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352 12th St (vault) CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247-5877 PERMIT INFORMATION LOCATION INFORMATION Permit Number: 24596 Address: ATLANTI BEACH, FLORIDA 32233 Permit Type: PATIO Township: 0 Range: 0 Book: 1 Class of Work: PORCH Lot(s): Block: Section:0 Proposed Use: SINGLE FAMILY Subdivision: Square Feet: Parcel Number: Est. Value: OWNER INFORMATION Improv. Cost: Name: ROBlCHAUD, WILLIAM I Date,issued: 8/06/2002 p►ddress: 352 12TH STREET - Total Fees: 68.00 ATLANTIC BEACH, FL 32233 Amount Paid: 68.00 Phone: 000)000-0000 ' Date Paid: 8/06/2002 Work Desc:.GLASS ENCLOSED CONCRETE_ PATI- ' X 29' CONTRACTORS PPLICATION FEES 68.00 PROPERTY OWNER -,� .Kee. ..}u',.,,�.,„„ _ ,.c,,..• -..s., ? .tt..: � [,: ,, .. µ. 1 ;tom ' 'fir sa d� NOTIC PACE, ANO BUILDING MATERI MUST BE CLEARED y HE. . "FAILURE TO COM : PROPERTY:OWNER EJECT TO REVOCATION' ISSUED ACCORDING TO APPR -_ .FOR VIOLATION OF APPLICABLE 0 : CNl41LE 1ypf: OC 1111107s!? ��.._ 14 4EAf1MINIXIS 1 IN N AT TIC BEACH UILDIN EPT. � $�-12Th N CAN l6ti:N ym**#,. INTIM Ree 12:18:49 CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET L Address 4� S Z S T-- (CIE0 ` Q Date ty4 - CZ— Heated CZ—Heated Square Footage @ $ per sq ft = $ k, Garage/Shed �b @ $ per sq ft = $ Carport/Porch @ $ per sq ft = $ Deck _@ $ per sq ft = $ �SF/ � Patio @ $ per sq ft = $ TOTAL VALUATION: $ Tota Valu4tion 1st $ 4 C C 0 Remai ing Value $cc! per thousand o' portion thereof TOTAL BUILDING FEE $ + 1/2 Filing Fee $ ( ) Fireplaces @ $15 . 00 $ BUILDING PERMIT FEE $ f WATER IMPACT FEE $ SEWER IMPACT FEE $ WATER METER/TAP $ CAPITAL IMPROVEMENT $ SEWER TAP $ ( ) RADON (HRS) .0050 $ SECTION H PAVING ( ) $ HYDRAULIC SHARES $ CROSS CONNECTION $ ( ) SURCHARGE . 0050 $ OTHER $ GRAND TOTAL DUE $_(L ADDITIONAL PERMITS OR FEES : Mechanical Plumbing Electric/New Electric/Temp ; SwimmingPool Septic Tank Well Sign Finish Floor Elevation Survey Other CALCULATIONS and/or NOTES : CITY OF f' nn1'- / f rillC Q - Office of Building Official REQUEST FOR INSPECTION Date VC(Z F1 Permit No. Time A.M. Received P.M. ` Job ddress `Lopcality Owner's ,��%(l.�'1 Q(�D Contractor M Name BUILDING ONC E ELECTRICAL PLUMBI G MECHANICAL Framing ❑ Footing 9 Rou h Wiring [i Rough ❑ Air Cond. & ❑ ❑ Re Roofing El Slab Q' Temp Pole 1-1Top Out ❑ Heating Final ❑ S Insulation ❑ Lintel ❑ ewer ❑ Place ❑ Pre Fab (� READY FOR INSPECTION A.M. Mon. �/ 1V Wed. Thurs. Friday-PM- 6;1 ` A.M. P.M. Inspection Made Final Inspection ❑ Inspector Certificate of Occupancy ❑ Date =tote y. Cityof Atlantic Beach City of Atlantic Beach 800 Seminole Road •Atlantic Beach,Florida 32233- ,gdlno and Zoning Phone: (904)247-5800 FAX (904)247-5805 • http://www/ci.atlantic-beach.fl.us BUILDING PERMIT APPLICATION FOR SINGLE-FAMILY OR TWO-FAMILY (DUPLEX) CONSTRUCTION (INCLUDING NEW CONSTRUCTION, REMODEL, ADDITIONS AND ALTERATIONS, MOVING OR DEMOLITION) DATE 7 02 S JOB ADDRESS 3 D- i�a —/a S-'-. APPLICANT 1�)I Il t a w---, ;?o 6 r,C ADDRESS 35-2— 2_221- _22�. PHONE: �C� `' y 3 LEGAL DESCRIPTION: BLOCK NUMBER ''� LOT NUMBER ZONING DISTRICT CONTRACTOR Gy IT I a•�. ''� � �i r {�crr..�{ STATE LICENSE NUMBER ADDRESS 13 S Z. / /Z� S7� PHONE CITY l7T/� QC't,, � STATE ZIP 3 2-233 FAX _{'Ass P,nc1Osecl , DESCRIBE//PROPOSED USE AND WORK TO BE DONE p 9---A No en-t,_5 d6 f-i*V C (AJ A \/ PRESENT USE OF LAND OR BUILDING(S) h C xS VALUATION OF PROPOSED CONSTRUCTION ,060 _ Is this an addition? ES 4g If yes,what are the dimensions of the added space: feet by feet Will the added area be heated and cooled? y, New electrical or increase in service? /tL" New plumbing fixtures? h G New fireplace? A u New heating/air conditioning? n Is approval or Homeowner's Association or other private entity required? n c` If yes,please subput with this application. WILL THIS PROJECT INVOLVE CHANGES IN ELEVATION, SITE GRADE OR ANY USE OF FILL MATERIAL? *NO. Applicant certifies that no change in site grade or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. PROCEDURE: (In order to expedite issuance of permits, please follow all steps and provide all information as appropriate.) STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information,please contact the Planning and Zoning Department at 904-247-5817. