310 4th ST - ROOF f
' '' `S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
;` ATLANTIC BEACH, FL 32233
\` Y INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
----------------
JOB INFORMATION:
Job ID: 16-ROOF-1210
Job Type: ROOF PERMIT
Description: RE-ROOF - SHINGLES
Estimated Value: $7,500.00
Issue Date: 5/26/2016
Expiration Date: 11/22/2016
PROPERTY ADDRESS:
Address: 310 4TH ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: SUNBELT
Address: 1467 Tama Ran PI ST
Phone: 904-635-7019
FEES:
BUILDING PERMIT FEE $87.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $91.50
I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
j,,,,,
sr� BUILDING PERMIT APPLICATION
j:i, CITY OF ATLANTIC BEACH
._ r
800 Seminole Road,Atlantic Beach FL 32233
-`,'319r Office: (904)247-5826 • Fax: (904)247-5845
1 (0—ROOF- )1 10
Job Address: SIO V44
5-4 614„ ), <. 13 .ct. . Permit Number:
ark 1
Legal Description < -6 el l(, tS-191.' AIL I,'J E Q t:A cn WI ( RE# 16 9)1 it. -00 o 0
Valuation of Work(Replacement Cost) $ ? add J 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 Residential •
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
.• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
(ILA ool% Skii. ..) ct ' fib JPe-el
I} .
1sJCtC
Florida Product Approval# P 1 /. l 91 S S , I :4/.l s4.,,h A nib',r for multiple products use product approval forst
Property Owner Information
Name: S// e_ca n-ie Address: 3 Id 3 Sf
City a)/ark , is c 8e.4 c k. State f ZZip 3,29/33 Phone '3 S o?- a.a.- 1-1/Z
E-Mail
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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 Company: S(Ad 9/E l.'( 1-rumk,s b R uo fi,iC LLC Qualifying Agent: 1 opyt .i Q S4)flrl
Address:ySo-Iu() Sri, l ^Jr-40S City 3 f S4 1N,1 (t_ State Zip 3 2 tS<)
Office Phone c)011-6 f-io ici Job Site/Contact Number %)'-i,631'-- '10)0)
State Certification/Registration# CCC 13 Z7 6 8 i E-Mail S4.,niaet.f C ANA 1404.E► Q A u1.. Co.4%
Architect Name& Phone#
Engineer's Name&Phone#
Worker's Compensation o lS t,i
Exempt / Insurer / Lease Employees / Expiration Date
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 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 o jsix(6)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,Heaters, Tanks and Air Conditioners,etc.
Signature of Property Owner: __ _ ,. _ - Signature of Contractor: j.," I\./----
Before me
this 1,9-',Day of t'h, i ,a. ;t me this 2 3-� o . _ _
I\
THOMAS BRAD 'T . No• rub State of Florida
NotaryPublic: JA I, •`• �'►Y COMMISSION#EE224705 / k Z. anon
, •:ar} Public: :a i �..t...,... :6
53
__103 f � of n.' Expires 06/03/2018
I hereby cert that I have read and examine t Ifs application and know the same to be true and correct. A 1 provisions of laws an
ordinances governing this type ofwork will be complied with whether specs/fed herein or not. The granting of a permit does not
presume to give authority to violte or cancel the provisions of any other,federal, state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
•
NOTICE OF COMMENCEMENT
State of J t..)R i m County of 0 L v A L
Tax Folio No.jiLcila 0 0
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: - _
9� Aft. N � t`ur S Ql Sr
Address of property being improved: 3I0 4/1'6 S f
Gn 5 FL 3aa31.
General description of improvements: 0 ,
Owner: 6 ;1/ 8 e�.6 n/e Address: ►J y Sr T
k.Owner's interest in site of the improvement: T�' Q �� 3 Z 2��
Fee Simple Titleholder(if other than owner):•
Name:
Contractor: S N Q L(,j' VI J;yl LJ
L T1-10
Address: 4<O- i (, S ft 11 ^.J yl &1 S (r 3v h t fit,
Telephone No.: (, S-)U►S Fax No:
Surety(if any)
Address:
Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the im Doc#2016118421,OR BK 17574 Page 2075,
Name: Number Pages 1
Recorded 05/25/2016 at 04:02 PM,
Address: Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Phone No: RECORDING$10.00
Fax No:
Name of person within the State of Florida; other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
. Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1) year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
x
Signed:i •v-- Date: S •1.1'
Before met s 2,}% v day of (n A'i 1.•.),t, in the County of Duval,State
OfF .. •ersonallyappeared J •rct. !tl'GAN+t.
ersonally n:
• od ;. 'entification: or
Notary Public: �� • SMITH
My commission expires: ' - BRA•. ,. • #EE224706
.� EXPIRES August 22.2016
��� pk, Np{gy$ervi0l.COnl
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