418 SKATE RD ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-559
Job Type: ROOF PERMIT
Desviption: REROOF 8 253.3.1
Estimated Value: $8,240.00
Issue Date: 3/12/2015
Expiration Date: 9/8/2015
PROPERTY ADDRESS:
Address: 418 SKATE RD
RE Number: 171558-0000
PROPERTY OWNER:
Name: ONDREJICKA, JOHN A
Address: 1750 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: SCHULTZ ROOFING COMPANY INC
Address: 216 N 20TH ST QA DOUGLAS ARTHUR SCHULTZ
Phone: -
FEES:
BUILDING PERMIT FEE $91.20
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $95.20
PERMIT IS APPROVED ONLY M ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: y I ? S KQ+e !'Cl FSI. fy, Permitr fir: S�0 'S
Legal Description 31- Ila 38-as-d4 t RIP Qo�zl Qa�rd'.krce►# I v SSt?-oo ao
Floor Area Sq.R. Sq.Ft
Valuation of Work$ 1 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Uwofexisting/proposed structures)(circle one): Commercial Residential
Han existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# f/ 2 53 . .3./
For multiple products use product approval torm �y r
Describe in detail the type of work to be performed: .tom f �.,T� Z* /-007»s
Property Owner Information:
Name rgn�a flll�son W . POr-S +-h Address: 1 -138 Se.IV4 t1'1ar � �4 nr
CityState 1 Zip 3��3 Phone 90 y - a y 1 3 3
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: wlt2 POOTii�y Ca . Znc Quelify'mg Agent: IQS r'T SC.V'1 u.1 Iz
Address: al to IQ 30'fP- S City A x(3c-(� State F I Zip 322-5 "
Office Phone '104 a U to A 31 S Job She/Contact Number 7 59 -DO(0 3 Fax# a y7- 3 WO
State Certification/Registration#
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 l certify that no work or installation has comm mead prior to the
issuance ofapermit and that all work wi!/beperformed to meet the standards ojdl laws regulating construe It inthisjurisdiction. Thupermitbecomesnu/l
and void fwork is not commenced within six(6)months, or ifconstruction or work is suspended or abarndonedfor a jpe iod ofsiu/I6)martths at arty time er
work is commenced. l understand that separate permits most be secured jar Electrical Work,plumbing,Signs, Wells,Pools,Furnaces.Edlem,H m,
Tanks amdAir Condaoners,ere.
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.
lherebycert�thWlha madandesaminedthis""aa��,,licationandknowthesamstobetrusardcormct. Allprovisions oflaws and ordinances governing this
type of work will be complied with whether sppeeclpea herein or rot. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany,other federal,state.or total law regulating construction or the performance ofcorutraction.
t
X Signatureof Owner J M ,
rIMAQ (VJ1•l, Signature of Contractor
Print Name5.V.1i)..-......k.52S37.. .. Print Name ..-_...._.b- -5.I.9S3neL)'.tL.—.__.._____
Sworn to and subsc� before me Sworn to and sub bed before me
th' Day of// .^eti .20 1E1- th' un Day of F1a�•c(- 201S
Otary Public ;(l "j'Sur � "MOORE OtaryL IC
MV COMMISSION a 5330 -. ,.. ..,,.i MY COMMISSION A,E':'053310
E
E%FIRES June 20,20!015 •'• eVI5Ed10gi�fjftQ I"its
poq 9BBOt v rmnaallom -
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Flom County of Duval
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: " -i (P 3 '8 a S - �R c. P P T
of P,aw 1 Po�'ms �dn1111f' aH— Lon
Address of property being Improved: T) S kmfepd
- ✓� +,
General description of Improvements:_-5P, r-n a�2 K ic-od
Owner irl a. P't' r 0nvW� r0fs �,
Address I � � g �e �UA r•l )0-rrn0 Or
Owner's interest in site of the improvement I-2 e
_ D a
Fee Simple Titleholder(if other than owner)
Name
Address
n r GCOntrector Douglas A Schultz Schultz Roofing Co., Inc
Address 216 N 20th Street Jacksonville Beach, FL 32250
f Phone No. Fax No.
Surety (if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person makinga 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 O NER
TEL(3
Ba reme thl �dayof - nihm
County of Duval.Stale of Florida.has persanally appeared
Tn lu is A"", W. COZ51'T{( heroin by
1111 herself and affirms that all state
Doc#2015056739,OR BK 17054 Page 1151, ere true and ecwrote ROBIN C.MOORE
Number Pages:l : MY C0MMISSI0NPEE1D5330
Recorded ONI2/2015 et 09:50 AM. �o '
Ronnie Fussell CLERK CIRCUIT COU RT DUVAL � �f'v"K ' g„•+ EXPIRES June 20,2015
110])]BB-0ta� fbMVNMan6`e,Y.m mn
COUNTY
RECORDING$10.00 Notary Pubfio at Large.Sate of . County of
My=nmlasionexpires: m
Pemnally Known'_ or
PodUMd Identl1catlon
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