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371 8th St RERF23-0170 fa '%;r_. BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY ':� City of Atlantic Beach Building Department PERMIT# REiz c Z3 - b I 70 r! 's' ' " 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process - W Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address 371 $ijs rT RE# f477175^omo,. Legal Description f 4 7 j b -?,S^s.q't o9714/en a afgcly 14 1 b,7t=r xd7324-34 £4o,7p7AMU 0.11,1ia Valuation of Work(Replacement Cost) /3/400;p Heated/Cooled SF Non-Heated/Cooled SF - Class of Work:0 New ❑Addition ❑Alteration ❑Repair EMove ❑Demo ❑Pool ❑Window/Door - Use of existing/proposed structure(s): ❑Commercial Ei Residential - If an existing structure, is a fire sprinkler system installed?: ❑Yes No - Will tree(s)be removed in association with proposed project? ❑Yes(Must submit separate Tree Removal Permit) ;a No Describe in detail the type of work to be performed: ee-- Roof 1// z ? .54z• X31- . Florida Product Approval# (For multiple products use Product Approval Information Sheet) Property Owner Information Name A Q Et y 7TNA;reit rip Phone Address 321 g/-0. ,r7--, City /9nA.yr'ic, ileAc/f State 1CL- . Zip 7.,,,y) 3 Email `23 C 13ttOb �Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company J,fcirr7( i?pa fiq/f Phone fel -5(3--;?oq Address (.3 5-1.f 5Alf(f Ik0 City .'",4c,LiA,I/t",1(e State t.L. Zip 71)-A4 Qualifying Agent ek.ind tM 1 TO State Certification/Registration# !}i GG / 326 TI' - Email f/4,1'7p. goof/44'0/PT,i/. r Job Site Contact Number gp4 - S73_ 26 o 9 Worker's Compensation Insurer I,f.7110 y A4/3-. '6, OR Exempt ❑ Expiration Date t/([2-1- Architect's Architect's Name Email Phone --- Engineer's Engineer's Name Email Phone 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAI , G,CONSU WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO NOTICE OF COMMENCEMENT. Pidys/c4'.cy P+ IYPc iL ,I I 1A-1PRes ant ,, • e1te..c e.. ffature of Owner or Agent) ature of Contractor) Signed and corn to(or affirmed)before me this /14 day of Signed and sworn to(or affirmed)before me this ', day of /14d4- e-2. ,„70-13 by 3 iic y V#o 12 4/111,00/130A4/111,00/130A , ...119,--T...119,--Tby /3 set 4,✓l/vti fll Signature of Notary 441/4‘:, ocy' _ Signature of Notary 4,,/a7Go(- Personally Known OR [ ] Produced Identification j<] Personally Known OR [ ] Produced Identification Type of Identification: Type of Identification: " ;�ci' • ,., WILLIAM L.POPE `'�' WILLIAM L.POPE "' •c MY COMMISSION#HH 412826 MY COMMISSION#HH 412826 .z .F 4.: EXPIRES:October 19,2027 `' b,:• EXPIRES:October 19 207 .•• i4` NOTICE OF COMMENCEMENT 3 0170 State of Florida Tax Folio No. 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: S'-6 f /G —2,p - 9r¢ (.tl 1V7 Pr l-d7"3�f Aor 3 f, /6.7 fLo�".�� Bt.e/o Address of property being improved: .77/ 57' General description of improvements: Ri-Roof Owner: 2"F�2Cmj a/ Address: 3 71 gli.17'. 4.-7A 04# 3 2 2.2.7 Owner's interest in site of the improvement: Jett/Dene e Fee Simple Titleholder(if other than owner): Name: Contractor: /3194/. - frit yht Address: /3 rzSr 5:44/,/r RO - TRGK5401 / Pi- 3-2.2 Telephone No.:370¢'7/3—2661 Fax No: 9e24—J,f f6 Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: nia 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: n/a Address: Telephone 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 Statues. (Fill in at Owner's option) Name: nia Address: Telephone 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): Pftyfcn'- (e�e_Ar THIS SPACE FOR RECORDER'S USE ONLY OWNER /Signed: \� Date: I J't/r;-3 Doc#')^')1-)36494,OR BK 20R71 Page 1690, Before me th'• rear? day of , VeMBtA in the County of Duval,State Number Pages:1 Of Florida,h:s •-rsonally appeared .�G4,e.,"ly Wosi 0 Via/if Recorded 11115/2023 11:14 AM, Notary Publi •t Large,State of Florida,County of Duval. JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My commission expires: COUNTY iumb ` or RECORDING $10.00 Produced Identification: 4 • WIuL1A14.4 L.POPE • a: . : MY COMMISSION#HH 412826 �o; • , .r; EXPIRES:October 19,2027 fie kiarr" PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED) *Project Address: 3 7/ Si • Permit#: RF,RF Z3— 017 0 *Owner/Project Name: 5xef/'v 4JOa j As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product approval may be obtained at:www.floridabuilding.org. Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# A. EXTERIOR DOORS 1. Swinging 2.Sliding 3. Sectional 4. Garage Roll-Up 5.Automatic 6. Other B.WINDOWS 1.Single hung 2. Horizontal slider 3. Casement 4. Double hung 5. Fixed 6.Awning 7. Pass-through 8. Projected 9. Mullion 10. Wind breaker 11. Dual action 12. Other Page 1 of 4 Updated 06/21/21 Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# _ C. PANEL WALL 1.Siding 2.Soffits 3. EIFS 4. Storefronts 5. Curtain walls 6.Wall louvers 7. Glass block 8. Membrane 9. Greenhouse 10. Synthetic stucco 11. Other D. ROOFING PRODUCTS 1.Asphalt shingles -09/11-(e A/lc ii/#_e?tIRL p . /f..15-5-: 1 2. Underlayments J G 22 u✓Tt e_p fee,{. 4'IVc/l A 253 '.J 3. Roofing fasteners 4. Nonstructural metal roof 5. Built-up roofing 6. Modified bitumen 7.Single ply roofing 8. Roofing tiles 9. Roofing insulation 10. Waterproofing 11. Wood shingles/shakes 12. Roofing slate 13. Liquid applied roofing 14. Cement-adhesive coats 15. Roof tile adhesive 16.Spray applied polyurethane roof 17. Other Page 2 of 4 Updated 06/21/21 Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# E.SHUTTERS 1.Accordion 2. Bahama 3. Storm panels 4. Colonial 5. Roll-up 6. Equipment 7. Other F.STRUCTURAL COMPONENTS 1. Wood connector/anchor 2.Truss plates 3. Engineered lumber 4. Railing 5. Coolers-freezers 6. Concrete admixtures 7. Material 8. Insulation forms 9. Plastics 10. Deck-roof 11.Wall 12.Sheds 13. Other G.SKYLIGHTS 1. Skylight 2. Other H. NEW EXTERIOR ENVELOPE PRODUCTS 1. 2. Page 3 of 4 Updated 06/21/21 In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation instructions along with this Product Approval Sheet. I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones listed in this document must be approved by the Building Official. *Contractor Name (Print Name): 3R(4 /5/1 %�/ *Contractor Signature: *Company Name: i J/`1,TH RDO,C/,i-C *Mailing Address: ,3 .s— .r SA!✓�t- t�� *City: K.S 4'-/ .//c *State: /-1 - *Zip Code: 5-- --1-4 *Telephone Number: — *E-mail Address: S/y/l/l/QA6F/.v"/0,4¢77. Cell Phone Number: Fax Number: 7¢ Page 4 of 4 Updated 06/21/21