Permit Windows 1815 Tierra Verde Dr 2013 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
U
INSPECTION PHONE LINE 247-5814
Application Number . . . 13-00002007 Date 1/22/13
Property Address . . . * * 1815 TIERRA VERDE DR
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 9500
----------------------------------------------------------------------------
Application desc
replace 13 windows
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
GRAHAM BETTY A TRUST PELLA WINDOW AND DOOR
0-. BETTY A GRAHAM POSR 8174 BAYMEADOWS WAY W
1815 TIERRA VERDE DR JACKSONVILLE FL 32256
ATLANTIC BEACH FL 322334527 (904) 731-8330
----------------------------- -----------------------------------------------
Permit WINDOW AND/OR DOOR PERMIT
Additional desc
Permit Fee . . . . 100 . 00 Plan Check Fee 50 . 00
Issue Date . . . . Valuation . . . . 9500
Expiration Date . . 7/21/13
----------------------------- -----------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
-----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
---------------------------- -----------------------------------------------
Fee summary charled Paid Credited Due
----------------- ---- ----- ---------- ---------- ----------
Permit Fee Total 100 . 00 100 . 00 . 00 . 00
Plan Check Total 50 . 00 50 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 154 . 00 154 . 00 . 00 . 00
i
PERMIT IS APPROVED ONLY IN ACCORDANCE M ITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
All Openings have existing glass
windows and are being replaced #20 #25 #30 #35 #40 #45
size for size. 7-1 G;;j F---71 F-a-
#55 #60 #70 #10 #15 #50
FEP
#6 5
24
34
BAS
F
14
L7�1 L�7ml��
Betty Graham 2
1815 Tierra Verde Dr FGR
Atlantic Beach, FL 322"13
FILE COPY
]REVIM"D FOR CODE COMPLIANCE 21
CITY OF ATLANTIC BEACH
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Florida Building Code Online Page I of 4
A
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BCIS Home Log In User Registration H�t Topics Submit Surcharge Stats&Facts Publications FBC Staff BCIS Site Map Links Search
Busin
Product Approval
Professi On'a' I USER: Public User
Product Approval Menu> Product or Aipplicat�on Search > Ar)piicat;on Lis >AgRIcatioq Detail
0 4-R4
FL # FL12604-R4
P
Application Type Revision
010D
Code Version 2010
Application Status ppro
CApproved
Doro
ppro e by DCA. Approvals by DCA shall be reviewed and
ratified by the POC and/or the Commission if necessary.
Comments
Archived
Product Manufacturer
Pella Corporation
Address/Phone/Email 102 Main St.
Pella, IA 50219
(641) 621-6096
pellaproductapproval@pella.com
Authorized Signature Joseph Hayden
jahayden@pella.com
Technical Representative Joseph Hayden
Address/Phone/Email 102 Main Street
Pella, 1A 50219
(641) 621-6096
jahayden@pella.com
Quality Assurance Representative Pat Bortscheller
Address/Phone/Email
1 102 Main Street
i Pella, IA 50219
1000
PJBortsc�ieller@pelia.com
Category Windows
Subcategory Horizontal Slider
Compliance Method
Certification Mark or Listing
Certification Agency
Window and Door Manufacturers Association
Validated By
Terrence E. Lunn, PE
Validation Checklist- Hardcopy Received
Referenced Standard and Year (o'Standard) Standard Year