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 6/18/02 STEP 3. Please submit Energy Code Forms,Notice of Commencement,Owner/Contractor Affidavit if owner is contractor,and four(4)complete sets of construction plans to the Building Department, which is located at the Atlantic Beach City Hall, 800 Seminole Road, Atlantic Beach,FL 32233 Telephone:(904)247-5826 In addition to construction and engineering detail, plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures,temporary and permanent,including setbacks,building height,number of stories and square footage. Identify any existing structures and uses. 3. Existing and/or proposed driveways. 4. If required by the Department of Public Works,a pre-construction topographical survey. 5. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 6. Impervious Surface area calculations. (Swimming pools may be excluded from total Impervious Surface.) 7. Other information as may be appropriate for individual applications. I HEREBY CERTIFY THAT ALL INF RMATION P E TH THIS APPLICATION IS CORRECT. SIGNATURE OF OWNER z ATE I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF THE LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH,WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY FEDERAL,STATE OR LOCAL RULES, REGULATIONS,ORDINANCES,OR LAWS IN ANY MANNER,INCLUDING THE GOVERNING OF CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION OF THE PROPERTY. I UNDERSTAND THAT THE ISSUANCE OF THIS PERMIT IS CONTINGENT UPON THE ABOVE INFORMATION BEING TRUE AND CORRECT AND THAT THE PLANS AND SUPPORTING DATA HAVE BEEN OR SHALL BE PROVIDED AS REQUIRED. SIGNATURE OF CONTRACTOR / r / t DATE ADDRESS AND CONTACT INFORMATION OF PERSON TO RECEIVE ALL CORRESPONDENCE REGARDING THIS APPLICATION (PLEASE PRINT) l NAME {(W/ aC MAILING ADDRESS S fir^C- PHONE FAX E-MAIL SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF STATE OF FLORIDA,COUNTY OF DUVAL NOTARY'S SIGNAT /1;""A '0 " 'oy J U ••, JENNIFER SCHLUETER AS T my COMMISSION#DD 121301 ❑ Personally known EXPIRES:May 27,2006 produced identification (� i 0,h '` Bonded Th u Notary Public Undenvriten �t �L- I Z 3 q.3�/�V• 3 3 Type of identification produce J AS TO CONTRACTOR: ❑ Personally known ❑ Produced identification Type of identification produced 6/18/02 NEW IMPERVIOUS SURFACE REGULATIONS On January 01, 2002, the City of Atlantic Beach enacted new regulations limiting the amount of Impervious Surface that can be developed on property. Within all residential Zoning Districts, the maximum amount of Impervious Surface area allowed is fifty percent (50%). Within all commercial and industrial Zoning Districts, the maximum amount of Impervious Surface area allowed is seventy percent (70%). The Zoning regulations define Impervious Surface as follows: Impervious Surface shall mean those surfaces that prevent the entry of water into the soil. Common Impervious Surfaces include, but are not limited to, rooftops, sidewalks, patio areas, driveways, parking Lots, and other surfaces made of concrete, asphalt, brick, plastic, or any surfacing material with a base or lining of an impervious material. Wood decking elevated two or more inches above grade shall not be considered impervious provided that the ground surface beneath the decking is not impervious. Pervious areas beneath roof or balcony overhangs