Loading...
Permit New Pool 353 7th St 2012 - H CITY OF ATLANTIC BEAC 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 R Application Number . . . . . 12-00001185 Date 9/27/12 Property Address . . . . . . 353 7TH ST Application type description SWIMMING POOL/SPA Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 31100 ---------------------------------------------------------------------------- Application desc NEW POOL ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ MARTINEZ JUAN CARLOS & WECHTER POOLS BY JOHN CLARKSON, INC. MARY ELLEN 600 ST JOHNS BLUFF RD 303 9TH STREET JACKSONVILLE FL 32225 ATLANTIC BEACH FL 32233 (904) 223-4050 ---------------------------------------------------------------------------- Permit . . . . . . SWIMMING POOL Additional desc . . Permit Fee . . . . 210 . 00 Plan Check Fee 105 . 00 Issue Date . . . . Valuation . . . . 31100 Expiration Date . . 3/26/13 ---------------------------------------------------------------------------- Special Notes and Comments NEED NOC 2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE REQUIRED INSPECTIONS : *POOL STEEL *ELECTRICAL GROUNDING AND BONDING *FINAL (PUMPS MUST BE RUNNING FOR FINAL) SWIMMING POOL SAFETY INSPECTION REQUIRED Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 3 . 15 DEV REVIEW-SINGLE & 2-FAM 50 . 00 ENG REV PRE APP > 3 HRS 2S . 00 STATE DBPR SURCHARGE 3 . 15 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 210 . 00 210 . 00 . 00 . 00 Plan Check Total 105 . 00 105 . 00 . 00 . 00 Other Fee Total 81 . 30 81 . 30 . 00 . 00 Grand Total 396 . 30 396 . 30 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. gms vaw-u'RXIII 3NM3N VOINTU 'HOV3a ViNyliV z 903 31ins 13311S Lqu 003 BsI.jDa9ZVY 3SN3311 YGM014 1 3 3 S H Vd Mi-mv 33unaawvf 3990 IDUSV 3SNDII vaisaw VIV III nsdna'm s3wv[ N; 0 d V) (n z 0 Ln > V) 2 1-n... n Mill < p rEj e z -2.-, 71 �L 0 .1 CV V% I I z ! 92-mou- Q N" '01 P- ik Z- -R; o w 17,85::! HI � - hoz"55521W:�Isn 01 OR @3'CD'CD'CD m w d z n U OEM �1! jift UO no jI ------ �5 t 0 mi, t5l 11.1. , , 9 I xn-m-w-m-M-M au Ig I IBM, It 9 U) w a V LLj U_ '00*02 H N-T N J o-.oz P.4 _j 0 C� E:� 0-00 cn Ln so 1!2A, ————— LLJ m Ld 02 � 3 J LZE coo Om I L 0 -0 Ln "Z < d Cn 7:nW-44 �4NI-1 NIVHD z '04 - cr (00,02 o o_ .Ll� H"P*V BUT 3AI�ja Isvoo iSV3 61 z Olt In 10 F -1 -n -n 'a 73 M 0 11 R11 CD B 3 -SO 3- ar co 0 7-5 �F- CD CD 0 =7 CD 3 CD CD 0 x 0 o .4 6 D) :0 > SU t 0 X' 0 X SL x 10 CD n (D ct 17 m U) <D — Y) W CD W N 57 C. co =r .0 2i CD 00 It -cc S, .6 0) (D 0, M > CL a CD CL m 79 tn 0 5' 1— NY\ E; S' CD > Q) (JpD c 3 z -35: L CD !R 0) 10, Z CD (D El -0 M CD cn QJ q (D 3 St -3 a 0 z M o (D CD CO CD C, 5: :S CD CD J1 cr < M 0 72. S, ar as' CD Ln. ft N 9 5 4 co cn 0 0 CD (IV C11--4 PSI(Pressure Gauge) CD 3 0 m I, ER ig 6� cn 0 = � B = +31-lull!l = I cr R. b,4. w --I En a--1 5 — . ca SSSU.-E:�E §E� TlS:z:A_-:tzSlAl M L, MEE CL �K 0 im! E e al��t a� E kwo�tl 8b <0 o RMM�.� E.M:!EEEE ;D 2 E R 2 El E t4 Dt 13 za V;Z.1=18 E El 1-21 2 laEll,2 E 2 2 2 i 0 52. m ——————— lz :0 R cn 2a 2 E 2 a m E 8 --I VMS a�3 V.In mj� �1. IS 8 fa 21 E, �.JEJ. .