1178 OCEAN BLVD ROOF19-0002ROOF NON SHINGLE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PERMIT NUMBER
ROOF19-0002
ISSUED: 1/11/2019
EXPIRES: 7/10/2019
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: I DESCRIPTION: VALUE OF WORK:
1178 OCEAN BLVD ROOF NON SHINGLE TILE ROOF REPAIR - 5 $12000.00
SQUARES
170288 0000 ATLANTIC BEACH
COMPANY:ADDRESS: '
SCHULTZ ROOFING 216 N 20TH ST JACKSONVILLE FL 32250
COMPANY INC BEACH
014 1 ADDRESS: CITY: STATE: ZIP:
A B OCEAN LLC 2859 PACES FERRY RD ATLANTA GA 30339
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION
ACCOUNT
QUANTITY
PAID AMOUNT
BUILDING PERMIT
455-0000-322-1000
0
$115.00
BUILDING PLAN CHECK
455-0000-322-1001
0
$57.50
STATE DBPR SURCHARGE
455-0000-208-0700
0
$2.59
STATE DCA SURCHARGE
455-0000-208-0600
0
$2.00
TOTAL: $177.09
Issued Date: 1/11/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
�- Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445��-Z�j L — O
Phone (904) 247-5826 - Fax (904) 247-5845
opt E-mail: building-dept@coab.us Date routed: 1
City web -site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I ((
Applicant:
Project: I ( ( —
C`.
N
Department review required Yes No
uilding
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPI IrATHIM cTAT114Z
Reviewing Department
First Review:
Approved.
❑Denied.
(Circle one.)
Comments:
UILDI
PLANNING & ZONING
Reviewed by:
� Date: /^/d
TREE ADMIN.
Second Review:
❑Approved as revised.
❑Denied.
PUBLIC WORKS
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
Date:
FIRE SERVICES
Third Review:
[]Approved as revised.
❑Denied.
Comments:
Reviewed by:
Date:
Revised 07/27/10
urr►c;E COPY
Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
11 Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: (� g �l��n �10 14 • �l1 Permit Number
Legal Description 5 _(� _� -A 5 '�(' e XI L6k i rr Tv ac c 1-F
Updated 12/8/17
RW F I �-i 4 CU6n
- i
RE# til
Valuation of Work (Replacement i ostJ $ I .800. Q0Heated/Cooled SF Non- Heated/Cooled_ j p
• Class of Work (Circle one): New Addition Alteratio Repa' v ool Window/Door 0 2
• Use of existing/proposed structure(s) (Circle one): CommerciMoReside U ca e�
• If an existing structure, is a firesprinkler system installed? (Circle one): Yes No N/A
t -�
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal O0 Lev �
Describe in detail the type of work to be perforn
T ► �+C r��a, �- �S �� vr�r�S
LU>.ra.M m
W f- t"I
S L'u C3
El 0 cn w Ze
Florida Product Approval # 8�f 8, anr ( t rrn �iia'f�,1�- for multiple products use product allproval form
Property Owner Informationm
Name: ocear, LLL Address: As Sg PQ(✓e$ ft� K� SC S'l c /1 V
City a.it State _ Gt . Zip Q3 3 Q Phone �0 7 �' � .36,(
E -Mail C. ri e' 4,'G h ne, r A ?A—
Owner or Agent (If Agent, Power oTAttorney or Agency Letter Required
Contractor Information
Name of Company: iC h l 1 f 'Wf;nr' G TnC . Qualifying Agent: 11b1.1o1iCr5 - JCJA'J_( Z
Address i(.a jli . ,_ City TA_X &cam State Zip
Office Phone �} D y a y( a
p �LS Job Site/Contact NumberU "�� no
State Certification/Registration # LC- - C_ 0 3 (G. E -Mail C�? 3 i s- ) y a_/16c'.
Architect Name & Phone #
Engineer's Name & Phone #
Workers Compensation .Su.n Z. =n 0it oY1 S LLC'y , C C, oyoOGS yi-'O$ .S -o.
Exempt/ Insurer/ Lease Employeee/ Expiration Date
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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and
there may be additional permits required from other governmental entities such as water management districts, state agencies, or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO ,
TO OBTAIN FINANCING, CO SULT WITH YOUR LENDER OR AN ATTO F&AP*4C Mme®:';i
RECORDING Y R NOTIC F COM NCEMENT. COMMISSION 0FF24a;4
EXPIRES June 30.2011C:: i
9107) �9B 0151 F
r %' `/ ('Signature of Ownef or Ag nt)
(Signature of Contractor)
(inc ' EY or) yy��
'gned and sworn to ( e this I"Aay of Signed and sworn to (or affirmed) before me this day of
tr C,Qb 19
by
PiRES
= 1!
APRIL it f tary) (Signature of Notary)
(] Personally Known ,C� a�� ttitl� `,
% �j'k'N�ltttut,ma"`P�` (] Personally Known OR
(rduced Identifi tiofY,Q (J Produced Identification
Type of Identification: `L�i""� tt,n Li c e Type of Identification:
NOTICE OF COMMENCEMENT OFFICE COPY
(PREPARE IN DUPLICATE)
Permit No_ 96-6 F! / ^ 000 2 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.
of property being improved: 5 - (oY to ` XS — Q 9 r`
Address of property being improved: L-7 ! E' an
General description of improvements: E 1
Owner
Owr
Fee Simple Titleholder (if other than owner)
Name
Address
Contractor 6� A L l 00 n G
Address / 42 /U "qzs _W C %<
Phone No. y a)�lg c�. l S 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 or herself, designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself, 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_
r
1Q
J
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
Signed: tt—
DATE %1
Doc # 2018279569, OR BK 18611 Page 1370, Be re a this f l in the/
Number Pages: 1 u o uval, o F r1d , has pers nally appeared
Recorded 11/2912018 08:54 AM, her in by
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL hi self/ herself an affirms that all statements -
COUNTY are true and accurate •,s ROOM. C MOORS ;'
RECORDING $10.00 MY COMMISSION # FF245774
EXPIRES Juni 30, 2019 j
.. .
(407)'798-0/63 :,anwarys.Mee.wcn