367 6TH ST - ROOF y
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CITY OF ATLANTIC BEACH
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}� 800 SEMINOLE ROAD
� 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-1477
Job Type: ROOF PERMIT
Description: RE-ROOF - SHINGLES
Estimated Value: $11,640.00
Issue Date: 6/28/2016
Expiration Date: 12/25/2016
------------ --- - ---
PROPERTY ADDRESS:
Address: 367 6TH ST
RE Number: 169902-0000
PROPERTY OWNER:
Name: BOUCHARD MARK S & SUZETTE A, *
Address: 367 6TH ST
GENERAL CONTRACTOR INFORMATION:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD QA HAROLD KERTIS VOSS
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $108.20
Total Payments: $112.20
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PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
JUL-06-2016 15: 12 JACK WILSON ROOFING 9043967700 P.01/01
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
. 800 Seminole Road,Atlantic Beach, F:,32233
Office(904)247-5826 Fax(904)247-5845
lob Address: 3 VA W• Permit Number:
,egal Description i"•CSC -33 CjL.K,'t, cJA31.04'1- .ktc-. -,=c-� Parcel# \ D 9 q (Y - 606
J.) Floor Area of Sq.Ft. Sq•FT
�
Valuation of Work$ `\� J Proposed Work heated/cooled non-heated/cooled
lass of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Jse of existing/proposed structures)(circle one): Commercial --,
fan existing structure,is a fire sprinkler system installed?(Circle one): Yes No) N/A
'lorida Product Approval# l (4, 1) -- t4(tO.i • 1io l t,0,t
For multiple products use product approval form
)escribe in detail the type of work to be performed: Uxocc
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?roperty Owner Information:
Same: \U C�� .k v .1-r:.c, Address: J o 1 +a ti. '
ity l--k-A,<---nkL� '+ � StateV1 Zip -.S: ,--4:-. 3 Phone tct -- 0-) _" ` 61 4"
Mail or Fax#(Optional)
:ontractor Information: s(- ( \'
L'ompany Name: _ cs :lX, r-C. 1ti >r` Lr1 J ` Qualify g Agent: R-t—?. -` `� ,
Address: `'�5 � W. N'1..y -..hr City A * State VA Zip 3��� �
Dffice Phone �'i tib" \Cut,, -LS` ; Job Site/Contact Number Fax# 1014' act c., 1-10")
State Certification/Registration## CX-C,c� c1 3' <
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication is hereby made to obtain a permit to do the work and installations as indicated I cent&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 of six(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.
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.
I hereby certify that I have read and examined this applicatign and know the same to be true and correct. All provisions of/awe 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 any other federal,state, or local law regulating construction or the performance of construction. �/
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Signature of Own- /� //A -`"/ Signature of Contractor
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Print Name Print Name
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Swop}to and subscribed before Swo d subscribed be e ` ,
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this o Day of _ 2014 th ' p . .•"W'I .� -t •HE£i vc
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Notary Public .'`,,g,...;°6(-% omm . on # FF 044••p:,;,,.4:40.04: Commission#FF 0
. T .°, Notary Public State of Floridalld -a► v
•; ,n ;• . My Comm. Expires Dec 3,2017
°P °`• Bonded Through National Not ASSN' i`��` ��Through National IV(
"--_--;,,.-..-_,§),: Commission Commission# FF 044467
Doc # 2016151689, OR BK 17620 Page 2344, Number Pages: 1, Recorded
07/01/2016 at 02:57 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
•
NOTICE OF COMMENCEMENT
IPREPARE IN DUPLICATE) I1 �./�,�
Permit No. r� Tax Folio No.' �0 p ^lJ l)O
State of r IV ACt e--- County of 'f_�1 _
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain re I property,and In
accordance with Section 713 of the Florida Statutes,the following information Is state•In this NOTICE OF
COMMENCEMENT. I
Legal descnpton of property being improved: 1,1*( ) )I-( , �
�1 ll.�f1e tY[ 0,�l
Address of property being improved:3� L'�h , , pJ ��-j
General description of improvements: ( 1 uc
Owner Q �VA►l W ASS �^
Address L. le Xf1
Owner's Interest in site of the improvement 00(4c,
Fee Simple Titleholder(if other than owner)
Name •
Address JACK C.WILSON ROOFING
Contractor 4522 St.Augustine Rd,
Address Jacksonville,FL 392n7
Phone No. (9 &)„39 13ex No.
Surety(if any)
Address Amount of bond$
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 Fonda.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 Liana's No ice as provided;n
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's option).
Name ____
Address
s
Phone No. Fax No. (4,12.'4
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a cc n c
different date is specified): e
THIS SPACE FOR RECORDER'S USE ONLY rA' OWNER 1
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Wore ref this day et
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