675 Beach Ave RES24-0018 Application BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach Building Department PERMIT# (1 D
- 800 Seminole Road, Atlantic Beach, FL 32233
**ALL information required to process
• Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address 675 Beach Ave. Atlantic Beach,FL 32233 RE# 15891-00854
Legal Description 5-69 16-2S-29E.23 ATLANTIC BEACH LOT 5 BLK 15
Valuation of Work(Replacement Cost) 45,000.00 Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: ❑ New ❑Addition ❑Alteration ❑Repair ❑Move ['Demo ❑Pool ❑X Window/Door
•Use of existing/proposed structure(s): ❑Commercial ❑X Residential • If existing structure, is a fire sprinkler system installed?:[Yes❑No
•Will tree(s) be removed in association with proposed project? E Yes (Must submit separate Tree Removal Permit) El No
Describe in detail the type of work to be performed:
Replace windows all windows and doors except for the following: Main Entry Door, Folding doors on East Side,Garage Doors.
Replacements will be Marvin hurricane impact rated units with turtle glass.
Florida Product Approval# FL-31327,FL-35391.1,FL-10196 (For multiple products use Product Approval Information Sheet)
Property Owner Information Name Benz James William Trust ET AL Phone 904-607-4430
Address 675 Beach Ave. City Atlantic Beach State FL Zip 32233
Email jwbenz48@yahoo.com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company McCormac Construction Co Phone (904)669-6222
Address 19 Sandpiper Drive City Saint Augustine State FL Zip 32080
Qualifying Agent State Certification/Registration# SC-CBC1252157
Email swaymarrero@gmail.com Job Site Contact Number 904-315-1990
Worker's Compensation Insurer OR Exempt ❑X Expiration Date
Architect's Name Email Phone
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.
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 city/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. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOT OF COM E CEMENT.
( ignate f Owner or Agent) (Signature of Contractor) }
Sigrtt?d and sworn to (or affirmed) before me this 7 day of Signed and sworn to(or affirmed) before me this I S day of
'!( � .�% by I, 5 / 4r I. V/ I el7�i 1�l U1'��, C l LI by A L\L 'CO L (A L
Signatur Iof Notary z , Signature of Notary .AA I I �� _
PF
[ ersonally Known OR [ ] Produced Identification [ ] Personally Kno n uR P' Produced Identification
Typ of Identification: Type of Identification: — I 'k 5-7-jGd- k.,
Notary Public State of Florida t 90 '9 JOCILUMG saJidx3
a Bethany S Caudell 41•L8£E HH#uolsslwwo0 .,:
q. Ittl My Commission MH 296395 O2JMI3d VNIe72i ' y;'„;, •`
Expires 8/2/20213 ^_ 120111.a
NOTICE OF COMMENCEMENT
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: 5-69 16-2S-29E .23 ATLANTIC BEACH LOT 5 BLK 15
Address of property being improvedf'75 Beach Ave. Atlantic Beach, FL 32233
General description of improvements: Replace windows all windows and doors except for the following:
Main Entry Door, Folding doors on East Side, Garage Doors. —
Owner:
Benz James William Trust ET AL Addres? Beach Ave. Atlantic Beach, FL 32233
Owner's interest in site of the improvement: Primary Residence —
Fee Simple Titleholder(if other than owner): —
Name:
Contractor: McCormac Construction Co. —
Address: 19 Sandpiper Drive. Saint Augustine, FL 32080
Telephone No.: (904)669-6222 Fax No:
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:
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:
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:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the dat of i$iing unless a ditterent date is
specified): c �" MARISSALORDA ,
.; . $--
>,FOF'' 'P EXPIRES:June 12,2026
THIS SPACE FOR RECORDER'S USE ONLY OWNER .
Doc#2024022731,OR BK 20939 Page 2152, Signed: Imo– ate: / -
Number Pages: 1 Before me t 9) day of A., . in the Co ty f D val,State
Recorded 02/02/202410:52 AM, Of Florida, s personally appeared .. ' ht•
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Pu c at Large,State of Florida,County of Duval. /1174-1V-
COUNTY
RECORDING $10.00 My commission expires:Personally Known: or
Produced Identification:b(I V- (S 1tC,t