Permit Roof 1656 E Park Ter 2011 \t,\ s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002611
Date 9/13/11
Property Address
1656 E PARK TER
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 13500
Application desc
ROOF EXISTING AND NEW
Owner Contractor
COTTRELL EDWARD K SCHULTZ ROOFING COMPANY INC
1656 PARK TERRACE EAST 216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246 -2315
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 120.00 Plan Check Fee .00
Issue Date Valuation 13500
Expiration Date . . 3/11/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 120.00 120.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 124.00 124.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
£7 e 'J
` � r 3UILDING PERMIT APPLICATION
fkin'"' 11 _ e)0O CITY OF ATL
0 / %'U ATLANTIC BEACH
800 Seminole Road, Atl4c Beach, FL 32233
Office (904) 247-5826 Tax (904) 247 -5845
Job Address: /1-r (p 6)4i, � e' ° Permit Number:
Legal Description , S ?96 'J a 7 Parcel # / 7 c9c - C> 3 /O
Valuation of Work $ /,3 -5/id . P ea of S.Ft. Work h ted /cooled S Ft
n - heated cooled
Class of Work (circle one): New Addition NO ! c"
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): Yes No N /A
Florida Product Approval # L
For multiple products use product appro or --Rtrt0 Ms Sao 5 lo 3 6. I .
Describe in detail the type of work to be erformed: moue (�2MaKn f 6R� 604+.1 Se not
� k ' p rxf � xt�r R<.c�� t Ns st - i
a ‘Pr /� , t n� 7 c'7 A r � G(S77n/� c /V � fr " 77vr✓r t / PPe �
Property Oilier Information:
Name: 1 - ' Address: /656 �, �. zev,
Cityt, 1�� ' � Sta t Zip Phone
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Schultz Roofing Co., Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20 St City Jacksonville Beach, Fl. 32250
Office Phone 904 - 246 -2315 Job Site/ Contact Number 759 -0063 Fax # 904 - 247 -3808
State Certification/Registration # CCCO36989
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 certifil that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed d 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__ pperiod of six 16) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVE
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certifi, that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will 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. -
�
Signature of Owner � Signature of Contractor
Print Name Print Name Douglas A. Schultz, President
Sworn o d subscribed before me Sworn o and subscrib bef a me
this.? ay of ?v/ , 20 // this Day of , 20 // (,..MiLia ?if NOTARY PUBLIC STATE OF FLORIDA - it , Notary J .....•,, Luz M. Roman Nota ! ROSALIND CLARK
3 i 1 1 1 . Comm #DD823743 ;E p PIV. MY CO MM ISSION M EE 00 e
'g „ „,J Expires; NOV. 07, 2012 As , EXPIRES' August 25, 200 viyd 01.26.10
swam THRt7 ATLANTIC BONDING COO NC.
Rf ,. Bonet ink 14o!•0 L IIiIA :I _ rw
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of '', , J7 - 03rd
County of ,P - �,,,p
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 of property being improved: Si,' - &.? - 0 9 . , 2 J - -
Address of property being improved: 4, yo ir.
8.;.� .e, ,6.82. '
General description of improvements:4 ri Q7dr.�.�l,O7,�>
11
Owner /./tf,pr .i �.t.�.
Address I, ,+ 7.: , s •
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor Douglas A Schultz Schultz Roofing Co., Inc.
\ ^ Address 216 N 20th St. Jacksonville Beach, FL 32250
Wk 904 - 246 -2315
Phone No. Fax No. 904 -247 -3808
Surety (if any)
Address Amount of bond $
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 within 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 following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
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 /'�_ OWNER
Signed .,s0� D ATE Z I '
Before me this 14 day of .73v; . zo e ■ in the
Coun of A0St of FIor fa, has pe na appeared
himself/ herself and affirms that all statements and declarations herein by
are true and accurate
Doc TF 20 "i'i'!y494, C R Bt< 15705 Page 978, G�
Number Pages: 1 • ra
Recorded 09'07 2011 at 'i 1 32 AM, Note is at Large, 1
JIM FULLER CLERK CIRCUIT COURT DUVAL My commission expires:
State of • 7►je/ County of �,
COUNTY Personally Known
RECORDING 810 00 Produced Identification or
•
NOTARY PUBLIC -STATE OF FLORIDA
' ''' Luz M. Roman
I ;. ;,. : Commission #DD823743
% ,,;,,, ,/ Expires: NOV. 07, 2012
BONDED TEBU ATLANTIC BONDING CO., INC.