AAMA 101/l.S.2-97 1997
AAMA 101/I.S.2/NAFS-02 2002
http://www.floridabuilding.org/pr/P�_app__�dtl.as�x?param=wGEVXQMDqtkfS`/`2fv�/�2fpAtoC7SN2OW8h... 1/11/2013
I
Florida Building Code Online Page 2 of 4
AAMA/WDMA/CSA 101/I.S,2/A440-05 2005
AAMA/WDMA/CSA 101/I.S.2/A440-08 2008
Equivalence of Product Standards
Certified By
Product Approval Method
Method 1 Option A
Date Submitted 06/28/2012
Date Validated 07/05/2012
Date Pending FBC Approval
Date Approved 07/09/2012
,Summary of Products
Description
FL# FModel, umber or Name
1 604.1
2=][Pella Impervia Sliding Window 47.5" x 47.5" XO Horizontal Sliding Window
Limits of Use
for
Limits of Use Certification Agency Certificate
Approved for use in HVHZ: No FL12604 R4 C CAC CCL for Pella 7-8-10 411-H-
Approved for use outside HV i HZ: Yes 1122.pd
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +50/-50
12/22/2013
other: Configurations of glass hall conform to current Installation Instructions
ASTM E1300 standard. FL12604 R4 II Sliding Window Drawing 1655.pd
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12604 R4 AE Sliding Window Drawing 1655.r)d
Created by Independent Third Party: Yes
12604.2 ��JPella im via Sliding Window 71.5" x 59.5" XO Horizontal Sliding Window
Limits of Use Certification Agency Certificate
FL12604 R4 C CAC CCL for Pella 7-8-10 411-H-
Approved for use in HVHZ: NO
A A ro"
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +30/-30
04/12/2014
to current Installation Instructions
Other: Configurations of glass hall conform
ASTM E1300 standard. FL12604 R4 11 Sliding Window Drawing 1655.i)d
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12604 R4 AE Sliding Window Drawing 1655.r)d
Created by Independent Third Party: Yes
12604.3 :�JPella Irn�ervia Sliding Window 71.5" x 71.5" XO Horizontal Sliding Window
Limits of Use Certification Agency Certificate
A pproved for use in HVHZ: FL12604 R4 C CAC CCL for Pella 5-29-12 411-H-
Approved for use outside H�HZ: Yes 1384.Qd
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +30/-30 12/12/2015
Other: Configurations of glass hall conform to current Installation Instructions
ASTM E1300 standard. FL12604 R4 II Sliding Window Drawing 1655j)d
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12604 R4 AE Sliding Window Drawing 1655.nd
Created by Independent Third Party: Yes
12604.4 �Pella Impervia Sliding Windo 71.5" x 36.75" XO Horizontal Sliding Window W/HP
��Iwlater Kit
,jLimits of Use ------7lCertification Agency Certificate
http://www.floridabuilding.org/pr/pi�_app—dtl.as�x?param=wGEVXQNvtDqtkfS�/�2fv�/�2fpAtoC7SN2OW8h... 1/11/2 0 13
7- Z �z Z FOR MAX. FRAME HEIGHT SEE APPLICABLE
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W. W* SCHA
'0 c JUN 42012 102 MAIN STREET
7480 150TH COURT NORTH
WAR PAL, PELLA, IA 50219
REN CHAEF E. BMH GARDENS.Fl. 33418
P I$ ER -744-3424 641-521-1000
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FL # FL12602-R4
Application Type Revision
Code Version 2010
Application Status Approved
pprovals by DCA shall be reviewed and
pproved by DCA. A
ratified by the POC and/or the Commission if necessary.
Comments
Archived
Product Manufacturer Pella Corporation
Add ress/Ph one/Email 102 Main St.
