141 15th St 2014 Roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
11Q:�- F
Application Number . . . . . 14-00001190 Date 7/25/14
Property Address . . . . . . 141 15TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6000
----------------------------------------------------------------------------
Application desc
reroof f17154-r4
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
AMES, WILLIAM H & REBECCA A SCHULTZ ROOFING COMPANY INC
141 15TH ST 216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 246-2315
----------------------------------------------------------------------------
Permit ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6000
Expiration Date . . 1/21/15
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 80 . 00 80 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 84 . 00 84 . 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 I 0-� -a s - Dq E Ma_nJ o-I ay LO 09.`0
rcel#
Floor Area of SO.Ft. Sq.Ft
Valuation of Work S ocyn C-) 0 Proposed Work he'ated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial (Residenti N
s
If an existing structure,is a fire spriWer system installed? (Circle one): es; No N/A
Florida Product Approval# F L -1 15 4 - R�
For multiple products use product approval form
Describe in detail the type of work to be performed: 1'e- cc)o+
Property Owner Information:
Name.,�.Aj Address: I S 1 1 S2
city t)E�� State ElZip_?,22 ,�_�Phone q c) 4 3 14 1 5�11 �0
E-Mail or Fax#(Optional
Contractor Information:
Company Name: 0!! C z - -T-4)C- Qualifying Agent:
Address: 3�1(o tJ city :T�x —State F I zip
OfflcePhone 'i()4 -,:),q6 - A--3i5_ Job Site/Contact Number Jax#
State Certification/Registration# C_(Z - C 0 3 '9
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
or installation has commenced prior to the
thisjurisdiction. This permit b�comes null
a
,feriod ofsq6)months at any timeer
el r
le n
t9EN9Mn=0V= eft,Pools, uIrnaces,Boilem M en,
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 YOVKi NOTICE OF
COMMENCEMENT.
I hereby certi mi.ned this.application and know the same to be true and correct. Allprovisions oflaws and ordinances governing.this
j fy that I haw read and exa
, 1
t) work will be con%lied with whether sYmcgled herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provi.A.onsofanyotherfe ralstate local avw regulating construction or the pe�formance ofconstruction.
(Agnature of Owner Signature of Contractor
Aint Name ..........//.......... ............................ Print Name
...................... ............................... ..................................................
Sworn to and subscribed before me Sworn to and subscribed before me
this this / Day of
-,Z-Day of t 1 .20 .20
RICHARD A.THOMASON
#FF11162481
Commission
Notary Public 1--7 A 7-S. Commission#FF 116218 Notary Public Exp1m ApdI 24,2018
Exores ApdI 24,2018
Swided TINuTmy Fain hmmmaWW4019 F
NOTICE OF COMMENCEMENT
State of -Florida Tax Folio No.
County of 12
=,,�7
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 C_0NVvT_NCENffiNT.
Legal Description of property being improved: I D- I k - D9 E
Lo
Address of property being improved: IA k 7::)4 2-3 3
General description of improvements: QQ_
Owner: �_.Q 1 0-rV-1 Pry-\,!t Address*,, 41 PM gc�, F-1
Owner's interest in site of the improvement: 3
Fee Simple Titleholder(if other than owner):
Name:
Contractor: Douglas A.Schultz Schultz Roofing Co.,Inc.
Address: 216 N 20d'Street Jacksonville Beach FL 32250
Telephone No.: 904-246-2315
Surety(if any)
Address: Amount of Bond S
Telephone 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 himselt designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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
0 0,/
Date:
_/4 Signed: j4 _Z 4to/5/
Before me this lx,;�' day of 2-a* in the County of Duval,State
Of Florida,has personally app d
Doc#201414-7273,ORBK16831 Page23330, Notary Public at Large,State of Florida,,County of Duval
Number Pages:I My commission expires: OOZY
Recorded 07/0212014 at 10:34 AM, Personally Known: or
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Produced Identification:
COUNTY X& RICHARD A.THOMASON
RECORDING$10.00 _',%* Comnlission#FF 116218
Expims AMI 24,2018
SwAad Thu Toy Foh bwxwm jog.