147 Pine St roof permit CITY OF ATLANTIC BEACH
800 SENHNOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
306 INFORMATION:
Job 10: 16-ROOF-2673
Job Type: ROOF PERMIT
Description:
Estimated Value: $4,000.00
Issue Date: 11/29/2016
Expiration Date: 5/2812017
PROPERTY ADDRESS:
Address: 147 PINE ST
RE Number: 170635-0175
PROPERTY OWNER:
Name: BENNIE, NIGEL
Address: 147 PINE ST
GENERAL CONTRACTOR INFORMA17ON:
Name: JUSTIN LARSEN CONSTRUCTION INC
Justin Earl Larsen,CBC1259833
Address: PO BOX 1942 LIC # BELOW 4 GERALD GOLLOBIT
Phone: 904-327-4311
FEES:
BUILDING PERMIT FEE $70.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $74.00
PERNWf IS APPROVED ONLY IN ACCORDANCE WEEH ALL CITY OF AT�IC BEACH ORDINANCM �D ME FLORIDA
BUILDING CODES,
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach Fl,32233
Office:(904)247-5826 . Fax:(904)247-5845
Job Address: IL� pit-e_ S1. AV C -BLpELM-33 PermitNumber: 10-Dop- akdT�
Legal DcscriptionC_;�LW '2
A),f- Ce-� , t%l Af& LZ-tOt"* RE#
Valuation of Work(Replaceirrent Cost)S_9=_Hated/Cooled SF Non-Ileated/Cooled
• Class of Work(Circle one): New Addition terartion- Repair Move Demo Pool Window/Door
• Use of existinglisroprosed stracture(s)(Ci e : uormnercial <1�esidge-.-ItP,
• If anexisting structure,is a fire sprinkler system installed?(Circle one): 0 N/A
• Submit a Tree Removal Permit Application if my noes areto be removed or Affidavit of No TrX Removal
Describe in cletail the type of work to be performed:
Florida Product Approvar# F1,4C)i-L"�, I firs multiple prodwis use product appm,al form
Property Owner Information
Name: Address:
City State , -.1 F
;Lzip ;4
E-Mail
Owner or Agent (if xs.� �fAmcy or Asency tcn.
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 NOYZE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City , State Zip ,2
Office Phone ej �i,711 Job SitelContact Number
State Certification/Registration# 4,SL�,, C,�
Architect Name &Phone# U
Engineer's Name&Phone#
Workees Compensation Empt Y Insurer 1,easc�p oyeei turatem me
n.en,.d
ri,draw��
ned or a
am nor,
F
FOMI
Ihe Mh
,drehy.cnifyllrt, ation and know the same to be t ecqX1ffi%
or inancer governor this type worK war Be comp lea with whether specifled herein rP&,,nl t
a,
R
a a,
jnresmnetogiveauthg�rlty to via ate or cancel thep vision,of"yotherfederal, state,orlocal taw reguiating construction or[ e
performance ofconsimcdon. Rev.3/14/16
NOTICE OF COMMENCEMENT
state of County of 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.
Legal Description ofproperry being improved; Ilk'* fi NE 5-r
JQ� -J(& "em"
Ad�,ress ofproperty being improved: /41
Gmeraidewriptionofixnprovements: 42�"2
Owner 7
Address: Y*'�71 NE- —sT /loll-
Owner's in arm site ofthe improvement: Ayz
Fee Simple Titleholder(ifother than owner):
Name:
Contractor: Z�'-"�
Addncss� �Z/z� A16-11— zw�&�6''971 z�-r C49'6z
TelephoncNo.: Fax No:
Surety(ifany)
Address: Amount ofBond$
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 ofperson within the State ofFlorida,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):
TMS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: Data-
Before me this dayof Wo in the County ofl)uval,State
OfFlorida,hasperstmallypppearSd
PersonallyKnomn: aa��
Produced Idenfificati
D.#2016271960,0REIK17791 Page1280. Notary Public:
Number Pages:1 My cmarrission expires: oc"�9�y zg Z-fk
Reoordedll�ISWG413PM.
Rmne Fussal CLERK CIRCUIT COURT DUVAL s,
C
OUNTY
MY=110'NT WFF IN517M
RECORDING$10.00 EXPIRES Debts,28 W46