Permit Roof 435 Osprey Key 2011 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
T far 19),
Application Number . . . . . 11-00002927 Date 11/21/11
Property Address . . . . . . 435 OSPREY KEY
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4635
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Application desc
REROOF
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Owner Contractor
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HINCHEE SCHULTZ ROOFING COMPANY INC
435 OSPREY KEY 216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246-2315
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4635
Expiration Date . . 5/19/12
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 00 . 00 . 00
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: Permit Number:
Legal Description - - - Parcel# /7 7-
Floor Area of Sq.M. Sq.Ft
Valuation of Work$1 Lj 635� Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Or Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one): Commercial
If an existing structure,is a fire sprinkler ystem installed? (Circle one): es No N/A
Florida Product Approval # FL. L -5"636,/
For multiple products use product apptoval form GA t= 3 0 Vi- f zc, j
Describe in detail the type of work to be performed: C9, )e cXr-4e"O Inco tvS Soo 1964 St:�
Property Owner Information:
Name:M,e,hgPJ �/�ye ��- A/ Address: � r> QStoP�rt
City X!!j-,40A State�lZip�Phone
E-Maif or Fax#(Optional)
Contractor Information:
Company Name: Schultz Roofing Co.,Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20`h St City Jacksonville Beach,Fl. 32250
Office Phone 904-246-2315 Job Site/Contact Number 759-0063 Fax#904-247-3808
State Certification/Registration# CCC036989
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 ifconstruction or work is sus ended or abandoned fora Period of six I6)months at any lime after
work is commenced I understand that separate permits must be secured for Electrical Work Plumbing, Signs, Wells,Pools, urnaces,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 hereby certfy that I have read and examined this pplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 work will be complied with whether sped ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of arty other federal,state, or local law regulating construction or the performance of construction.
Siglwim wfQww Signature of Contractor
Print Name ................ Print Name Douglas A. Schultz, President
Sworn to and subsc i ed before me 7 Sworn to and subsc ' d before me
this Day of 20/'L this Da of 20ZL
ND
N a t EXPI
;* MY COMMISSION N EE 001736 ugust 25,2014
EXPIRES:August 25,2014Pf1h ,. Bended Thru Not Public Unde
�1 ers
Bonded Thru Notary Public Underwriters led 01.26.10
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of ori a Countyof
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:_ ZI--�5-,5- /6
Address of property being improved: S
General description of improvements: y/) " we '
Owner - 122,ah.s?P / �j. lVea A'K�w P ,Z�1
Address -�/ r-6 44 ��-�T�An pry /-
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. CCC-036989
Address 216 North 20th Street Jacksonville Beach, Florida 32250
Phone No.
904-246-2315 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