Permit Roof 1850 Live Oak Ln 2012 J I ATL *,1 CITY OF ATLANTIC BEACH
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- r 800 SEMINOLE ROAD
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ANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000295 Date 3/15/12
Property Address 1850 LIVE OAK LN
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 12780
Application desc
reroof
Owner Contractor
SHELLENBERGER, ROBERT SCHULTZ ROOFING COMPANY INC
1850 LIVE OAK LANE 216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246 -2315
Permit ROOF PERMIT
Additional desc .
Permit Fee 115.00 Plan Check Fee . . .00
Issue Date . . . . Valuation . . . . 12780
Expiration Date . . 9/11/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 115.00 115.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 119.00 119.00 .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: /8, D C i l/P O /9 6° Permit Number:
Legal Description Qr- Lei Leivfi in ��} � & �' ( AA Parcel # /
ao Floor Area of Sq.Ft.
Valuation of Work 8 /A '7b - Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial esidenti 1
If an existing structure, is a fire sprinkler system installed? (Circle one): No N /A
Florida Product Approval # 4``N `t•i l/ Ft S636 ,1
For multiple products use product approval form A'cJP 30
C� C el.vn4ee -J ace MS ..3
Describe in detail the type of work to be performed: ,1,9 / m 406 /Pee/ f'f frc_K vn dei /4 )4ne,✓T
Pro t Owner Information:
Name... (set', , e//onAC,eagee _ A ddress: (.i l�,�
City •rl A. .L State/ Zip Phone �t _4),g1
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 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 f6) 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 hereby certify that 1 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 Owne4V-fr'7,/ � Signature of Contractor
•int:Wet Name Douglas A. Schultz, President
Sworn to and subsc ' - d before me Sworni.9 and subs d before me
this ' _ Day of Am! , , 20 /.. ` this Day of � 2, J ,20 /c2
�rrr o
otary Public : "r ROSIWND LARK r� �l _ _ I %G /.'!.�
! r MY COMMISSION N EE 001738 � , 01 0
EX l C ( M ?LIND CLARK I
�i,u �' F Bonded
EXPIRES: August u61ic Underwriters MY C ^IO(v A EE 001736 ters
„ ,. Notary �_ •or XI: h u 25, za . ed 01.26.10
Pf h Bond Th Notary tg r utfic Undenml
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. /7Y>
State of Florida County of wig/
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: c;?9• d y, c7S v7 ?C / � /tJA2 //2 //27
Address of property being improved: /r- `2) 't# d A
SEC . Z r �G
General description of improvements: tiA,/7l/ /7.
Owner 4ic P,p, e h ee) 1 6 t
Address /1r,
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner)
Name
Address
1 \�VAY Contractor Douglas A. Schultz /Schultz Roofing Co., Inc. CCC- 036989
7 Addres 216 North 20th Street Jacksonville Beach, Florida 32250
904 - 246 -2315 904- 247 -3808
Phone No. Fax No.
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