- - 94 IS -er T m 0 32" Channel Drain Flat Grate Anti-Entrapment A A Suction Outlet Cover and Three-Port anuf actured Sump AquaStar line Of suction outlet covers, compliant with the new VGB Series Product Specification Sheet Virginia Graeme-Baker Pool and Spa Safety Act(ASME/ANSI A112.1 0 R .8a-2 08) Features A single,unb(ockable suction outlet that The Unblocka' ble!' exceedsthe newVGB mandateandASME/ ANSI A112.19.ga-2008 standard For single or Multiple drain use(see installation instructions for plumbing, hydrostatic valve/drain pipe and single or multi-purnp connections) Single Floor:316 GPM at 3.9 fps Wallt 208 GPM at 2.6 fps Floor/wall:122 GPMat 1,5 fps. 25.9 square inch opening #316 stain lessste el screws Manufactured from superior UV468IS611t�englneeirecl-901yrners Three Porfs;bottorn 2-1/2"'0 b 1 2"I D 8/S.;Inside V thr6ade�FPT; two-V thr6adda pjug�j .4 n.cludda I M.�osi or ektb d- 515 N :5 0. A$� ATi.2 b4pj0s.ft F ad d MTryl:G!5 4 VM N �p U��en.,A'00% t..49' -,--WF 3::.!;-- -,!L`P ages""'. U t With SUMP(concrete pools) Pa a rt#32CDFLxxx Two Drains in One! Part Numbers Colors 32-19132 5 32CDFL101 White- 5/16 2 -27/32 5 32CDFL102 Black* 4 3 32CDFL103 Lt.Gray* 32CDFL104 Blue* 32QFL105'-Dl(.'GraY* —4-ITI/32 32011106`Bone�� I 0-� 3-2CDFL107*Taupe*' 2-1/2"spigot x 2"socket x 2"NPT C10). 32C.lJFLi08 TtlO, Also.avallable�as sump on(Y 4 1.32"three-port manufactured sump bucket 2.32"channel drain,cover,flat VG&20. 8`Co im-, If �n 3.2"NPT plug,city 2 4.32"channel drain, plaster shield ........... .......... With a flow rating of 200 gpM on the floor and 192 gpm on the wall SDX is compatible with Pumps up to 3 hp, In most cases this eliminates the need to calculate the system total dynamic head. Two SDX High Row Safety Drains HIGH FLOW SAFETY DFZAIN FLOOR-200 gpm(756 ipm) WALL-192 gprn�C726 j1pm) 'n)ree SDX High Row Safety Drain., FLOOR-300 gpm(1186 1pnl) WALL-288 gpni(1090 1p,n) Four SDX High Flow safely Drains FLOOR-400 gpm 0 514 1pm) WALL-384 gpm(1456 IPM) Order SDXfor new Pool construction or when installing a new Plaster ring (,such as when a new interior finish is being applied). SIDX is available for concrete, vinyl and one/piece fiberglass pools Order SDX Retro when replacing-an existing suction Outlet cover up to 10" in diameter. SDX Retro is available for concrete and vinyl pools Avallable in eight colors to comPlement any Interior surface, 0 1 41'qW While 81011A light Day Cray Helga Taupe tl9IA Blue Blue ill 07 04 Do 05 WARNING: SIDX and SDX Retra Must be,Installed In accordance wItI­j Paramount's written instruc�tion manual, and in conformity with applicable Federal, State, Local and Swimr-ning Pool Industry building and safety codes. .... ........ Paramount Pool LifQ.Simplified, World's#1 In-noor systeryis corylpat)y 295 Fz�,tk,,A corporate pja�_e,suite 10() Chandler-,Arizona 480.803,7607 1 1,800k2 1.5813E,I vv,~I 'SC)X SDX Reu`0�rci,Protected by U S,I'Welit Nurr) Po(veredby. tiers I'MMINUSA 7,178,179 M� Caramou nt SDX0814 004-022-,5630-00 nF Pool Life.Sfmplffied. R Energy- Efficient Jandyo ePump The Jandy ePurnp is innovatively designed to Dimensions exceed the strictest energy efficiency codes. ePump delivers an ideal exper'ence by combining optimal Optional Off-Board Remote Control performance with Jandy's patented quiet technology, The convenient ePump off-board so users can focus on the moment, rather than controller, includes 2 timers and 8 annoying pump noise. And, its robust motor is built pre-set speeds with easy-to-read to last with minimal upkeep. With its large-capacity LCD/LED display, 2 time-out trap basket, it also reduces maintenance time, so pool settings, pump priming, freeze protection and a pressure cleaner I owners can spend more time enjoying their pool and pump interface. It also displays less time maintaining it. Imagine that... power consumption in watts and includes a global RPM limiter and eStar custom setup. The controller can be installed