recorded 05/25/2016 at 12:02 PM,
Name Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Address RECORDING$10.00
Phone 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 •WNER,, ^�
Signed: Of "tet ( DAT �_15_`N
Before me Ai,day of As i • 4110 - in the
4
County of' - State of Fl da has•=rsonall appeared
' 3 411. h erein by
himself/he nd affirms t'. nts an•d• laxations herein
'��""f%''•. TONI GINDLESPERGER are true an, urate ��
' o's
_„ v ..: MY COMMISSION II FF 924951
EXPIRES:October 6,2019 •
1:4f Nd:' Bonded Thnr Notary Public Underwrters - 11111 r
i \
Notary Public at Large,State of County of •
commission expires:
- onally Known or
Produced Identification