that are subject to inundation by stormwater and which allow the percolation of that stormwater shall not be considered impervious areas. Swimming pools shall not be considered as Impervious Surfaces because of their ability to retain additional rain water, however, decking around a pool may be considered impervious depending upon materials used. Information verifying Impervious Surface must be provided prior to issuance of Building Permits whenever new construction, including building renovations or additions, new driveways, decks or porches involves any increase in Impervious Surface area MAP SHOWING SURVEY OF LOT 5, BLOCK 21 SENA MARINA UNIT NO. 11 AS RECORDED IN PLAT BOOK 23 PAGE 4 OF THE CURRENT PUBLIC RECORDS OF DUViSL COUNTY, FLORIDA. City of Atlantic eac Planning and Zoning Department This approval verifies compliance with applicable zoning, subdivision and other local land development regulations, but does not constitute approval for the issuance of permits. Complic, with Florida Building Code and all other applicable local, State and Federal ur ofttinthe Cituire enis of Atlantic must be verified by gnatre Beach Building O i lal prior to the ante of a Building Permit. Approved By' ommu Development Director S'— Date:— -- � � If fOt/NO 9/4"�L�o•�-� rZ= 7eB.5� i.:o '� 5. 87' 2 89'37'9 7':e. (v/. 7¢' (� ,oma ems:. ----- — • � N 27 5' ,p 20' M ti • � VI V N D l No. 352 b :0• 074 ' /G ro , l: N N o _ O -_� Ffi✓cE posr� oN coizriE.4 4 /✓ 3 /4 H. A. DURDEN & ASSOCIATES INC gEG18 TER E0 SURVEYOR NO 1674 FLq. LAND & HYDROGRAPHIC ---SURVEYORS POST OFFICE BOX 50670—� SIGNED 58 aTH STREET SOUTH JACKSONVILLE BEACH, FLA.32250 SCALE �O�j c �iX c, IF slab pkhne,-4 +-o howse �o�hdo.-ltor wl * ,r re6gr 020�� fiber Bei n �orce-A 4o'fev^ 3" rA.n. Gover- APPROVED CITY OF ATLANTIC BEACH BUILDING OFFICE AJ6062 22 �y: C • C; Y ries�6�X 6��� f x � � u ; i I ell G A an � "� JV y z :3r� 0 a a al x } � F oc fill r _ l ttv ccs � a 0 • �9 ' ya # re cA �� re b�r v e c e c` c o,^c rc4er fs cn SAA o "-b rs►V�� J�� 9�c/NO 314"1,4 o•✓'`" 4Q. 78e, 51 ' ii�o,G 5 67' 30 57t oA N P /''°. 352 N o, hl 274 ' O 3y' _n aa�x 3,z� J � o WOOD-CHAPTER 3 i =F 1i = Z i - 6x6 W1.4 x W1.4 W.W.F. 2 DOUBLE 3'@ EDGE z_ 6x6 W1.4 x W1.4 W.W.F. N — — -------------- � -III=III =1 I I-1 I III-1 11- 1 �_��� • • T=1/2W W 3"MIN. COVER W FIGURE 303E FIGURE 303F - MONOLITHIC EXTERIOR FOOTING MONOLITHIC INTERIOR FOOTING = 5/8" DIA.ANCHOR BOLTS w/3x3x1/8"WASHER SPACED PER TABLE 303.3.2 2x SILL PLATE SLAB KEYED TO STEM WALL - � W.W.F.6x6 W1.4xW1.4 OR 7"EMBEDMENT-',, FIBER REINFORCED HEADER BLOCK I I I / 1#5 BAR #5 FOOTING DOWEL LAP -- {i #5 WALL REINF. 25"MIN.w/WALL @ 8'o.c.w/GROUTED CELL REINFORCEMENT TERMINATING IN HEADER BLOCK II / WITH STANDARD 900 HOOK o MIN.6" EMBEDMENT .A` . / 3"MIN. COVER 20" FIGURE 303G STEMWALL FOUNDATION WITH SLAB-ON-GRADE 94 1999 SBCCI Standard for Hurricane Resistant Residential Construction© WOOD—CHAPTER 3 300.3 MONOLITHIC SLAB-ON-GRADE FOUNDATIONS 303.3.1 Concrete slabs and footings shall be poured as a monolithic unit. The minimum size and reinforcing require- ments for exterior footings for uplift resistance shall be as shown in Table 303D. The outer bar of foundation reinforc- using corner bars or by bending the bar. Minimum bar lap shall be 25 inches. ing shall be continuous around corners I TABLE 303D MINIMUM MONOLITHIC FOOTING SIZE— 1 & 2 STORY T1 W Reinforcing i One Story 20" 12" 2-#5 Two Stories 20" 16" 2-#5 i 1.Thickness of footing includes thickness of slab. 303.3.2 Wall to Foundation Anchorage: Wall bottom plates shall be anchored to a slab-on-grade foundation system with anchor bolts having a minimum bolt diameter of 5/8 inch and 3"x3"x1/8" washers. A minimum of one anchor bolt shall be provided within 6 to 12 inches of each end of each plate. Anchor