1095 CORNELL LN - ROOF { ,\ti, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ry J 1319''
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3009
Job Type: ROOF PERMIT
Description: NOC REQUIRED - re-roof using GAF architectural shingles
FL10124.16
Estimated Value: $6,251 .00
Issue Date: 1/17/2017
Expiration Date: 7/16/2017
PROPERTY ADDRESS:
Address: 1095 CORNELL LN
RE Number: 177545-0000
PROPERTY OWNER:
Name: HOWELL, EMILY JEAN
Address: 1095 CORNELL LN
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Ronald Wayne Russell, CCC1327484
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: - -
FEES:
BUILDING PERMIT FEE $81.26
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $85.26
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1095 Cornell Ln. Atlantic Beach, FL 32233 Permit Number: 11-V-OOF— 3009
Legal Description 38-2S-29E .229 B DE CASTRO Y FERRER GRANT PT RECD O/R BK 1040-98(EX PT RECD O/R BK 5981-1761
Parcel# /77545 D000
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 6,2.5 1 • o o Proposed Work heated/cooled '747.4 non-heated/cooled_/ 7S
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): o
Florida Product Approval # 1012-9• /6 _
For multiple products use product approval form /
Describe in detail the type of work to be performed: gc -i -R /�•r-c ,,s,K 6/l-►— )r4i
SkiIei 29 ¢
Property Owner Information:
Name: EM;1ll J No *-C I I Address: /4915 cowl e /( Ln
City At Pints' &s ei— State FL Zip f7233 Phone SBS-0427-
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:fort F-v.ssc// A.A.,. Z14- Qualifying Agent:044.11f //
Address: by lq //+. 1wm/I City State FL. Zip 122o-r
Office Phone %H-7/4-/9on Job Site/Contact Number 600 3 Fax#
State Certification/Registration# <« 13214 84
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 a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes
null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time
after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers,
Heaters, Tanks and Air Conditioners,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.
I herebycertify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofworkwill be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
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ture 4 , tractor7. ........,it__614/......_
Signature of Owner /�� 7 .,. .
Or 'tint Name Eo /I g Si /1
Print Name Jnr,-4, -..,,.e/j —
Sworn to and subscribed
Sworn to and subscribed before me
before me this /2 Day of J an
this 4/ Day of J4v1 ,
, 20/7 20 I-1
Nota lic
Nirai-f.:521----4.--
Revised 01.26.10
Ryan Renick Eyiick • Ryan Renick Eyrick
,-,>" 1)1i NOTARY PUBLIC ,�' NOTARY PUBLIC
��`d STATE OF FLORIDA _`:o 1 STATE OF FLORIDA
-• v-'r Comm#FF945229 ; ':'4--Comm*FF945229
Expires 12/20/2019 Expires 12/20/2019
NOTICE OF COMMENCEMENT
,PREPARE IN DUPLICATE)
Permit No.'s I7- keof -J ca Tax Folio No.
State of Florida County of
To whom it may concern:
The undersigned hereby informs you that improvements will he 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 /✓"t w1 property being- improved: 3ZSR-z 6 , 224 8 p C.- C PtI rIZt
\' ferric c (7 02 � sae-,y b/g is L f I o — /Qp (Ex
plT
?14D o/iZ R1t n5g £rf —/^76)(,..D
Address of property being improved: /015 re)LH Z.-^ •
nth..Ira ffe ch / FL- 32233
General description of improvements: Reroof
Owner Crihi if J(cin /Tawe i f
Address /0115 Corsic I/ In AtAari(t)3ckckf Fl-- 322 33
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Ron Russell Roofing.Inc.
Address 4419 Hudnall Road,Jacksonville,FL 32207
Phone No. 904-714-1907 Fax No. 904-636-9909
Surety(if any) N/A
Address Amount of bond S
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
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 Ron Russell Roofing,Inc
• Address 4419 Hudnall Rd.Jacksonville,FL 32207
••,.....
904-714-1907 904 636 9909
Phone No. Fax No.
• In addition to himself.owner designates the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
ice: Name N/A
1 ,
Address
r.
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 OW� u�
Signed'___ IP" DATE ��"r/7
Befor me this day of��ny�Ar�y�o r 1 in the
Doc#2017011932,OR BK 17845 Page 1 County Duv4 tate ofpiorida.has personally appeared
Number Pages:1 g 963• r o.re� reinherby
himself%herself Ind affirms that as statements and declarations herein
Recorded Ot;17/2017 at 12:02 PM, are true and accurate
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY Jr
$10.00 �
• Ryan Renick Eyrick
• o l rrge.State of r.- . County of �" 7,7•.:,'• .OTARY PUBLIC
r • mi•- , expires: r2�¢s-/y �b
I Personalty Knownk. '� SATE OF FLORIDA
•
Produced Identification✓/7v �•�1ri+r�',�`Comm#FF945229
• t' ° Expires 12/202019