1955 Main St re-roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 16-ROOF-2377
Job Type: ROOF PERMIT
Description: NOC REQUIRED - re-roof
Estimated Value: $5,200.00
Issue Date: 10/21/2016
Expiration Date: 4/19/2017
PROPERTY ADDRESS:
Address: 1955 MAIN ST
RENumber: None
GENERAL CONTRACTOR INFORMATION:
Name: Palm Island Homes, Inc.
Tommy C.LopeIz,CCC1329450
Address: 2294 Tyson Lake DR
Phone:
FEES:
BUILDING PERMIT FEE $76.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $80.00
PERAHT IS APPROVED yLY IN ACCOMANCE WITH ALL CITY OF AT�IC REAM ORDINANCE!I AND THE FLORIDA
BUILDING CODES.
BummNG PERwr APPLicATToN
Crry oF AnANTic BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5945
lb -"Or - a I-I i
JobAddress: 1� 55 r'\Fr6q ST ATLA.,h', A,.� 'tLJ33 Permit Number:
Legal Description Parcel
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work S D 0 Proposed Work heated/cooled non-beated/cooled-
Clam of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa windowlilmy
Use of existing/proposed al.act re(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one)�: �. N,. (H3
Florida Product Approval# R io,56 -s LOMAJrV Fl- 09-106 )1,0,5- :5;r,9N/qo FL
For multiple products use product approval form
Describe in detail the type of work to be verformed: RE - koof--
PraveM O"or Information:
Name: Jae, ,,�/ e- d.., Address: 15634116f- AI-46-1 S7-
City Ar1-4Aj(rIC 404�h �Z-P_2jj&LPhoae '94 K- .5 5-3 - Y/6 0
E-Mail or Fax#(Ophonal)
Contractor Information:
ContpanyNamc: I'PIn -TOAND Tr4e-, QalifyingAgent -T-nm�q C . LOPCZ-
Address: ZMLI I',ror-s L�k� Dr City _Stde Fi zip3-zz-zp
OfficePhone Job Sim/ContomNumber-9VV- 646-3,VSV Fax#
StateCertification/Registration# C-C-C- 13Z9 '450
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and
Address
Bonding Company Name and
Address
Mortgage 1,ender Name and Address
Application is hermby mmle to obtain a permit to do the work and insuaUalimu,m imifeated I cerrify that no war*or installation has commenced
Uto the issuance of a permit and that all work will be gd1broved to meet the stemakurai,ofall laws rnlulatipg constructum in thisjurisdiction,
perout becomes null and mid if work is not commem,e within six (6) months or if construction or work is sespeded or abandamoijor a
(XrIh wed, I understand that separate permits most be seeuredf,,r Elearical WerI4 Plumbing,
F.Y,:==ktW.;,kZ Tca—nb andAir Condlub.,r;a,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
UWPROVEAVENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING,CONSULT WITII YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
I hemby mnify that I ha�mad and�wd thu appla�afion and k�the saw to b�tt�and cmmet. All P�isions ofla�s and ot�douwes
7hed w�,�r.pect�,,ed - - a' The p,�..l to gm�authority to
g=.i-9c=?'hApf1=,1W-"fU &'f�:',h 4 rar a!'�,;1au;goas tZ;t'; f ha�
Signature of0wner SignatureofContractor
Print Narne Print Narne
S t and subwri to Swonv7 and subscribM behmme
v 20 //p' 6i, )f 20 11f
this Day of
�S=Y�
Notary Publip
Nofgy Pb#c
ELIZABETH RAMOS-LOPEZ Le,!'�-�ELIZABETH RAMO�S-Aff 01.26.10
&f. MYCO�SSIGNNFFW�
MY CO�SSJONNFFMM r!�_.Wig
M:F��24.2018
�]6E
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATr)
Permit No. R til P1OOr- 23�� Tax Folio No.
oune Or 1-- (012-D A County of pw� Fj�
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
JIPG A: Y 5,4,6r1,'v1.E ;oV
Address of property being improved:
5�5' 1WQ1�,j all 05�L 2y Z2
General description of improvements:
Owner 0�qy/.o
Address ZZLS /?�Z-,"h� &±S� 32 2!.z,!
Omer's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor-Rbo iE�A�o 1,"es 2'w�,
AddressZ-2-�!Z :Z�Twj L-Q�- pc .52�x E2 322ZI
PhoneNo. Fax No.
Surety(if any)
Address mount 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 Florida, 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 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
different date is specified):
-------------
THIS SPACE FOR RECORDER'S USE ONLY OWNER
I
Signed: �6 DA
Before me-.I, .:lay of
Coul wfD,1d,UrfFI d
I I �n m.n.ily Ppea h rein by
'"Tal herself and affirM5 that all statarra, h,and declarations herein
�5'n "3
2�xate
Coo#1MD1 6242983,OR BK 177W Page 2m3l o. are 7twe and amurate ELIZABETH RAMOS-1,90ga
X=
NumbW.pal I
n
R.Mirded!1 Y21/201 a at 01.39 PM,
CL Cl CUTr C 'T'UV
Ronnie Fu
.._�aaall CLERK CIRCUIT COURT DUVAL
COUNTY 4AZ -
ry
RECORDING$10 00 No Awublij att Lame.state of u
'a
My wMirrission"Pires
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Pemonally Knoa,ri 7L or
Prooll Identification