bolts shall have a minimum embedment of 7 inches in concrete slabs-on-grade. Anchor bolts shall be located within 12 inches of corners and at spacings as spec- ified in Table 303.3.2 for anchor bolts resisting lateral, shear, and uplift loads. Approved alternative plate anchors and wall anchoring systems shall be installed in accordance with the manufacturer's published recommendations and shall meet the following design requirements. a. Shear in the plane of the wall per Tables 305P1 through 305P3. b. Uplift loads per Tables 305F1 and 305F2. c. Lateral loads perpendicular to the plane of the wall equal to 213 plf. When uplift connectors are provided at every full length stud and are continuous from the exterior wall into the foun- to 3 feet on center for one story buildings. Standard washers may dation wall, anchor bolt spacings may be increased be used (See Table 303.3.2). TABLE 303.3.2 WALL TO FOUNDATION ANCHORAGE Fastest Mile Windspeed(mph) { 90 100 I 110 I Anchor Bolt Foundation Maximum Anchor Bolt Spacing(ft) Resisting Supporting: Lateral, Shear& 1 Story 2 1 1/2 1 1/2 Uplift Loads 2 Stories 2 1 1/2 Lateral&Shear 1 Story 3 3 3 Loads Only 2 Stories 2 1 1/2 1 1/2 303.3.3 Interior Footings: Under slabs, interior footings shall be the width, W, of the exterior footings and the thick- ness, T, shall be a minimum of one half the width, W (See Figure 303F). iggq SBCCI Standard for Hurricane Resistant Residential Construction© 93 dAO-- e.,4rhr- -- b x b /4el us-/.¢6/e Pelf 8.4s Y I 10 41. '7/lMin _.. ,_. s,1Q6 pch�e -1-o Iw�se-. •da-flc� W S re6or e-vex-j _oZOn — -�ibeo rei n �oi•c -- .o �F er pR C"I �IANT.� v BU►LD1NG OFFjG� -- -- _ _ . le-_p,S f_,S.asO S- a x o NN 4 re CP f r X 41 -14 _.. ....... c� n e � � -t- � r -v r ffv ccs - y # re mi n;mL&W%. C over, /i Ma 10 • tiIt 6721A K, o i� /3. 4 27. 4 � • � �.29, � � ��,s• 1,01 0 � o 3y' a 0 �y � { i li lr IZnn 1 .��.Pr6 VY aa�x.3�z� ---_ sr ti WOOD—CHAPTER 3 _z 6x6 W1.4 x W1.4 W.W.F. DOUBLE 3'@ !Z, EDGEz 6x6 W1.4 x W1.4 W.W.F. N Cn �i-- - �� III-III I I I II I I I I II I I I I-1 I ,,I I I_I I I- =III T=112 W, W 1 i-3"MIN. �- COVER N: FIGURE 303E FIGURE 303F MONOLITHIC EXTERIOR FOOTING MONOLITHIC INTERIOR FOOTING a' — 5/8"DIA.ANCHOR BOLTS w/3x3x1/8"WASHER -= = SPACED PER TABLE 303.3.2 2x SILL PLATE SLAB KEYED TO STEM WALL W.W.F.6x6 W1.4xW1.4 OR 7"EMBEDMENT FIBER REINFORCED •, _ HEADER BLOCK \ f / 1#5 BAR #5 FOOTING DOWEL LAP I #5 WALL REINF. r = 25"MIN.w!WALL I I @ 8'o.c.w/GROUTED CELL c REINFORCEMENT j TERMINATING IN HEADER BLOCK I \ WITH STANDARD 900 HOOK I r ••: MIN.6" EMBEDMENT •i" . �. - / 3"MIN. COVER FIGURE 303G �F, = STEMWALL FOUNDATION WITH SLAB-ON-GRADE �i A i' tf _ iif 94 1999 SBCCI Standard for Hurricane Resistant Residential Construction© WOOD—CHAPTEH 3 303.3 MONOLITHIC SLAB-ON-GRADE FOUNDATIONS 3153.3.1 Concrete slabs and footings shall be poured as a monolithic unit. The minimum size and reinforcing require- ments for exterior footings for uplift resistance shall be as shown in Table 303D. The outer bar of foundation reinforc- ing shall be continuous around corners using corner bars or by bending the bar. Minimum bar lap shall be 25 inches. TABLE 303D MINIMUM MONOLITHIC FOOTING SIZE— 1 & 2 STORY Eil 4 1� E— T1 W Reinforcing lit One Story 20" 12" 2-#5 Two Stories 20" 16" 2-#;5 � 1.Thickness of footing includes thickness of slab. r;i{rr 303.3.2 Wall to Foundation Anchorage: Wall bottom plates shall be anchored to a slab-on-grade foundation system with anchor bolts having a minimum bolt diameter of 5/8 inch and 3"x3"x1/8" washers. A minimum of one anchor bolt shall be provided within 6 to 12 inches of each end of each plate. Anchor bolts shall have a minimum embedment of 7 inches in concrete slabs-on-grade. Anchor bolts shall be located within 12 inches of corners and at spacings