Permit Roof 1105 Ocean Blvd 2012 ►�"j�-11�1 f
CITY OF ATLANTIC 4t' NTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number 12-00000680 Date 6/01/12
Property Address . . . . . . 1105 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4500
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Application desc
REROOF
--------------------------------------------
Owner Contractor
------------------------ ------------------------
MARTIN HENRY FLETCHER JR SCHULTZ ROOFING COMPANY INC
5895 HEAD RD 216 N. 20TH STREET
ORANGE PARK FL 320036108 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 . . . . 4500
Expiration Date . . 11/28/12
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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
arcel#
Valuation of Work S oe5 oor ea o q, t. t
Proposed Work heated/cooled non-heated/cooled
Class of Work(circle ane): New Addition Alteration r-
'h' Mov Demolition Pool/spa window/door
Use of existing/pro sed structure(s)((circle one): Commercial Residentia
If an existing structure,is a fire sprinCiler system installed?(Circle one): o N/A
Florida Product Approval# 4V -Rq TAc-( pee/ � 51iCK 10 y
For multiple products use pro uct approve form
Describe in detail the type of work to be performed:
Property Owner reformation•
Name Address:
City S ,,Zip -3 Phone b
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,Ff. 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. !certify that no work or inhas commenced prior to the
issuance of a permit and that a1!work will be performed to meet the standards of all laws regulating construction in this jurisdiction This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for apertod of six(6)months at any time after,
work is commenced. I understand that separate permits must be secured for Electrical WorA�Plumbing,Signs, Wells,Pools, Furnaces, Boilers,Heaters,
Tanks and Ali Conditioners,eta
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 here
,lb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type
provisions o will be complied with whether sped red 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 perjbrmance of constrrection.
Signature of Owner �
C'�" Signature of Contractor
inft�ame A� esi�lent
Swo o and subsc efore me Sworn and subse ' efore me
thin Day of 20/ this d- Day of
20
No Public SFY11?Y ROSALIND QLAN9
MY Commisslu V#k�f9i 7 5 of a ROSALINO CLARK
EXPIRES};
ly�ri MY:�CiOt�MeMs 5c r
° ev ed0l.26.10 August 26
PA; Bonded Thru N.Aary pu' merwriter:
NOTICE OF COMMENCEhENT
(PREPARE IN DUPLICATE)
Pettit Tax Folio No. /70j
State Off on a
County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real properly,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:
yc a
Address of property being improved: r
General description of improvements:
Owner 1 t ^
Address
Owner's interest in site of the improvement c
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 N0. 904-246-2315 904-247-3808
Fax No.
Surety(if any)
Address
$
Phone No. Fax No. Amount of bond
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
different date is specified): (1)year from the date of recording unless a
THIS SPACE FOR RECORDER'S USE ONLY
OWNER
t--vti.
Signed: DATE4L7�
Before me this�—d.,of in the
County of Duval,State of Florida,has personally appeared
Joc u 2012,11., himselF/herself and amrms that all statements and declarations herein by
JumSer Pages:1 1'GR BK 15957 Page 1162, are true and accurate
Rh.FULLER
ded 052 2012 at 09 43 AM,
COUNT,4 ER CLERK CIRCUIT COURT DUVAL
RECORDING S10A0 ? r
/!�
otary PubBc at Large,State of County of "
My commission expires:
Personally Known
Produced Identification / or
� n
"°"......, RGSA AU(PARK
I tdt IX;h1tkiMION 4 H 001738
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