1545 MAIN ST COMM24-0007 2ND APPLICATION w/ NOC BUILDING PERMIT APPLICATION FORINT RNAL OFFICE USE ONLY
0 City of Atlantic Beach Building Department PERMIT# Qfj�� 211-b00
800 Seminole Road, Atlantic Beach, FL 32233
**ALL information required to process
Phone: (904) 247-5826 Email: Building Dept(�coab.us
Job Address J 5-14 s fi ri 3 /4}LanA cL .\ RE# /7 a3 07 s-„,ao/O
Legal Description Goy* LOQ Li %. cd O/R //$C.!11—cad Eeilvd P -c.t_\S iia,?
Valuation of Work(Replacement Cost) �Q Opp Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: ® New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential • If 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) ❑ No
Describe in detail the type of work to be performed:
/-45p A-V ove-A0.y X9 'Rcs ;P.% L-.°
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner InformationtiName j I ,,G 'Roar;� u- Z _ Phone goy-Oi0ci - 76?
Address /5'L' / ' ,1r1 S'i— City A+/Ccrfl•,C . State Fl- Zip 30,9 33
Email , C `L� ,,`_p,0 .;.c(iwner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company 1_ A;�f.fzti9- G Gs;I,ov 1 1-- Phone ..5 2-6 p- L/7�
I
Address c.5'7y F, lei' Cei4e - Ott,),J City jc. .c ✓Lvi'J(p_ State(7-.. Zip , :;)QJJ'
Qualifying Agent �3tjrel State Certification/Registration# 6S"^OsOloe4cy
Email //<j ,' �®8f-ne,;� C.0 in. Job Site Contact Number d' a�� 3'oa•s6c9• y209
Worker's Compensation Insurer itfe,.,v-j- i hSureryGr,_ OR Exempt ❑ Expiration Date b.•j 0 . a Li
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.
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 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 NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)bef a mg,this b`' day of Signed and sworn to(or a ed) befor• me t•is 1. da •f
1'11OYdh by -R- f I t^k J 1( Ltil'- - - G� - ” `' "i by •.�.t�i d )rd Com:
Signature of Notary _ I �ii�C,4, tiC)LNm U - Signature of Notary ' - �•
[ ] Personally Kno n OR [ Produced Identification [ ] Personally Known OR [ ] Produced Ide 'cation
n . I 1
iia"ti'•.. JENNIFER it•i in '•
TYpe. =
I s?° Notary Public-State of Florida :�?'•°Pe
o`_ I ;�.•' .c':. TONI GINDLESPERGER
Commission;HH 152381 u.
( o'F ; My Comm.Expires Nov 7,2025 ; MY COMMISSION#HH 407122
''''"v' EXPIRES:October 6,2027
Bonded through National Notary Assn. ( ''f:°f: :
•__----,-__ ewrr•
NOTICE OF COMMENCEMENT
State of FL 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 improve.. ' ' ' - - • -
/ 1/S-- /7 s+ Atli t --''c, k[—
Address
Address of property being improved: 1545 MAIN STREET ATLANTIC BEACH -
General description . improvements: ASPHALT OVERLAY
/
Owner: , , I / (J - ' Address: , ' _ —
Owner's interest in site of the improvement: /f 7O I
Fee Simple Titleholder(if other than owner):
Name: EDWARD BURDEN
Contractor: ATLANTIC ASPHALT
Address: 12574 FLAGLER CENTER BLVD JACKSONVILLE FL
Telephone No.: 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 date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER J/IryQ�
Doc#2024047911,OR BK 20974 Page 629, Uctor ROO 4441 3/8/2024
Number Pages:2 Signed: Date:
Recorded 03/11/2024 11:04 AM, Before me this 8 day of March in the County ofhestr e State
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Of OtWaVictor Rodriquez Chas personally appeared
COUNTY Notary Public at Large,State ofJ XXX,County of Rt rol. Chesterfield,
RECORDING $18.50 My commission expireVlraj n-ieI /31/2025
Personally Known: or
'-'entification:Florida Driver License
NotaryCam Doc ID: d6dOde2d-1396-455e-80b7-4e7a44ed5044
Certificate of Acknowledgement
Commonwealth of Virginia
City/County of Chesterfield
On 3/8/2024 before me, Kelley M William5personally appeared, Victor Rodriquez
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed
to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) or the
entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal % — Amiffiiiibribmihr— — — —
KELLEY MARICA WILLIAMS
1 Electronic Notary Public
Commonwealth of Virginia
WRegistration No. 7961837
Signature (Seal) 0 My Commission Expires Aug 31, 2025
APRISPIIIPPROPRIOPRIIIPROPROPRIIMIWINPRIPRI
Commission Exp. _ 8/31/2025
Completed via Remote Online Notarization using 2way Audio/Video technology
NotaryCam Doc ID: d6dOde2d-1396-455e-80b7-4e7a44ed5044