421 OCEANWALK DR - ROOF PERMIT i1 r.i
•
f 0 FEB 0 8 201 J
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CITY-0 0 ' .".4":""we
ROOFING PERMIT APPLICATION
74414Date:
Job Address: L IZ% Dee* ,iit - by, S c'L 'S22��
Owner of Property: $.. lµ•c Lv IA o���
Address: 5611.-Ph Telephone: 8 x,3
5 3 - 5
Per
Roof Contractor: r e �r ��- K-n.ac (L� State License Number: C. V51 654
Contractor's Address: 2255 Marc*-4r QR- Or feo FC 52.Bo"1
Telephone: go/ -2(0- /50S Fax: 3 2 I -2 3 9 - 1913 Email:
Scope of Work: RC-(-ooE Roofing Material SW•AdoLia.
FL Product Approval# 5 Lk t44 Valuation of Work: $ 1S42.$ °
Required Inspections: Sheathing/In Progress- ry In /Final
If re-roof: Assessed Value of Structure: <$300,000/_>$300,000;Roof-to-wail improvements required?
(Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED
ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTOR BEFORE RECORDING OUR NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: / /416,- Date: CZ -03 'l0
AS TO OWNER: r
Sworn to and subscribed before me this — day of -f S• 4 ,20 LC
St., • • lorida,Cc�ggpi(ADMIf ,
??" NOTARY PUBUC Notary's Signature: (
ter.• STATE OF FLORIDA ❑ Personally known
n_tar C. Produced identification v ���
` omrn#D00925944
Explrots 9/16J2013 ype of identification produced ''1J{Z- - � IO'S J-261(o-
SIGNATURE OF CONTRACTO Date: 2/5/1 0
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of 20 /0 .
State of Florida,County of Duval , nn /i
Notary's Signature: /ai2u.X�( C'
KATHLEEN ANN CASEYPersonally known
. Produced identification
���;,p�.:-., Comm#DD0676201 • ❑
'�'~, �= Expires 9113/2011 Type of identification produced
;Aco f` Florida Notary Assn.,Inc 800 Seminole Road•Atlantic Beach,Florida 32233-5445
•
Telephone: (904)247-5800•Fax:(904)247-5845
F:\roof permit applicaton.docx 7/28/09
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
•
Permit No. Tax Folio No.
State of fL/R:•A County of Qi/VG/
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: fe- {o
Address of property being improved: `AZ I btu :on\xi& I K OR; 1L 55
f-rt,.ekvitc B-k cf— 3z233
General description of improvements: t(L" if bo(
Owner fAt, C,r kk e 4 t L y -3;749 r)-a-IC(
Address `4 Z I attCt.•., 'AJ&kk lOR.Nt 1h ATL i3c.k Ft 3 Z z 3 3
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Y\Contractore/� v A G v)(9- V2-00 .n!� Li 5 6"'"{D
Address U 2 s t -N a 1/8-
q y
Phone No, (!�4 Z Z �C - 310 z� Fax No. /D J I - I ( L I
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. o t
Name D
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom no or
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.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a U 0
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER j LL m
/ m
Signed: m••W� A L SLI.I. Q kr/DATE
Before me ; •^' day of 0 • in the
• C. nly,ofDuval, tate of Florida,h: .persona a•• .red 03 2 Q
Doc S 2l1)002o02O,Oh(l3K 15)44 rage.1349. .rl ` - - -' ■ herein by ,Q !—
himselfr herself and a .s that all statements and•edarations herein to
Number Pages:1 are true end eccurat=
Recorded 02'032010 at 12.43 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00 47AIL•4111
Notary PubAt Stat ..county of_.1Xt� � ;, •''i
M commission e
My :
_ _. .__ _ ._. • PenProduced ucallyIdentification ♦Krwwc _ _.. — —°rC•"):SSiir
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r , CITY OF ATLANTIC BEACH
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,4°619'"
• 800 SEMINOLE ROAD
• ATLANTIC BEACH,FLORIDA 32233-5445
• Telephone: (904)247-5800
• Fax: (904)247-5845
• www.coab.us
FAX
To: -7e _ Fax #: /" .32/ -2_3 -79 73
From:
til/
'-'21- a/44' Date: �
Pages: / Re: L4t /1---e--. 71—yairgent El For Review ,Please Reply
Notes:
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A
lary1:7
THE CITY OF ATLANTIC BEACH
BUILDING INSPECTION DEPARTMENT
ROOFING INSPECTION AFFIDAVIT
Re: Permit# (0 —f�
I, ,`c-H•[a 4x0 1/21.AtA)s S , licensed as a �., ,RAt Contractor*/Engineer/Architect,or Building Inspector*
(print name) (print type)
License#: C- 59(054 -4 CCCO5765if
On or about c j 2:Okt did personally inspect the roof-to-wall connections as required
by Rule 9B-3.0475 at t\ \ Dc e J@ Ttr ,
(Job Site Address)
•
Based u n that examination I have determined: (circle one)
The roof-to wall connections were installed according to the Hurricane Mitigation Retrofit Manual
(Based on 553.844 F.S.)
I made the necessary corrections to comply with the Hurricane Mitigation Retrofit Ma f`9
Signature
A
STATE OF FLORIDA
COUNTY OF 9
Sworn to and subscribed before me this day of gLJ11-7 C'
,20 O
By &CU A-I L. dA-i/J�� , r
,....: KATHLEEI ANN CASEY
Nota Public,Stat of • •rida
w`,"Tp4 :omm#DD0676201
A.00.P
aires 911312011
'Vey.�g' riond6 Notary Assn.,Inc (Print,type or stamp name)
1.47--ut&L.JUAN - - V
Commission No.:
Personally Known x or
Produced identification
Type of identification produced
*General,Building,or Residential Contractor or any individual certified under 468 F.S.to make such an inspection. This form must
be on file at the Building Department prior to calling for a Hurricane Clip Inspection,
F:\roof permit applicaton.docx 7/28/09