Pella, IA 50219
(641) 621-6096
pellaproductapproval@pelia.com
Authorized Signature Joseph Hayden
jahayden@pella.com
Technical Representative i Joseph Hayden
Address/Phone/Email 102 Main Street
Pella, 1A 50219
(641) 621-6096
jahayden@pella.com
Quality Assurance Representativ Pat Bortscheller
Address/Phone/Email 102 Main Street
Pella, IA 5021.9
(641) 621-1000
PJBortscheller@pella.com
Category Windows
Subcategory Single Hung
Compliance Method Certification Mark or Listing
Certification Agency Window and Door Manufacturers Association
Validated By Terrence E. Lunn, PE
Validation Checklist - Hardcopy Received
Referenced Standard and Year �f Standard) Standard Year
AAMA 101/I.S.2-97 1997
AAMA 101/I.S.2/NAFS-02 2002
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AAMS/WDMA/CSA 101/I.S.2/A440-05 2005
AAMS/WDMA/CSA 101/I.S.2/A440-08 2008
Equivalence of Product Standards
Certified By
Product Approval Method Method 1 Option A
Date Submitted 06/28/2012
Date Validated 07/05/2012
Date Pending FBC Approval
Date Approved 07/09/2012
:attM�p,airy of Products
Number or Name --IlDescription
(112602.1 JlPella Impervia Single H 135.5" x 59.5" Single Hung
Li—mits of Use Certification Agency Certificate
Approved for use in HVHZ: FL12602 R4 C CAC CCL for Pella 7-8-10 411-H-
�H 1124.Pd
Approved for use outside H Z. Yes
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +50/-50 12/22/2013
ss �hall conform to current Installation Instructions
Other: Configurations of gla
FL12602 R4 II Single Hung Drawing 1653.pdf
ASTM E1300 standard.
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
F 12602 R4 AE Single Hung Drawing 1653.pdf
L
Created by Independent Third Party: Yes
12602.2 ���Epella Im ervia Singl 147.5" x 77.5" Single Hung
Limits of Use Certification Agency Certificate
Approved for use in HVHZ: No FL12602 R4 C CAC CCL for Pella 7-8-10 411-H-
J.'—" "Se Yc��
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +30/-30 12-/22/2013
Other: Configurations of glass shall conform to current Installation Instructions
'ASTM E1300 standard. FL12602 R4 II Single Huno Drawing 1653.pdf
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12602 R4 AE Single Hung Drawing 1653.odf
Created by Independent Third Party: Yes
12602.3 ==FPella In
Evia Single Hung 47.5" x 95.5" Single Hung
Limits of Use Certification Agency Certificate
Approved for use in HVHZ: o FL12602 R4 C CAC CCL for Pella 5-29-12 411-H-
Approved for use outside H HZ: Yes 1388.pd
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +25/-25 11/29/2015
other: Configurations of glass �hall conform to Current Installation Instructions
FL12602 R4 II Single Huno Drawing 1653.pdf
ASTM E1300 standard.
Verified By: Warren Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12602 R4 AE Single Hung Drawing 1653.pd
Created by Independent Third Party: Yes
:�[Pella Impervia Single Hung 35.5" x 65.5" Single Hung
Limits of Use �FCertification Agency Certificate
Approved for use in HVHZ: No FL12602 R4 C CAC CCL for Pella 5-29-12 411-H-
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Product Approval Menu> Product or Armlicat on Search >Application Lis > fica
FL # FL12603-R3
Application Type
Affirmation
Code Version 2010
Approved
Application Status
Comments
Archived
Product Manufacturer Pella Corporation
Address/Phone/Email 102 Main St.
Pella, 1A 50219
(641) 621-6096
pellaproductapproval@pella.com
Authorized Signature Joe Hayden Sandi Robinson
pellaproductapproval@pelia.com
Technical Representative Joseph Hayden
Address/Phone/Email 102 Main Street
Pella, 1A 50219
(641) 621-6096
jahayden@pella.com
Quality Assurance Representative Ali Zarghami
Address/Pnone/Erridil 1UZ Main '�-t
Pella, 1A 50219
(641) 621-1000
zarghamia@pella.com
Category Windows
Subcategory Fixed
Compliance Method Certification Mark or Listing
Certification Agency Window and Door Manufacturers Association
Validated By
Terrence E. Lunn, PE
Validation Checklist - Hardcopy Received
Referenced S -Mard --A -ear.�a,',Standerdl) Standard Year
AAMA 101/I.S.2-97 1997
AAMA 101/I.S.2/NAFS-02 2002
AAMA/WDMA/CSA 101/l.S.2/A440-05 2005
1-ittp://www.floridabuilding.org/pr/pr_app—dtl.as x?param=wGEVXQwtDqtkfS%2fv%2fpAtoHx%2bnVBH... 1/11/2013
Florida Building Code Online Page 2 of 4
Equivalence of Product Standards!
