769 Jasmine St re-roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Y
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-ROOF-3045
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $15,000.00
Issue Date: 1/19/2017
Expiration Date: 7/18/2017
PROPERTY ADDRESS:
Address: 769 JASMINE ST
RE Number: 170930-0000
PROPERTY OWNER:
Name: DEMPSTER, GORDON D
Address: 769 JASMINE ST
GENERAL CONTRACTOR INFORMATION:
Name: K & D ROOFING & CONSTRUCTION
Robert Hile,CBC1258249
Address: 2758 DAWN RD SUITE 1 NE QA ROBERT ANTHONY
HILE
Phone: -
FEES:
BUILDING PERMIT FEE $125.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $129.00
PERMIT LS APPROVED ONLY IN ACCORDANCE WFFH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
-" BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-582612 Fax(904)247-5845 IT R00 F - 30 4 S
Job Address: —I(09 t�QSmlhr' S'- A"anfie. lbcci\ . Permit Number•. _
Legal Description k"D \lk ZW-b SeO N L. 5 IM 1q'1 Parcel# 1"70930-0000
J?of
or
01eate1545 9-
Valuation of Work$ ELq Proposed Work hdleooled non4.F-heated/cooled
Class of Work(circle one): New Addition AfterationiciiDMove Demolition pool/spa window/door
Use of eristing/pmppoosed structures) mitre one): Commercial
If an erjsting strncmre,is a Bre spr er system installed?(Circle one): es No
Florida Product Approval# R-w12A.Pl -4yge f-
For multiple products use pro uct—d appro�2orm A �� ��r1
Describe in detail the type of work to be performed: r1C l04 USind 50\1,r. Shi mks
Property Owner Information:
oAlxilcName 'gca.c,Fl 32233
city State�223aPhone tft9 - "ilk
&Mail or Fax#( �)
Contractor Information: �,(� f`
Company Name:l(� D RUIlrl ctrl Qualifying Agent;Qe4l (kt�G
Address!iy Ie S Stt city State-�_Zip ?,V-so
Office phone 5L11_r-InD lob Site/Co�ctNumber ri5?n- l` RI Fax#,?Ih9-3Z49
state cmtiscation/Registration#c jr l a?.S ,51.
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title holder Name and Address
Bonding Company Name and Address
Mortgage Leader Nettie and Address
Applicanan is hereby madam obtainn apermiA to do the work and butalladov as biasaxed I certify theaem work a Netal[mim her commexed prior fo the
befi anee o a permG ad that allworkwill be0armed ro meet the standards ofaV knee regrzlmingcwrsnaction to darjurirak0an Thvpermit becomes wll
aMvoid ijwarktrnarcammmmedwUhbett(, amheo,ifemuwctionarwork to u�ppeended a aberdmredfor a��(ad ofslz/6)monthsm mry time o/�r
work ircommenced I wuloW M thin separam peradn must be secwedfor EIe�IWork,plumbing,skin {ielLe,PooLq Fmwcea,Boaag HE.'.,
F.M.and Al,Cmdtdoners,ac
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 FINANCINGCONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO'QR NOTICE OF
COMMENCEMENT.
Ihereyby certify that l have read and e,tam4wd thtr ¢onion and know the same to be true aMcorrect AAprvroims ofJ'1.,aMordirmmesgovmdngAids
type afwork wIIl be cromplied wdh whedm herein ar nm. Ae graining of a permit doer rot prenvme to give eathody to violate a cancel the
Yprovistom ofarry orherfederm.atme or local;5.ow rg conrbucti m m ohe perforrrmme ofronmumfom
Signature of Owner / �� � � Signature of Contractor `,
Print Name �Qrd�L1 �./JPe'f1S_L� Print Name 1'�o16Gr 'IT1IPi
Swom to and subscribed before me Sworn to and subscpbed before me
this JL_Day of_net, .20 ho thiss - ?,-Dayof L71r'-fi .20110
N u�li: No Public
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Doc S 2017011420, OR RK 17845 Page 119, Number Pages: 1, Recorded 01/17/2017
at 09:13 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMUT
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