upto 200 feet from the pump. The ePump can also be operated from an Aqualinke RS One Touch or Model Specifications Carton Overall PDA control system. No. HP volts Watts Pipe Size Weight Length'A! 10-t5 ':A2," 1" 230VA'c� 7-- 7:tt�iW 9 34% 'Z7 ' I j 161181-7 JEP-J,.O U5- 00VAC 2�1_011'1 1 lbs 4'W', JEP-k Jand�e�vmio'Rem4i cohiroller, 151/4" Performance io LL 100 0 14 3/4"--� F- 90 W Front EX of Union to 113/8" W 80 Centero oftHoles C) 70 < LU 60 -----JEP-2.0 HP,3450 RPM 40 < JEP-1.5HP.345ORPM Z 30 HP JEP-2 0 HPI 300D RPM -1 20 JEP-2.0 HP 2400 RPM JEP-1�5 HP,3000 RPM F< 10 1500 RPM 0 _1 5 JEP-1,5 HP,2400 RPM jEp HP 10 3/8" 1 500 RPM 0 10 20 30 40 50 69 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 FLOW GPM i_� 9. Solt Holes, Center to Center W1191mummm. Cartridge Pool Filters -CL and CV Series Filters Page 15 S ektion 10. Head Loss Curves 10.1 Jandy'CL and CV Cartridge Filter Design Head Loss Curves CL340 CV340 CL460 CV460 C I �.q rxjr n Q L580 CV580 28 26 24 12 22 20 10 Design 18 Design Head Pressure Loss 16 (ft head) 14 Drop (psi) 12 6 10 8 6 2 2 0 0 0 30 60 90 120 150 Flow Rate (gpm) HYDRAULICS DESIGN FOR PARAMOUNT IN-FLOOR SYSTEMS. Paramount makes systems that operate and 40 to 45 gpm and 60 to 65 gpm and the gpm of the system will be listed on the drawing from Paramount. If Paramount main drains are used: MDX2 is GVB approved and rated at a maximum flow of 90 gpm at less than 1.5 ft. per second, and is less than I ft. of head loss at that flow rate. SDX is GVB approved and rated at a maximum flow of 200 gpm on the floor and 192 gpm on the wall at less than 1.5 ft. per second and is 3 ft of head loss at that flow rate. When used as the second safety drain to our MDX2 at 90 gpm it is rated at less than I ft. of head loss. The Paramount water valve has around 10 ft. of head loss at 65 gpm. (NOT COUNTING ANY PIPE OR FITTINGS). NOTE; ON POOLS WITH 9 OR 12 PORT SYSTEMS THE HEAD LOSS THRU THOSE VALVES WOULD BE 20 FT. OF HD. NOT COUNTING PIPE AND FITTINGS. The nozzle loss of each circuit on the water valve (NOT COUNTING ANY PIPE OR FITTINGS) is 25 feet of head. EACH CIRCUIT (NOT INCLUDING PIPE AND FITTINGS WILL BE AROUND 35 FEET OF HEAD LOSS EVEN IF THE SYSTEM IS 40 GPM OR 65 GPM BECAUSE OF THE LOSS IN THE WATER VALVE AND THE PRESSURE AT THE NOZZLE NEEDING TO BE 10 PSI FOR MAXIMUM CLEANING DISTANCE . ON A SINGLE PUMP SYSTEM YOU MUST ADD IN THE POOL EQUIPMENT LOSS, ALL PIPE AND FITTING LOSS AND AN EXTRA 15 FEET OF HEAD LOSS ALLOWING FORTHE PROPER FLOW ATTHE NOZZLES WHEN THE FILTER IS DIRTY, On a booster pump cleaning system YOU WILL NOT HAVE TO ADD THE 15 FT. OF HD. FOR A DIRTY FILTER AND NO EQUIPMENT HD LOSS WELL BE ADDED. Just the pipe and fittings must be added. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road ,I P 0 Atlantic Beach, Florida 32233-5445 ���-, , 1 Phone(904)247-5826 - Fax(904)20-5845 E-mail: building-dept@coab,us Date routed: 12— Cityweb-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM _/f_9 -S�r Property Address Department review required Yes No �Bui f�5_rannin�&Z Applicant: Tree Administrator Project: ri) it 'n � 15_u_blicyv�r Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: FlApproved. 4Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: 4F Date: TREE ADMIN. Second Review: 5�pproved as revised. nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by:7!K� Date: FIRE SERVICES Third Review: nApproved as revised. FIDenied. Comments: Reviewed by: Date: Revised 07127ilO City of Atlantic Beach APPLICATION NUMBER Building Department lip (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-544�r` Phone(904)247-5826 - Fax(904�'2'47-584,,5,, .7 E mail: building-dept@coab.us L_�ate routed: Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: b7� -7t--g Y7- Department review required Yes No IBui 6 �-F—ranning!