Certified By
Documentation from approved E aluation or Validation Entity
FL12603 R3 COC Compliance Letter FL12603. df
Product Approval Method Method 1 Option A
Date Submitted 12/22/2011
Date Validated 12/22/2011
Date Pending FBC Approval
Date Approved 01/05/2012
'Summary of Products
trL # �M�odel, Plumber or Name Description
112603.1 J[Pella Impervia Fixed Frame 84" x 84" Fixed Frame (Direct Set)
LWiWrff ITs—e Certification Agency Certificate
Approved for use in HVHZ: No FL12603 R3 C CAC CCL for Pella 5-4-10 411-H-
Approved for use outside H HZ: Yes 1066.nd
Impact Resistant: No I Quality Assurance Contract Expiration Date
Design Pressure: +50/-50 01/07/2014
Other: Configurations of glass hall conform to current Installation Instructions
ASTM E1300 standard. FL12603 R3 II Pella Fixed Frame Window Sealed
Drawing 1656.pdf
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
Ind
F1 1?6n� P'3 AF PpIla Fiy-ed Frame \Atindcw Q,,p
Drawing 1656.1)df
Created by Independent Third Party: Yes
:::=IPella Irn�ervia Fixed Frame 60" x 120" Fixed Frame (Direct Set)
ILimits of Use Certification Agency Certificate
Approved for use in HVHZ: No FL.12"6'03 R3 C CAC CCL for Pella 5-4-10 411-H-
Approved for use outside H%JHZ: Yes 1069.pd
Impact Resistant: No
i Quality Assurance Contract Expiration Date
Design Pressure: +50/-50 11/21/2013
Other: Configurations of glass hall conform to current Installation Instructions
ASTM E1300 standard. FL12603 R3 II Pella Fixed Frame Window Sealed
Drawing 1656.odf
Verified By: Warren W. Schaefer, P.E. 44135
Created by Independent Third Party: Yes
Evaluation Reports
FL12603 R3 AE Pella Fixed Frame Window Sealed
Drawing 1656.pdf
Created by Independent Third Party: Yes
--:7][Pella Impervia Fixed Frame 190" x 78" Fixed Frame (Direct Set)
F12663.3
Jurnits,2f use Certification Agency Certificatp,
Approved for use in HVHZ: No FL12603 R3 C CAC CCL for Pella 5-4-10 411-H-
Approved for use outside H HZ. Yes 1070.pd
Impact Resistant: No Quality Assurance Contract Expiration Date
Design Pressure: +50/-50 11/21/2013
Other: Configurations of glass hall conform to current Installation Instructions
ASTM E1300 standard. FL12603 R3 II Pella Fixed Frame Window Sealed
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Q��RIIF�CAT W DRAWING PTL: N0.1 RE�WON DESCRIPTION Sy DAM _;2
IMPERMA NON-IMPACT FIXED FRAME WiNDOW
CONSULTANTS VANU C%RER
(-nF.
13 PE A RPORAITION
-z W. W. SCHAEFER ENCINEERING LL GO
& CONSULTING, 1 02 MAI, STREET
5895 N.WUTARY TRAI 5 17,C-204 PELI-A. IA 50219
?ALU SEACH GARMNSL�.F 33410
WA; Pl. PKONE:561-775-4902 FAX: 561-775-4903 641-621-1,DOG
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CERZ71 CA-TION IMPERVA NON-IMPACT FIXED FRAME WINDOW NO. REMSION GESCRIPTION__ OArE
CONSULTANTS UFACTURER
W. W. SCHAEFER ENGINEERIN CORPORATION
m 5 2009 & CONSULTING, P.A. MAIN STREE'
8895 N.MIUTARY TPA SJrrE C-204
PALM SeACX G
WA�Ep,'N.SCHAEFER ARDENS,F. 33410 -Ad LLA, IA 502Tq'
P E.