as spec- ified in Table 303.3.2 for anchor bolts resisting lateral, shear, and uplift loads. Approved alternative plate anchors and wall anchoring systems shall be installed in accordance with the manufacturer's published recommendations and shall meet the following design requirements. a. Shear in the plane of the wall per Tables 305P1 through 305P3. b. Uplift loads per Tables 305F1 and 305F2. c. Lateral loads perpendicular to the plane of the wall equal to 213 plf. When uplift connectors are provided at every full length stud and are continuous from the exterior wall into the foun- dation wall, anchor bolt spacings may be increased to 3 feet on center for one story buildings. Standard washers may be used (See Table 303.3.2). TABLE 303.3.2 j WALL TO FOUNDATION ANCHORAGE Fastest Mile Windspeed(mph) r n: 90 100 110 1.1- . Anchor Bolt Foundation Maximum Anchor Bolt Spacing(ft) Resisting Supporting: k Lateral,Shear& 1 Story 2 1 1/2 1 1/2 Uplift Loads 2 Stories 2 1 1/2 1 1/2 i Lateral&Shear 1 Story 3 3 3 re. Loads Only 2 Stories 2 1 1/2 1 1/2 ' � dk a 303.3.3 Interior Footings: Under slabs, interior footings shall be the width, W, of the exterior footings and the thick- as ness, T, shall be a minimum of one half the width, W (See Figure 303F). i; 1 7449 SBCCI Standard for Hurricane Resistant Residential Construction©, 93 CITY OF Office of Building Official i� REQUEST FOR INSPECTIO Z#-;Z Permit No. --- DateSOY--lY---f/—"— Time P.M. Received -- —� cality _— job Add' Owner's Contracto MECHANICAL Name UMBING -, ELECTRICAL J —R-0 u-9 Air Cond. & BUILDING CONCRETE Rough Wiring Heating Footing Top Out Fire Place r Framing n Temp Pole Sewer Pre Fab Slab — Final ` Re Roofing _ Lintel insulation RE OR INSPECTION Thurs. Friday Wed. Mon. Tues. A.M. Final inspection inspection Made _ f [' Certificate of Occupancy Date _------ ----- -- - PSR-38,�4 DEPARTMENT OF BUILDING VX CITY OF ATLANTIC BEACH ! - ---- PERMIT INFORMATION - ------- LOCATION INFORMATION --- Permit Number : 14128 Address : 352 TWELFTH STREET Permit Type: PLUMBING ATLANTIC BEACH , FLORIDA 3223? Class of Work :ALTERATION --------- LEGAL DESCRIPTION --------- Constr . Type:WOOD FRAME Block : Lot : Trap: Proposed Use : SINGLE FAMILY Section: 0 Subd: Rna: Dwellinas : 0 Subdivision: Est . Value : 0 . 00 mprov . Cost : 0 . 00 Total Fees ' 25 . 00 Amount Paid: 25 . 00 h SEWER - ------ - )WNER INFORMATION - -------- APPLICATION FEES -------- -- Name , WILLIAM T . ROBINSON PERMIT 25 . 00 Addr , 31D2 12TH ST , ATLANTIC BEACH , FLORIDF Phone—, 904 , 247-2787 ------ CCNTFACTCR INFORMATION Name: PLUMB-MASTERS Addr: P -0. BOX 50111 JA'KSONVILLE BEACH . FL 32240 Lir: CFC040041 Exp : / 1 Type,: 4 NOTES: NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. ATLANTIC BEACH BUILDING DEPARTMENT By: �, a � CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT JOB LOCATION: 3SZ �2 OWNER OF PROPERTY: ��L�/�'� T PLUMBING CONTRACTOR: CONTRACTOR'S ADDRESS: STATE LICENSE NUMBER: ��"C�2'�T TELEPHONE: 2�7"Z7g� HOW MAVY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATORIES WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS WASHING MACHINES FLOOR DRAINS SHOWER PANS OTHER SEZJE� TOTAL FIXTURES: X 3.50 + $15.00 MINIMUM PERMIT FEE = $25.00 SIGNATURE OF OWNER: 09 dv SIGNATURE OF CONTRACTOR: G INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE 1994 STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826 SEWER CONNECTIONS MUST BE CALLED IN TO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - (904) 247-5834. t CITY OF ATLANTIC BEACH ROOFING PERMIT APPLICATION JOB LOCATION: OWNER OF PROPERTY: �i I t ��1,,�' kC�w l TELEPHONE:: ��1� 1v CONTRACTOR: CONTRACTOR'S ADDRESS: (--I• ZIP: STATE LICENSE NUMBER: �C r)QC I t6 TELEPHONE: DESCRIBE WORK TO BE PERFORMED. fX�0�1 ✓1i o� VALUATION OF PROPOSED CONSTRUCTION O MATERIALS TO BE USED: Sj//���/�-,� F� Z.,5-- Xz�;l SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR: /of— SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF VOU 19� AS TO OWNER: NOT Y Pt2t77� MONNv SWORN TO AND SUBSCRIBED BEFORE ME THIS voN_MNON Ew. 1?