1860 N SHERRY DR RERF21-0259 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
•
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r S r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us I
Job Address: /J60 /t/cc- fn �Jjte., Permit Number: RERr�[�Z l - ---
Legal Description `ACL VA) )2,14'R,N4 0//17 IC> -C' L.C7 1 s RE# 31-40 o`4
Valuation of Work(Replacement Cost)$ /.S, c,C) Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial laggidential
ReroF
• If an existing structure, is a fire sprinkler system installed?: ❑Yes Dido
• Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
Corryte<c / c ) QIP F %.nrn_..
Florida Product Approval# /0/2r1 /42t.- fL/f ,4G/IP/ for multiple products use product approval form
Property Owner Information GRA T, b` 1"` �Q``'
Name ile {12,) A . el4A145 Address /540 /1//2%F-/ .W PPf
City 47 d4c'// State CL Zip 5,22 33 Phone (,,641 f/ 7 -36-78
E-Mail ) (. s /cio r'[%we/1 7-, ��7
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company rho,-,, hum jZa„ F�..s Co..�� ��Qualifying Agent ` fmo��•�-.
Address 2 So lc,.._)J C-trC1 City Josef- State Pi., Zip 3 e zc �.
Office Phone 47 'I -SGS - 01`7Z' Job Site Contact Number -7-6,>, Sc- y-i z -
State Certification/Registration# 2 ti 4( E-Mail / C>1‘)/1 el n.,. G2 CC,vvw c u.r-1 n.€ I--
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date / S /Z 3
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 regulating
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 PROPERTY. IF YOU INTEND
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RCORDI Y2i ' ► s ICE s.' COMMENCEMENT.
°." (Signature of Owner or Agent) ( (Signature of ontractor)
E,m o D
a-9. 3 Cl
'451 N. r .igned and sworn to(or affir efor meth' V day of Signed and sworn to(or affirmed)before me this day of
Q m 1 O'.[ / ' 2D 2- ,by 1 ! _)F�.. s K}� e5/' �' — o0.`
Ga :r11WA
(Signature of Notary) (Si'r'S -o =wl
n N m
O
A :, •,, PATRICIAHEHRY
o • to► '";< Commission#GG 187484
]Personally Known OR Personally KnownIt: -`,o_ Expires May 9,2022
roduced Identification [ ]Pro.uce. I. i ic. itilj}aFo? T�yFelnhreurancea003&5701Y'
ype of Identification: Flu/. 6 5 Lc) U L
"7 c!/ y DS Type of Identification: __
6/SIZOZC.
NOTICE OF COMMENCEMENT
Permit No. Parcel ID/Tax Folio No. / 6 9 2419 O S SZ 2
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement.
9'Description of property Y(le al description of propertyand address if available):
Lc'A MA2irye 6,ft//7 /a- C Lo T i 37-41v OS- -2S -- 29a
2. General Description of improvements:
Conneic4e . ere," F
3. Owner Information:
a)Name and Address: R, c,hard ,en, k i l.&GU s-htrr-1 Or,
b) Interest in property: owner
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: McCICIho r, 206 Fr r,S CC". f ncic10 rj �'N C 20Sa ,� r,,S C,e- cf e
b) Phone Number: 22/ -00 5 c Nep s"u„t r4
5. Surety Information: z2GC
a)Name and Address:
b)Phone Number: N
c)Amount of Bond: $
6. Lender Information:
a)Name and Address: tv� i-
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7,Florida Statutes:
a)Name and Address: N I p.
b)Phone Numbers of Designated Person:
8. In addition to himself/herself Owner designates of to receive a
copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
a)Name and Address: N J 4
b) Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,'PART I,
SECTION 713,13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the : of my knowledge and belief.
XSignature o O ,e or Owner's Authorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me this / day of O(qt.){ 1 ,20 Z / ,
by 'K014-4102... rt,L. 2 �L� as N 4-v ILL., for N F L1.F .
(Name of Person) (Type of Authority,i.e.Officer/Attorney) (Name of Party Instrument was Executed for)
;;:1 KATHERINE PERRY g4_, ,LL
, , Ccmmission#G6 280740 NOTARY PpyLICf, STATE Q FLORIDA
Expires February 6,2023
Bonded Thru Troy Fain Insurance 800.3854019
Print Name:
❑ Personally Known _
a dd ntification'Type:f i )113\-Z v ---1(4 I ( , Z.-S--L .
(Affix Notary Seal Above) L, 5-2_01..(_
Doc#2021284499,OR BK 19981 Page 1348
Number Pages: 1 Revised 1/18/18
Recorded 10/28/2021 02:46 PM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00