74 W 4th St roof permit �3 CITY OF ATLANTIC BEACH
;l 800 SEMINOLE ROAD
V 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-2433
Job Type: ROOF PERMIT
Description: re-roof shingle-to-shingle with self-adhering underlayment,
30-year architectural shingles
Estimated Value: $3,600.00
Issue Date: 10/28/2016
Expiration Date: 4/26/2017
PROPERTY ADDRESS:
Address: 74 W 4TH ST
RE Number: 170826-0000
PROPERTY OWNER:
Name: COX, RUSSELL AARON
Address: 14003 TOMAKA RD
GENERAL CONTRACTOR INFORMATION:
Name: PIMENTEL ROOFING INC
Ramon O. Pimentel,CCC1330935
Address: 321 4Th AVE
Phone: - -
FEES:
BUILDING PERMIT FEE $68.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $72.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32237
n Office:(904)247-5826 a Fax:(904)247-5845
Job Address: /L / ��SY' Permit Number: (b—"0E-a%(3
La /��.fdRE#
Legal Description /k:T�/7 - 2 S-a Sk f)7�t<�
Valuation of Work(Replacement Cost)$ _ d0 Hested/Cooled SF /& Non-Heated/Coaled
n Class of Work(Circle one): New Addition <Alteratio Repair Move mo Pool Window/Door
a Use of existing/proposed structure(s)(Circle one): Commercial ---;deride
a If an existing structure,is a fire sprinkler system installed?(Circle one): a No
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 performed:
7rnSA/ � /�O �I—�i+l -p�ltr-a �,d�s}�•vi, tai/JLr�
Florida rodid Approval# F /19,51r,4 �QaQ,kn 3n 1, for multiple products use product approval form
Property Owner Information
Name: Co Address: �y(�>![-L Vy11
City A-7Lwal 1r R/n-et- State�LZip a== Phone Gil k-A64/
E-Mail
Owneror Agent tvhemdt,rawer arMdoroeym Aamey t<m taywrem
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 NOT013 OF COMMENCEMENT.
Contractor Information:
Name of Company: (fes I L' Qualifying Agent: IGLiLn�
Address:-&-5-/ --",,d�ti r), City 'T.e �$rq 'd State Zip s K%�
Office Phone K75 /-g fq, Job SiteJContact Number 7 ag-5V-"Q°
State Certification/Registration# C/"C/z3o03.5' E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
xempt nmrer tap oYees xOdnbon to
Application u hereby made to obtain a permit to do the work and installations m indicated. I certify Ihat no work or imtollanon hay rommeneed
4Nm the Issuance ofa pennant and that all work will be performed to meet the saurdards of al1 laws regulating.canstruction in this jurisdiction.
Thu permit becomes nutl and wid if work is not mmmenred within six(d months. or If construction or unuir u swppeended o bandana
§egad a//''sir(6 ontlrs m any lame after work u cammerwed. l undersmm�that separam permits must be second jar ElecMnl Wank, m n
Signa,Wdrs,r1ada,Furnarea,aolkm Neem,Tan and Alr Co.
rrc.
Signature of Property Owner — .__Signature of Contractor.
Before
g� fore m
Day of / ___._ Bee this z ym
thisy of �/ i 11_A/F.
an
a ) rLn1YP0a�`��
Notary Pu - / ISSlae,,, Notary Public: f6ES..S
q� IE%PflES:sy%ert3sr is.:pts _. :•: :yl EXPIRES:Segmnx AS.2418
ry' BorAtlllwtlalrnrueaileae,wrnr 'n....,W ntleelMulbunluEk UMvwYn
I hereby car is application and know the some to be nue an
ordinances 6 r g r di.v Open of work will be compbed with whether speci ted herein or nor. r mg u a permu does nal
presume!o giro nurhnr iry rn riolnre or cancel the provisions of any other(e anal..nate, or loco(Imr rrgulunng conafrucnon or the
prrfarmance ofconstrvclion.
Rev.7/14/16
NOTICE OF COMMENCEMENT
State of ell County of pla Lgrgl Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT i, !u L�/m 3��,!✓<7
Legal Description of property being improved:/$ -3V /�`;•t,5,_,3T�a-T�.
41 Address of being improved:��yi �T
ProPY g P L
General description of improvements: S{h ��h r�.T,// L-!r "e'4
ti 5 4
Owner. Address: -7V
Owner's interest in site of the improvement: 4421h, ew,N
Fee Simple Titleholder(if other than owner):
Name:
r
ontracmr: -99 m_T,_.i
Address: 'S1 tai r-t�,/ AI 7 eI Z,lv 41Z, C7P
Telephone NO -U4f? Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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:
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(tire expiration date is one(1)year from the date of recording unless a different dale is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed Date:D&&_.�)iff.ZOI�
Beforemed rs�_dayof in the County of Duv ,State
Doc a 2016248900,OR BK 17758 Page 2179, Of Florida,has personal appeared or
Number Pages'. 1 Personally Known:
RewrdW 102&2016 at 0248 PM, Produced Identifi
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Notary Public: y•,}
COUNTY M commission ex fires:• ? aki MYGOMABIi'rF 1511
RECORDING$10.00 y p � �3E%PIKES'.SePrM^ s - 18 —
'4' ....•�• AoMaCRrvNaIery MGi[UMe