/tmw AS TO CONTRACTOR NOTARY12 Liability Insurance Supplied Workers Compensation Insurance Supplied Contractor License Information Supplied Occupational License Information Supplied CITY OF ATLANTIC BEACH DEPARTMENT QF BUILDING 800 Seminole Road -Atlantic Beach, FI 32233 -Tel. (904) 247-5826 ROOFING PERMIT PERMIT INFORMATI9 LOCATION INFORMATION Permit Number: 19182 Address: 352 TWELFTH STREET Permit Type: RE-ROOF ATLANTIC BEACH, FLORIDA 32233 Class of Work: NEW Township: 0 Range: 0 Book: Proposed Use: SINGLE FAMILY Lot(s): Block: Section:0 Square Feet: Subdivision: Est. Value: Parcel Number: _ Improv. Cost: 3,310.00 OWNER INFORMATION`T Date Issued: 11/18/1999 Name: ROBICHAUD, WILLIAM T. Total Fees: 25XXX $30.00 Address: 352 12TH STREET Amount Paid: 21)= $30.00 ATLANTIC BEACH, FL 32233 Date Paid: 11/18/1999 Phone: (000)000-0000 Work Desc: REROOF CONTRA ;—0—M.—ALL APPLC N'fEE3 .. xiffum ABLE ROOFING PERMIT $30.00 Ins ections-Re hired NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. PAID NOV 1 8 1999 My 0f Atlantic Bch' $38.69 14 �� — Date: 11/18/99 91 Receipt: 981665 CITY OF ATLA TIC kA—CH CASH BUILDING AND ZONING INSPECTION DIVISION CITY OF JACKSONVILLE, FLORIDA APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, III, and IV. I. Street Address: _3 5 Z f r, 5 7` A LOCATION OF Intersecting Streets: Between And BUILDING Sub-division II. IDENTIFICATION — To be completed by all applicants In consideration of permit given for doing the work as described in the above statement we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards of good practice listed therein. Mechanical State Certification or Contractor Name h9 yyt A I;rQ Registration Number 49'D .7- Qualifying Qualifying Agents Ze-/ Masters Card Signature � Number / Property Owners R Signature of Name ( C Architect or Engineer III. GENERAL INFORMATION A.Type of heating fuel: B. IS OTHER CONSTRUCTION BEING DONE ON lectric THIS BUILDING OR SITE? L ❑ LP Gas ❑ Natural Gas ❑ Oil El Solar El Wood IF YES, GIVE NUMBER OF CONSTRUCTION Other - Specify PERMIT IV. MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK ( rovi a complete list of components on back of this form) A. �sidential B. 11 Commercial Heat: A. —_ Space B. ElL Recessed C. _"Central C. ❑ New Building D. ❑ Floor ❑ Fire Place ❑ Wood Stove D.L;-Existing Building it Conditioning: A. A-A'lr-to-Air Heat Pump E.emplacement of existing system B. ❑ Water-to-Air Heat Pump C. ❑ Straight Water Cool F. ❑ New installationNos stem previously D. ❑ Straight Air Cool ( Y P y installed) G. ❑ Extension or add-on to existing system ❑ Duct System: Total Capacity n cfm ❑ Refrigeration H. ❑ Mobile Home ❑ Cooling tower: Capacity g.p.m. ❑ Fire sprinklers: Number of heads ❑ Elevator ❑ Manlift ❑ Escalator (number) ❑ Gasoline pumps (number) THIS SPACE FOR OFFICE USE ONLY ❑ Tanks (number) (Received) ❑ LPG containers (number) Remarks ❑ Unfired pressure vessel ❑ Boilers ❑ Rangehood Permit Approved by Date ❑ Cooking Equipment Permit Fee ElWater Heater LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Capacity Approving Number Units Description Model Number Manufacturer (Tons) Agency HEATING - FURNACES, BOILERS, FIREPLACES Capacity Approving Number Units Description Model Number Manufacturer (BTU) Agency I j qtr, TANKS How Many Nominal Capacity Type Liquid Name of Serial Approving and Dimensions Contained Manufacturer No. Agency PS-428 FOR OFFICE USE ONLY Date......./..