E.No.441 PHONE'561-775-4902 FM.561-775-4903 El 641-621-1000
City of Atlantic Beach APPLICATION NUMBER
t--
Building Department (To be abbv
by do BUK"D"ftst)
SW Semincle Road
Atlantic Beadi.Florida=33X-StAA5 -7
Rae(M)247-M - Fax( )247-5845
E-mail: bui1dn9-dept*cw0ab-u Date rmited
):-u I
City web-site. ht1pWwww.coab s
APPLICATION R VIEW AND TRACKING FORM
Property Address: V6t'016 4�r Department review requ YM I%D
uilding--) too-,
Applicant: //4, Ing&Zoning
Tree Administrator
Project: Public Works
-Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Requlmd of Permit Verified By Date
Flodda Dept.of Environmental on
Florida Dept of Transmrlatfon 11
SL Johns River Water lklanagem!�District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Offler
APPLIPATION STATUS
Reviewing Deparbnent First Review: B�Wroved. ElDenied.
(Cirde one.)
Comments:
PLANNING&ZONING Reviewed by.___Z21 Date:
TREEADMIN. Second Review: ElApproved as revised. ElDeniU.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date.
FIRE SERXACES Third Review: 0.4pproved as revised. [--]Denied.
Comments:
Reviewed by: Date:
Revised 07127110
pfe -r -7 -7 6v he� Pe.-2
'Se CI\ 7,,7
Lg rint Form
BUILD0 G PERMIT APPLICATION JAN 16 201.3
F1
CITY,OF ATLANTIC BEACH
FILE COPY ,
800 Seminole Road,Atlantic Beach, FL 3223 y
�4)247-5826 Fax(904)247-5845 ....
Office (9
JobAddress: --Flerro, Verja br, Permit Number: 0 07
Legal Description 3Sr�-,�s-v? -)� 7,c- Skiv,._ T-terrat. "*"P`a1rceI# I 9-5-Y.) --5_d i'd
V Hoor a of Sq.Ft. sq.Ft
Valuation of Work$ 9�;00 Proposed Work heated/cooled ht-ated/cooled
Class of Work(circle one): New )Addition Alteration Repair Move Demolition pool/spa(��
Useofe�Ki�ting/pro osedstructureQ) circleone): Commercial Residentia
If an existing structure,is a fire snrin=system installed?(Circle one 0 N/A
1,
Florida Product Approval# ) t,��oL. i
For multiple products use product approval fo�m
Describe in detail the type of work to be perfo7ed: CY�Lu_ 13 temudow 5
Property Owner Information:
Name:, gem L(AA- A�ddress:
City State6L; i Phone
11b
E-Mail or Fax#(Optional)
Contractor Information.-, g/1" U/14201-5
CompanyName: PWT1-r1-Uando, Inc. -Qualifying Agent: James Rowland
Address: 350 W. State Rd. 434 Citv Lonqwood State FL Zit) 32750
OfficePhone 407-937-2826 Job Site/&ntact Number '4 0 7-4 6 3-4 10 6 Fax# 407-937-3214
State Certification/Registration# CBC046712
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4polication is hereby made to obtain apermit to do the work aid 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 laws regulating construction in thisjurisdiction. This permit becomes null
and void ff work is not commenced within six(6)months,or if construction or work is suspended or abandonedfor a
w eriod of six�6)months at any time after
e
j
work is commenced. I understand that separate permits must be securedfor Electrical Work Plumbing,Slins, dis,P6ais, rurnaces,Boiieiw,Heaters,
Tanks andAir Cond7donen,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESUL IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU I TEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTOLEY BEFORE RECORDING Y&R.NOTICE OF
�OMMENCEMENT.
