356 MAIN ST - ROOF ` Jee
G;
�' ' CITY OF ATLANTIC BEACH
An 800 SEMINOLE ROAD
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: 17-ROOF-3566
Job Type: ROOF PERMIT
Description: re-roof FL10124-R19 & FL15487-R5
Estimated Value: $6,000.00
Issue Date: 3/23/2017
Expiration Date: 9/19/2017
PROPERTY ADDRESS:
Address: 356 MAIN ST
RE Number: 170873-0000
PROPERTY OWNER:
Name: HALL, MARY
Address: 356 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: GREAT WHITE CONSTRUCTION INC
, CCC1329097
Address: 4320 DEERWOOD TRAVIS SLAUGHTER
Phone: - -
FEES:
BUILDING PERMIT FEE $80.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $84.00
PI:RMrr IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
.itAd.„, Building Permit Application
r:
A�Y City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
-on 9' Phone: (904) 247-5826 Fax: (904) 247-5845
345 le 111 S- AFIPn 4i-ISP c,,6 • . v i - 9-p OP -.3S-b�
Job Address: ` t n n,o '4 '�4{
...Permit Nulmnber:
Legal Description S-eC Ike C°. bej .,1 , L.,0\- l� "'�\ 1 O. RE#
Valuation of Work(Replacement Cost)$ ca - Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alterationepair ove Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial R Iden al
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 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: r excoc i ns 4 , Ib'1 a- pilt�h
Florida Product Approval# 112ik - V-19 /ii S4 �Q� for multiple products use product approval form
Property Owner Information
Name: Address:356 PA*611 $1. #444-41/C,ATOIC..AiJ
City State _1• Zip 327....V3 Phone 1149 —j1 D 4sitp
E-Mail v
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information /� �-
Name of Company: a> !(•? " _• Qualif ing Agent: .A�`L�\S SVij.j. L'— l it
Address A'z10 PX\�.XJ� WIN OCAA.NA I- City aost441 N Ci State,\.Z'� Zip 21 to
Office Phone U 471-'I-17S Job Site/Contact N mber 1(D 1 1
State Certification/Registration# roC V2,2.45q1 1 E-Mail V--'I , ck1 (11J . aVJC is C�I t 6 . ��
Architect Name&Phone# c
Engineer's Name&Phone#
Workers Compensation -
Exempt/Insurer/Lease Employees/Expiration Date
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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 NOT CE�fOFFf COMMENCEMENT.
4XJC_ . -
(Signat a caner or Agent including Contractor) (Signature of Contractor)
Signeln�d and sworn- ttnno��or affirmed)before me thi Ir 2 day of Signedp� and sworn to(or affirmed)\ J is iay of
�O�,,_101_,by N\ , n T�u - 1"`��11�1:/t � Rfl , by
TRAVIS Y SLIMMER (I" 0.4 A.611
,
'' NYCOMAfIS"°FF I (Signature of Notary) (Signature of Notary) a Iv/
:I EXPIRES:January 22,2020 �..••
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our 4111111111.- • . .,..,';": 1 l rtY►_,-^ KRISTINESANTOS
'��` quay 22,2020 ►OA Navy Mac•e to of Florida
[ )P sonally Known OR ;;;rr ublel TTJ'Personally Known OR Commies pp I QS 031300
1 Identification Produced Identification - ' - '" [ )Produced Ident c t.:4, Illy COMM.Eykat Sep 1S,2020
Type of Identification: _ Type of Identification:
Doc # 2017058949, OR BK 17909 Page 304, Number Pages: 1 , Recorded 03/14/2017
at 01 :10 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
.RE,ARE''N O..P;.ICATE
Permit No. Tax Folio No, g
State of F\UYI.A� !i X County of u
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.
t
Legal,FleScslpton 9!properyy�eing improved:_ —a �, � �,t tv ...I_,;^, lLL��J1/ I
1 ... �'r5 i1 t 6uv- ay
d: J / A' N sk.Ad/ to/=ei Irovep
General description of
improvements.
Owner Address - W\k C1JY S ldAiAe \K kr) L, S7,-e' Z
O::tier's interest in site of the improvement
Fee Simple Titleholder!if other than o..rter,
Name
Address
Contractor Nagai"►I CUV4 t- C.S3Agj?,� "rtA,�L'Q 4
Li Address -y J Ltrt1 Q- rik-'4)
e"
Phone No. 104 316 -S3-7 Fax No.
Surety itif any)
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
Address
Phone No. Fax No.
Name of person:;;thin 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 follo..ing person to receive a copy of the Lienor's Notice as provided in
Secticn 713.0E(2i ttb).Florida Statutes.(Fill in at O..ner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement ithe expiration date is one i,t i year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNERs.gried / �1
Cefrxe CATE spit
sero;a me;es day c j -----7•1 ! the t
Co:.nti cf C.::al, to -f -i as perso.'fat,aopeareo —
herein t,
hi `M'ee..a.e v .reef a..s;ateme yno e-• al, S here
a • e antl acc.,re e !! � JUNE UNDERYYOOD
MY COMMISSION N Si003ba13
EXPIRES October 04.2020
AI i Lai j,!..
Naar ::one at La'.., to of _ ocnl:of AIA'
tk c rnm.ssicn expires' '
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