700 BEACH AVE RERD22-0031 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
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 400 tQjch i v ?you ip..)+IC BL Ct}1Permit Nu"gfr� BEROC)F z 2—�
Legal Description Fr t o -e 1 t' .se 1 e r i 0 yl) RECD (yeA2'i,5 RE# 1}02'/'1-0'5O V
Valuation of Work(Replacement Cost)$ IV 117.132 //Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ‘Repair ❑Move ❑Demo DPool LiWindow/Door
• Use of existing/proposed structure(s): ❑Commercial CfrResidential
• If an pxicting ctrurturp is a firp cnrinklpr cyctpm inctallprl7• flYpc ITNn
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) '`No
Describe in detail the type of work to be performed: c, 10 6 q--1-i P [
e ' 00 kf. ___ 14- c - - - . - R
Florida Product Approval# ?U)6✓J C.QV'YV 1 " NIK)'J for multiple products use product approval form
Property Owner Information J
Name t U I t(? , St Q p ?v- Address �r?�CL Y ve 1'V P 44 '
City g." . `. . i -. ' a State_____ Zip 32T 3? Phone ( 704) ?LI - '''jf Z G
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Lk .
Name of Company c,F1 E C{-t t) O(l�(Nucr St'yVtCe I Qualifying Agent U 1 S {p�O V1,CJ✓O
Address G 2A .. 1(.,(3-.SS 0 gt of New ./ City b1& ) • v• State t Zip" 32,0 k4I
Office Phone Job Site Contact Number 0 c(— 35'2,- 6 y 31
State Certification/Registration# CCC 1333'i5 2- E-Mail --V I S. 61,10,►QL)"O 6>Eirecf) V e✓Oo[F-Ai .-v-e-1
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 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 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
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YeiUR NSTICE OF COMMENCEMEN.
g - . V
(Signature of Ow er or Agent) ( (Signature of Contractor)
Signe and sworn to(or affi �• before me this , ( day of , ned`aannd sworn to(or affi e• before me thi 1 1 day of
Z�ZZ, by!': L)lte ...4� e:,i r- P_r • z .y _ iS /L' ►.��,
TONI GINOLESPERGER .' Si natlop )%
/f` ,•, MY COMMISSION#GG 353178AO -`
,1's•.%�.a; EXPIRES:October 6,2023 ,
1I''.'nodi'?' •.,.•• I 5;J Public Underwriters -
_�_ _ [ 1 Personally Known OR �nYpG' TONT GINDLESPERGER
[ ]Produced Identification .c--
[ ]Produced Identification ,-. ' '",•,'•.�, b1Y COMMISSION#GG 353176
Type of Identification: ` Type of Identification: :, t` _ .•-,.: , ,
'+?,....`. .. Bonded TNu Notary Public Underwriters
Doc # 2022042968, OR BK 20147 Page 51, Number Pages: 1,
Recorded 02/11/2022 09:42 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal descripti.n of prope and address if available):fi
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b^ -ZRE z tc •. . L tic_ h-[
_ eIv�IL �r�Tr scc�i
�d ' S'�U0- •cD • z�•r o' b 2 til�
2. eral 1 escnption o improvements:,)�w 6-1-11N6-(
3. Owner Information: 1 N
a)Name and Address: J 01-1 GT tE A
b)Interest in property: 1•1 Fri
c)Name and address of simple titleholder(if other than owner): fjR
01
4. Contractor Information: / (�
a)Name and Address: T� E- rit(C)- V24 PItC r Aida
tiA
b)Phone Number: [�t� � j
5. Surety Information:
a)Name and Address:
b)Phone Number:
c)Amount of Bond:$
6. Lender Information: N.
/
a)Name and Address: f
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 : .
a)Name and Address: ..._J1gmt' a • 00 1 —: • = 1C11LA 1d.z 32.2.s3
b)Phone Numbers of Designated Person: f) s. . ,
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:
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,1 declare that I have read the foregoing notice of commencement and that the facts stated
therein are true to the best of my knowledge and belief.
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v1..7I -Q �u1/ere A -J/ee�e✓'
Signature of Owner or wner's Authoriz d Officer/Director/Partner/Manna�ageer Signatory's Printed Name& itle/Office
The(f�or�Q1(gooing instrument was acknowledgedtbefore me by means of 6d'physical resencc or/Donline notarization,
this"t' day of T€',Qt1 .v v` ,20'Il ;•by .]ik`� J1 ttf.v,who is personally known to
(� J /� u (Name of Person) 1
me or produced. V\ U� Sl*\\.QATi���las identification,as R C L ( A(
•
` (Type of Au Dri1ly,c...officer,attorney in fact,etc.)
for�U
S\ l(
(Name of Party Instruinerk was Executed for)
CX)
•;p,':":u'yfi,-LEANNE DONOHUE NOTARY PUBLIC SIGNATURE—STATE OF FLORIDA
Commission 9GG943250 Commissioned Notary Name: 1ICM \f t/t\C \'J`
i Expires April 28,2024
taw..' Bonded Thor Troy Fain Insurance tto'385.7019
Revised 1/1/2020