I here certify that I have read and examined thisa lication nd know the same to be true and correct. Allprovisions of laws and ordinances governing this
lied with whether P
1�work will be coTp eg r not. 7he granting of a permit does not presume to give authority to violate or, cancel the
provist.ons of any otherfederal,state,or localsrali �rstruction or the peiformance ofconstruction.
Signature of Owner Signature of Contractor
Print Name ....................... Print Name
I�__ 1'.t y I ..... ........
Sworn 1p and subscribed before me Sworn toand subscribed before me
this ly Dav of .200 this /0/'Day of j�)^_ 2013
Ni&rar��Pu 2
Ormvkll TIMOTHY ROLM MULEY
77MOTHY ROLAND 01MAMEY
Revised 01.26.10
my commissioN#DD 87=5 MY COMMISSION 0 DD 87015
EXPIRES:August 7,2013 EXPIRES:August 7,2013
luxled Thru Notary Pubk Undorwgers i 'k
....... BWXW Thry Notary Public Undowters
Doc # 2013017859, OR BK 16223 Page 2002, Number Pages: 1, Recorded
01/22/2013 at 10:55 AM, Ronnie Pussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
Permit Number
Parcel ID Number F'syJ-'s-0
NOTICE OF COMMENCEMENT
State of Florida
County of D"
The undersigned hereby gives notice that the improvement(s)will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of pronerty(legal dqscription of the property,and street address if available)
Address A-13' :Zj� wr'b 4,
Legal Description_49-4 k Q? -,)S��O'f Celli 74111 /Or W
2. General oescription of Improvement(s)
1&0'44�' &AadgEl:
3. Owner Information
Name&Tly Ark"-M 7ne 11p;Number
Address Wr'_V'4Wk 1ACYT7 Z_r,—1f 3r.14
Interest In Property_'P�
4. Fee Simple Title Holder(if other tha�owner shown above)
Name Phone&Fax Number
Address
5 Con'li
NameWIL 1040161�'� L6 Ph &Fax Number
Address�;S-0 3/Z Y 31f .2 07
Lp,. 01 -J 7 0
6. Surety(if any)
NameNIA Phone&Fax Number
Addressi
7. Lender(if any)
NameN/A Phone&Fax Number
AddresSNIA
8. Persons with the State of Florlda esignated by Owner upon who notices or other documents may be served as
provided by 713.13(l)(a)7,Florida tatutes.
Name Phone&Fax Number
Address
9. In addition to himself or herself,Owner designates the following to receive a copy of the Lienor's Notice as provided in
713.13(l)(b),Florida Statutes.
Name Phone&Fax Number
Address
3.0.Expiration date of Notice of Commencement(the expiration date Is one year from the date of recording unless a
different date is specified:
WARNINGTOOWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR I PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
"T"
COMMENCEMENT MUST BE RECORDED 4APOSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCINWCONSULT RLEND ORAN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF COMMENCE.?
11.
i fc
StnatdPe-oTo�ne-ri6row�,AAWoriii-ed -er/Dlrector/Partner/Manager Print Name
Sworn to(or affirmed)and subscribed before me this '4 -
Z!day of 3)'� 201 by.R-rl�Xft;." as
(�Sm Atle (type of authority, g.officer,trustee,attorney In fact)for (name of party on
behalf of whom ment was executed. -personally known to me or -produced
as identification.
...... TUOTHYPO-WOVALLEY
'!!tofP6t&ry (Seal) My COMMISSM 0 DD 81
EXPIRES: 7,2013
81 Tft Notary
'2LU.6= Undroniers
Name(print)
--AND--
Verification pursuant to Section 92.525,Flori da Statutes. Under penalties of perjury,I d;�;that�l e r7 the foregoing and
that the facts stated are true to the best of rr y knowledge and belief.
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