�L� Applicant: Le"e"r-'n '0 Tree Administrator Project: /I co u n 'b 'Pee J Oy�ld)- ublic�Lv�r lic Utilitiec> Public Safety Fire Services Review fee Dept Signature(,��q� Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: pproved. [-]Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Zl-;;D Date: TREE ADMIN. Second Review: FlApproved as revised. Denied. Comments: TI 4;-1 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F _]Denied. ]Approved as revised. Comments: Reviewed by: Date: Revised 07127110 Y, City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 5" Phone(904)247-5826 - Fax(904)247-5845 2— E-mail: building-dept@coab.us L__�ate routed: 90 7F Cityweb-site: http://www.coab.us I — I APPLICATION REVIEW AND TRACKING FORM Property Address 7tv S�- Qgpartinent review required Yes No 'Bui oe Applicant: .0,0 L Tree Administrator 1 /10 '15-u-blic W_0Jr52' Project: r6 1A nb P ��Iic utilitis�E;� Public Safety Fire Services Review fee L10 Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS (6 Reviewing Department First Review: 1�4proved. RDenied. (Circle one.) Comments: BUI_11� (fl:��NNIN– ewed by: Date: TREE 0Cf Ua(I s revised. ElDenied. PUBL[ 47c, - ce).4 PUBLIC 0 _tL4 C, W eS CL'C'o PUBLI( 0 WY1 C4� IOU IJ r- eL__L)Bwed by: Date: FIRE Ic s revised, E]Denied. ewed by: Date: Revised 0712 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 9 12— Cityweb-site: hftp://www.coab.us 10 _J1 APPLICATION REVIEW AND TRACKING FORM Department review required Yes/rNo Property Addres 7tg S4- ;` Bui Applicant: Joit k6znell POO ��anni�in &Z�_ Tree Administrator (/Vi- d) --,fu-b 7c Wo_r�q> Project: /I rt) 14 n b �Iic Utilitie'!�� Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: &Approved. nDenied. (Circle one.) Comments: UILDIN PLANNING &ZONING Reviewed by: Date:- TREE ADMIN. Second Review: ElApproved as revised. nDenia PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. [:]Denied. Comments: Reviewed by: Date: Revised 07/27110 12- — CI1Y OF Al I,ANI IC I'll-AGI I M114 'I J- I I(I)At).A I I ANI It,III A1.11,I 1 1.')1 1 FILE :,),:1 11 4)--4 1 Ml,'f I*$A�,1,11 1 (!1D4)�'4 1!414f� I it III I)INI;111 1-1(41.1 W I 11!1 BUILDING PERMIT APPLICATION DIJVAI (;()I IN I Y ggsjoaggo V LOAl 7M Sr )to 47 0 I I NI W III III I)IN(i I IOIMOIIIION 1-41 M01 N I IAI 1,01 11114,CK I SUBDIVINION I I AI)I 111 ION 11('ONVI I?1114, 11!it Iiii""'M ` ar"Dr.5clorf I(A'0wW'0f* Oak I IAI IlliAlION I I Al:I;I!�!;OIIY III DO NKI 1441*31till" 10 I-Atli 14,"'0, VWA yl N/A o MOVI I I 1�11111 14 1 114() WOMWOM"ARC"ITC-,03 9.RAMI v V, G1 lMlq�Y NAMI, �3 COMPANY NAMI J. . \ 3Vr1-j 'A41r�� 16 NAM[ WV ','4 1 ICI N!;I I NAMI 10.ADDIV 11.��I A I I (It I I()fill)A I ICI N!;I NO !T,,!dAII III llOI4IDAII(:IN!.I No C 24--Q 0 �!- IbCO3 T11* In AoDlil'�!;' '.41 AIII)141 141.1-111f, L'v s r- 14 11�Ill 1 113 1 1104,11 1 1 AX NO,: 19 (if I 1 '-1 "1 1 1" 111IONI �,It I A)(Ni) 7?5-11— 13.GI 11 PI I(PNI A.(3 If IIIIONI C�9 4/,— ;-1# (3 1 1 1-1 II)NI ";`�"Y� 22-2-1 14 1 MAII At 110il I MAtXiI.!'1;' :Ill I MAII Word 'ifLINS"k, 'TIM T Ij0L'?ER,. so I 0" M 'W kl 31,NAMI Xi.NAMI 3!�.NAMI 32,ADDI it 34,ADDRI!