121 JASMINE ST - ROOF rS, CITY OF ATLANTIC BEACH
2800 SEMINOLE ROAD
K . _,_. ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
9131_,--99%r"
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1762
Job Type: ROOF PERMIT
Description: re-roof shingle-to-shingle
Estimated Value: $5,200.00
Issue Date: 8/4/2016
Expiration Date: 1/31/2017
PROPERTY ADDRESS:
Address: 121 JASMINE ST
RE Number: 170849-0000
PROPERTY OWNER:
Name: GILBERT, JOSEPH & NICOLE, *
Address: 121 JASMINE ST
GENERAL CONTRACTOR INFORMATION:
Name: HAMMER TIME ROOFING
Address: 13465 SOLEDAD CT DR ANTHONY BETANCOURT
Phone: - -
FEES:
BUILDING PERMIT FEE $76.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES ANI) THE FLORIDA
BUILDING CODES.
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;�i"`''''r BUILDING PERMIT APPLICATION
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'�"'r CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
:tl>' Office:(904)247-5826 • Fax:(904)247-5845
Job Address: 1 d I TGsm;mc, 5-I-. Pe it Number: R9_ 0,00 -11-(0?)-
5 P Cot- S di IS
Legal Description It-39 3$-, s-aq�.e y A+lar4+c gogch Sec/I RE# 1-161-1,gt- 0060
Valuation of Work(Replacement Cost)$ 572 0 6 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one)- New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed struc e(s)(Circle one): Commercial Resi s entia
• 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 performe :
6 - 4,6c 5Airvd. 5i i i frie
Florida Product Approval# s f2%79./44/ k-/ 15a)l . 1 O for multiple products use product approval form
Property Owner Information
Name: is f )`)h&C - Address: /01 3 c6m�lle 54.
City • ■' '. h State FL a.Zip 33 Phone 90(4-1-n-.1 SSI
E-Mail t I r"+.j 13 t Rvtnq . Ca vv
Owner or Agent (If Xgent,Power o homey 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:
y;:t }°p LLC Qualifying Agent: Arik rt /rout(7
Name of Com an /G/n/�rr l✓>7�e � yy
Address: !3Lib `Solecdccl 64 City )UdisonW I)4 State/Zip 1 J ?a-g-0-1--/
Office Phone (9 oL f)7l(;-9/9 q Job Site/Contact Number ��' , I
State Certification/Registration# CCC 13,0995 E-Mail I cam:;67-4 e, /(�ham-[ r ){ ya1/• CUA
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensations -{•1 su(o PC e
Exemp re / 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
nor 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.
"his permit becomes null and void if work is not commenced within six(6 months, or if construction or work is ended j abandoned for a
period o fsix(6 months at any time after work is commenced. 1 •#• r t separate permits must be secure,fr r Llectr"'1 ork,Plumbing,
S ns, Wells,Pools,Furnaces,Boilers,Heaters,Tanks and Air t,n, toners C.
�; -15 n A
Signature of Property Owner: :14.-.1 ~ Signature of Con��
Before me
�� Z� l cr-,
this 3r'�•Day of A A. .t ....... __
_ . u. Before me this ` D Ti
R _......_,
Notary Public. A L,.-_-_i- /_ •7 !i �ce � E : Notary Public: --- � I� -
n 1 the same to be true and .+ r ro ' 'onDC 5'8RGERind
I hereby cert that I have read and examined this applicati��� �:"''.. P �
ordinances governing this type ofwork will be complied w"i ti r r .•ecified herein or not. ;,_''.,4;• tpgr�ra aassiowtl 4sbmt
presume to give authority to violte or cancel the provision . j)i7r i federal, state, or local w;r i rng pr !cr te72otbe
performance of construction. " ?p:d'W BoddThru Notary PubicUnderwiters
. .... . .
[�j NOTICE OF COMMENCEMENT
State of '1"lDC:CI CI County of ,OLofA f Tax Folio No. )) d89 9-(Y)60
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 OTIC OF COMMENCEMENT.
Legal Description of property being improved: Ig—3 '$- .3— �9j'4-, (Jc'L/
44 -i c �PG Sec H S ziD-FJ Zc�1 .5' � E
Address of property being improved: 1,,,p) J ..5ryliri P 3. / '/Q, i( /9, (1,-, / 3)-,:a33
General description of improvements: t""- tis �h'
Owner: ,)cyyrr? g)c;1& 4- Address: /..2/ Tale/v rte 574/er4- 4 'ch 13')
Owner's interest in site of the improvement: ? i,Actry 1-1.31de_vt02, -'
Fee Simple Titleholder(if other than owner):
Name:
. M c7J7Jz
v
Mj . 7 � LCfr Contractor: l/ ry ozwag
^,)c ke J0`� z . $
/ QAddress: to 1P ,G 'kJ
Telephone No.: 7p��� Fax No: ��
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o r8—v
Surety(if any) g m 8 0
Address: Amount of Bond$ 53 w co
Telephone No: Fax No: c> 8
Name and address of any person making a loan for the construction of the improvements g d
co
Name: -1
N
Address:
Phone No: Fax No: r
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):
Nril
THIS SPACE FOR RECORDER'S USE ONLY 'to WNER
Signed: 4..-- 1I Date: SA/16
Before me this Ara, day of S4 in the County of Duval,State
40,
Notary public State of Florida Of Florida,has Dersonally appeared , h C i lbe r4-
a� Ptr,; Nancy mL Masten PersonallyICn or
My Comission FF 232574 Pro uce Identification:
Expires 06/26!2019 Notary Public: C�..4t. ,( 7 Ct4 i
pa
My commission expires: (p( (,/cz)CI CA