696 Kestner Rd roof permit 1,:Ly
CITY OF ATLANTIC BEACH
j 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:
lob ID: 16-ROOF-2247
lab Type: ROOF PERMIT
Description: RE ROOF SHINGLES
Estimated Value: $7,000.00
Issue Date: 10/4/2016
Expiration Date: 4/2/2017
PROPERTY ADDRESS:
Address: 696 KESTNER RD
RE Number: 172382-0010
PROPERTY OWNER:
Name: GREEN ET AL, WAYNE & KAREN,
Address: 3842 COOPERS LAKE RD
GENERAL CONTRACTOR INFORMATION:
Name: CERTIFIED ROOFING CONTRACTOR
,CCC1328787
Address: 915 Cherry Tree Rd ST
Phone: 904-669-8411
FEES:
BUILDING PERMIT FEE $85.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: 589.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax(904)247-5845 (o_Ro F ZZ4
Job Address: 60qp SPS ytq Permit_Npmb r:
Legal Description/e fR5- 7L" /p9 ZCT/ / �I P�reselXr#t�14 Zp2322 -COIC)
-' Foor Area rf r;q t, Sq.rt
Valuation of Work$�proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residen '
If an existing structure,is a lire spprin er ystem sstalled?(Circle one): es o N/A
Florida Product A proval# /O f / /
For multiple products use product approval form r
Describe in detail the type of work to be performed: T
Prooertt//y O�wner Iufa m+ation: / t' -
Name:�fdC2.111 Gr2R�rl Address: �8�r� 1C.. —�o-r—i�l
City�a t State�ip Xd Phone ?QY- . I S
E-Mail or Fax#(Optional) \ _
Contractor Infor/m�ation:L CONTTR�ACTOREMArL ADDRESS: 'r (2i V
Company Name: ( 1L-+�l� l tuns �j��_Quali 'ng gent 1, 5
Address:Ql.S ry 'T 1201 City - U State Zip
Office Phoneu G• r Job site/Contact P?umber -8 G Fax#
State Cerarication/Registration# r"r ( 5A.V7N7
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 apermit to do the work and installations as indicated. Icen fy that no work or installation has commencedprior to the
issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in this jurfadtch'on This permit becomes null
and void jwork is not commenced within six(6)moods, or ifcomtruction or work is sus ended or abandoned for a period afsix/6)months at any time after
work is commenced. I understand that separate permits must be secured or Elecirim Work,Plumbing,Signs, Wells,Pools, unurces,Boilers, Healers,
Tanks and Air Condithoners,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.
Iherebycertify,thatlhave readand examined this powned lication andkn.the same to be true andcorrect.. Allprovisions oflaws andordieanesgoverning this
type work work will be complied with whether sppeci ted herein or not. The granting ofa permit does not presume to give authority to violate or cathe
provisions ofany other federal,state,or local iew regulating construction or the performance ofconstruction.
Signature of Owner Si ture of Contractor 2—
' R L /
Print Name Name ._._....._........._L.........1....... ._. .5
lC�v�_n.._6....... r....e...n_.............. s 1`
Befo e \ f
his Day of ('Y'_tLo D-�.� 20 jj
W 8 kgs crDay of 20
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etOLCLtosW. y�r` ` t u is
atfrrl 41 a4�o rn
Revised 01.26.10
�RYlpira 3lTd rlrCa ♦�a I
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
*1. D scription of roperty(legal dQscgion gf p open a address if availabll
�/Ct tS �t� � r IzC1 VNlun�le c^eLl rL / JRg��'�9/ •1 Cid1J�
#2. General Description of improvements: "� •� ��— I' CC Q 2 IZ
�cQ /�mo ism »a
'f•3. Owner Information: K_C1 rem �'� , ��� � 9 I��` rp
a Name and Address: EF2/ l � X I'(_
b)Interest in property: rn E
c)Name and address of simple titleholder(if dther than owner):
P #4. Contractor Information•
I a)Name and Address:
,�` �
b)Phone Number. QOC/'�/' C'{- _
5. Surety Information:
a)Name and Address: N m�a°229ages:809 ,OR BK 17732 Page 124
b)Phone Number: Recorded 10/042016 at 01.19 PM,
c)Amount of Bond: $ Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
6. Lender Information: RECORDINGs10.00
a)Name and Address:
b)Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herwlf, Owner designates _ of _ to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
SECTION 713 13, FLORIDA STATUTES, AND CAN 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 ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stat
ep ,\
therein are true to the best of my knowledge and belief. IWC
` fLA tyA IJ L/I �'g n l«ren �, � n
Signature of Owner ' '
r skAuthorized Of icer/Dimctor/Parmer/Manager Signatory's Printed Name Title/Office
The foregoing instrument was acknowledged before me this�r _day of �0 ,201(aby .C� otp 6��77 as / for
(Name of Person) (Type of Authority,i.e.Officer/Attorney) (Name of Pang Instrument was Executed for)
44� Rarr Fuar sur a Fru. NO Y PUiB IC, STATE OF�FLORIDA I
MY Ciesr Lee iFF1o.nim lf' �^� l25fAl— )i C7J
J r]ererrer36"111ea Print Name: XVI\t
q,J� E+wx0]QYlOtF
asonally Known
tification/Type: LI C4-.✓) n
(Affix Notary Seal Above)
Revised 3/15/12