�S: :Ill ADDRI Applicalloti I-, hereby made to obtain a pormit to do tire work and If ist;Ill;itions if,; indicated, I corlify that no work or In-*i1hition lim; comitioncod prior to the Issuance of a permit and that all work will be porlorrued to moot the standards of all laws iollulating construction in fill!; jurisdiction. This permit becomes null and void it work I.,.; not corninoncorl within six (6) months, or if construction or work Is stv;pondod of abandonod for a period of six (6) months at any timo after work is commoncod. I undorstand that soparato ponnits, must ho socurf-tri lot Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Alr Conditioners,etc. OWNER'S AFFIDAVIT- I cot tify that all the foregoing Information Is accurato and that all work will be dono In COFTIplillf)(7.0 Will I Al ;If It Ill laws ro( gul;dIng construction and zoning. I will not occupy or use tire rohnonced building or any pait thorof, untilall inspections ato finalod mul prior to obtaining a certificate of occupancy or cornplettion Issued by tho building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT. i V ERRPS A' 'E r .QP 'X4� ,w ,,;M man'"ANNOR, 'n M,oil ra 1WW Signed Dalo: T/1-7/11 0 day of Ill 40 day of Below _,2OMn the county of SB.1 re met 4��n the cotinty of .1 ppearet Duval,Slato of Florida,has personally.4peared Du 1,St4te'of Florida,has per nalld. d Z Of Sy tAN-f lite 11 4 r k; 0#%. herin by hillISOlf It herself and affirms that all staternenis and declarations are harin by himself/herself and affirms that all statemonts and declarationsaro trurt andac.cmate. true and accurate. 'County0f Notary Public at LaFqe,S N ry Public at Large,State of 0 flemonally Known. J"CLAW" Zursonally Known XP(odticod Idonfificallon- W COMMIS"If EE 153736 11 Produced Identificall R 10,908 Notary Signal ure. F.- I'lidemilift- Notary Signal GRM R.TEDOER ;1M EN My COMMISSION#EE 830884 [em I r L120—7!�-2-2,�; 0 EXPIRES:September 9,2016 BonW Thru Wary Public UndeNolters- COABFORMBI- OVIREVISE01:11/15M7 NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of County of 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:. L-or *1 - 5—Ala a 51coJ 4 Address of property being improved:.. S6 3 6 4f vW-1 'y General description of improvements: %41 1"M)4- jk,�L— Owner—L.),6- 1AV"'ixh�S, z Address...,,3:5-3 -2?tk- . X�Ic7t Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name * Address Contractor P 60,ft-5," lraa,, Address 15,j- jj 44-�>hhdX- Phone No. aq za--,� -+Zrj� Fax No. 2 Surety(if any) Address mount of bond$ Phone 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 Phone 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 Statutes.(Fill in at Owner's option). Name Address Phone 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 ev, -7 Signed., k ,,,,DATE 9 1' Beriorer�at cl`�of _ 0 Q— in—the Doc#2012210401, OR 6K 16084 Page 761, County.Yue,State orldl�basper Inally appeared Number Pages: I I I A herein by himself/herself and s that all statements and declarations herein Recorded 09,127/2012 at 10:47 AM, are true and accurate JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING$10.00 WO'FarY Public—at Large,-§—tate c—f Myc 'as: y 0 6awnwNweam ei so nally Known GHIzWHLN K.I tUUtK ion AhAkille(SION#EE 830884 EXPIRES:September 9,2016 Booded Tfiru Notary PUblio Underwriters m ol 0 ca > ;u 0 z -0, ;mo cu 0 ljj (Ai -n 0 r- X 0 0 C) 0 0 ca 0 m W.0 --1 b m G);o 0 o -2,mao lw M> o >>"I M txl Z ;t m 0 m ca m -f m 0 a -n a) > �A m 0 -4 ro WO 0 < .;a m L) M -n P m M ;u 0 ;o r- Z > b z 0 Z� m 0 G) r- ;u m goo zo ——————— m c2 - ———————————————- z >0 o.g -- --------------- -n cl 00. - -------- ----- -