589 Clippership Ln re-roof permit AWL
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
JOBINFORMATION:
Job ID: 17-ROOF-3263
Job Type: ROOF PERMIT
Description: re-roof FL5444.R9 & FL10450-R8
Estimated Value: $6,200.00
Issue Date: 2/15/2017
Expiration Date: 8/14/2017
PROPERTY ADDRESS:
Address: 589 CLIPPERSHIP LN
RE Number: 170703-0216
PROPERTY OWNER:
Name: MOORE, PHYLLIS
Address: 589 CLIPPERSHIP LN
GENERAL CONTRACTOR INFORMATION:
Name: SCHULTZ ROOFING COMPANY INC
Douglas Arthur Schuft,CCCO36989
Address: 216 N 20TH ST CIA DOUGLAS ARTHUR SCHULTZ
Phone: -
FEES:
BUILDING PERMIT FEE $81.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $85.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORD@UNCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,Fl,32233
Office(904)247-5826 Fax(904)247-5845
Job Address: `� 9 C,{ t� per �.-c.P Ca Permit Number. 1�- R-OUF-3a1
r �1s31K2
Legal Description 3 5'to U 7 -a$ -a 4 E SeasP-fes' arcel#
door Area o Wit. Sq.F1
Valuation of Work$�,,A Q Q. Proposed Work heated/cooled/3 7� nm-heated/coole�d.�,2 /�
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa windoW/d0or OT
Use of existing/prorsed structure(a) circle one): Commercial esr
Han existing structure,is a fire sprinkler system installed?(Circle one): es No N/A
Florida Product Approval# 5 4 4 4. R Q [S��+x"af2zo �
For multiple products use product approval form
Describe in detail the type of work to be performed:
Procerty Owner Information:
re. - Address: SSq C.l pper
E-Mail or Fax# StateZio ,?. Phone R o 4 - 103 - to
(Optional)
Contractor Information: � t /� r
Company Name: Scr�tu +Z R 17071 11Q l� 1 n .Quaffing Agent: fluq I a S I-F � SC,6,L't
Address: l aD - - City k2c1! a If tate ( Z-p Z S
Office Phone Huy -QkAU-4315 Job Site/ContactNumber '1 S9 -t?O(o � Fax# Qq-) - 3E $
State Certification/Registration# G C G O (o C A �1
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name Rod Address
Application is hereby made to obtain commit to do the work andinstal/mionr as,indicated. /certify that no work or insman ion has commencedprior to the
issuance
permit and thin all work wd/bepe armed to meet the sumakad,ofa//laws regulating cme"clionm thisjurisdiction. Thu permit becomes na/!
mid void! work is not commenced wdhin six(6, montds,or if consmtcaon or work u surr ded m abandooedfm a pertad ofsu 6f moathr at are time anter
work is commenced I understand that separate permits must be secured for EleaW Work,Ph nbh g,Slgm, WdIA Pool; umom Boilers, Hailers,
Tanks andAir CauBdouers,ete
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.
Thereby rertfy Lhat7have read aid examinedthu licatiort and btow the came to be ave and correct Allprovuiom oflawr aril mdinanres governing this
tl9e nl wwk wiU ba complied wflX whether,ppaeti ted herein or not. The granmg afa permit does rtot pre,ume to give authority to violate or emere(the
provisions ofatry athrfederak smte.or lacd la+v regdanng comtrucdart m lheperfmmanre ofcorulructian.
'Signature of owne �KSignature of Contractor
Print Name �dQ�-�_._ 9grim Name iDoti§ Sc�AdHt_
Sworn to and an 'bed before me Swom to and subsggbed before me
this /A of . 20 )--,
_r1fiW ROOM MOORE �; R(
Notary
CMOORE
Notary Public - Notary Public My
emwwii ExPIRES.WM b.2kta' i EXPIRE"Junp,aHa
q. G
man n'io.m.. �;.I ,i
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of
County of
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: 3 s- to y 17 -oZS -a q C
easPra Cot 83( K2
Address of property being improved,
ect CA
General description of improvements: \]i1..C.n a I+P �2i,�p
Owner
Address_i'0 CJ62afr
Owner's interest in site Of the improvement Ee-�
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
Address_ 11 a (—
Phone No. 'nt0'4 �`4 �n val..l Fax No. C1dk' rJ �. / 3 3Z2'S�
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: e a
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 Owners 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 1WvNER
S ned DATE
Before math 0 dayof In the
C�i�ity,f'9 I.State of Fbrid�,has personally appeared
Doc Y 201701530.5,OR BK 17850 Pege 1288, VYIMx-E' harem by
Number Pages:I hlmsel�anumsthat s,l�ataym{ye,nts and declarations harm
Recorded 01202017 x111:21 AM, are"a and accurate N" ROBIN C MOORE
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY MY COMMIBEIONq FF20.77
p
RECORDING E10.00 v H01Xb,1n.: EXPIRES Jun,30,2019
Notary Public at Large.State of . County of
My commission explms:
Personally Known Y w
Produced identification