•..... Permit Fee$... ...... CITY OF ATLANTIC BEACH Valuation C)"t—, ................................................. FLORIDA House #-----------------_---A-------- ------------5w-------------------- ------------------- APPLICATION FOR BUILDING PERMIT ---------------------------------------------------------------------------- Application is hereby made for the -approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that alist of sub-contractors be submitted to this office so that licenses can be verified. � I--- Date........................ 19---------- 41 ---- -------/ / _ --------------_----- . 6 41 Al 1- 0 0 ........�__/ - ---------------------- -----.-Address-.I-s"�_­- ----------Telephone No/1 Owner ....... L---------------------------------- Architect...............-----_-----------------------------------------------------------------------Address----------•••••--------------•-•---------•--------------•--Telephone No----------_-----_--------- ContractorBuilder-----------------------------------------------------------------------------Address------------------I--------------------------.----------Telephone No---------_----------_------ Lot No.--------�57_ -------------------Block No------ --------------------Sub DivisionS --------------------------------------------------------r---------Zone--------- 10 kA A.- ------- ------Jo.............................Street. --- -----:Side Between--- --------I------------------------------------and------------------------------------------------------Sts. e 6�Type W'6 Valuation $------- ----------For what purpose will building be used . ..... � of constructionO ----------------Dimensions of BuildinOv- g--- -Dimensions of Lot---//­_P_A_.9_ - . .40 ------- .....I-------------- ---------------------------------Size of Footings 4-14-t -- ---------- Size of Piers...-----_------------------------Size of Sills........---------------_------Greatest Sill Span in ft------------------------.-Type Roof g+ How will Building be Heated?----- - ------ .......-------.......................Will Building be on Solid or Filled Ground?-. ------------------------ Size of Ceiling Joists------------------------------------------- Distance on Centers-----------.-------------.---------------_._, Greatest Span---.-------------.-----_-------------------- " Size pan------------------------------------------ Size of Floor Joists----------------------------------------------- Distance on Centers--------- --------------------------------- Greatest Span---.---------------------------------------- " Size pan-------------------------------------------- Size of Rafters------------------ly'_�----------------------, Distance on Centers ----- -- ------------------- Greatest Span.......f --•---------..---.-------- " This ---------- -------- This rectangle is to represent the lot. Locate the building or buildings in the right position. Give distance in feet from all lot-lines and existing buildings. REAR LOT LINE 5 Two copies of plans and specifications shall Ir w be submitted with application. Inspections required. 1. When steel is in place and ready to pour footing. 2. When steel is in place and ready to pour columns and/or lintel. Z Z 3. When steel is in place and ready to pour beam. 4. When framing is completed. S E-4 5. When rough plumbing is completed,and ready to cover up. 6. When septic tank drain field or sewer is laid but before it is covered. 7. Electrical inspection by City of Jacksonville. 8. Final inspection. Note: In case of any rejection,re-inspection MUST be called for after corrections are made. FRONT OF LOT In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications, which are a part hereof, and in accordance with the building regulations of the Cii:ty Jof tlantic Beach. Vt_ Signature of Builder----- .... .. .... . . . . ............ .. . . . ..........:.................. Address---- ------------------------------41L�_ ------------------------------------------------ Signatureof Owner.........._ .........1ST................fl ................. Address...........................................................I.................................. S� r;4 i N d•� CITY OF , 1 Ve4d-9&,aa Office of Building Official J((� REQUEST FOR INSPECTION Date Permit No. J �� Time A.M. Received P.M. District No. Job Address Locality Owner's � Name r BUILDING CONCRETE LECTRICAL PLUMBING MECHANICAL Framing - Footing - Roug irin Rough ❑ Air.Cond.& Re Roofing Slab - Temp Pole ❑ / Top Out ❑ Heating Lintel - Final C•/ Sewer ❑ Fire Place READY FOR INSPECTION Pre Fab .�.,Q A.M. o V ` Tues 7 Wed. Thurs. Friday P.M. Inspection Made Inspector Final Inspection Certificate of Occupancy Date CITY OF ATLANTIC BEACH, FLORIDA Approved by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: ` 19 IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. ELECTRICAL FIRM: MASTER ELECT IAN SIGNA RE JOURNEYMAN NAM , LC _ADDRESS: �?� `4 ` RFD BOX BLDG.SIZE BETWEEN: RES.( APT. ( 1 comm. ( 1 PUBLIC ( 1 INDUS. ( 1 NEW ( ! OLD ( 1 REW. ( 1 ADDITION ( 1 TRAILER ( 1 TEMP. 1 1 SIGNS ( 1 SO. FT. SERVICE: NEW( 1 INCREASE� REPAIR ( ► FEE CONDUCTOR SIZE O AMPS 2_00 C��O��P`,`PEER ( 1 AL1U1M. 1 SWITCH OR BREAKER 2a0 AMPS 1 PH W -!9tl>NOLT Cv RACEWAY �' O® EXIST.SERV.SIZE 06 AMPS PH 3 W Z�()VOLT 5 � RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.30 AMPS. 31-100 AMPS, SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. OVER APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW HEAT 0.1 OVER MOTORS H.P. I VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELL,ANEOUS TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO. lKVA NO.NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN n FORWARDED TOTAL FEES ':3Sr ®® DEPARTMENT OF BUILDING 9324 I CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO._. PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB i P000 T Date December 4 19 87 20.t!OrKT. 1915 1A I2/04/s j Valuation$ Fee$ 20.00 93R4 000CA 1915 I1! 12/04/0 This permit not valid until above fee has been paid to City Treasurer,and is subject to revocation for violation of applicable provisions of law. This is to certify that Huxham Heat/Air RA0024353 has permission to MU replace existing system i! Classification Residential Zone i Owned by _Bill Robichaud Lot Block S/D J House No. 352 12th Street According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS „ AFTER DATE OF ISSUE j / 10 'rte 0 Building material, rubbish and debris II zi from this work must not be placed in public space, and must be cleared up and,hauled away by either con- +I tractoi.oi owner._ i - Bui Official. I I j FOR OFFICE PERMIT DATE CONTRACTOR USE ONLY NUMBER I PLUMBING I JI+ ELECTRICAL I i SEWER WATER CITY OF ATLANTIC BEACH s 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 f s3 Application Number . . . . . 14-00000201 Date 2/11/14 Property Address . . . . . . 352 12TH ST Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 16600 ----------------------------------- Application desc reroof ----------------------------------- Owner Contractor ------------------ -------------- ---------- ROBICHAUD, WILLIAM HICKMAN METAL ROOFING 352 12TH STREET PO BOX 5515 ATLANTIC BEACH FL 32233 GAINESVILLE FL 32627 (904) 779-5786 ---------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . 00 Permit Fee . . . . 135 . 00 Plan Check Fee • • 16600 Issue Date Valuation Expiration Date 8/10/14 - ----------------------- --------- 2 . 03 Other Fees STATE DCA SURCHARGE STATE DBPR SURCHARGE 2 . 03 Fee summary Charged Paid Credited Due --------------------------------- ---------------------------------------- Fee ------ -- --------- ---------- ---------- - . 00 Permit Fee Total 135 . 00 135 . 0000 00 . 00 Plan Check Total • 00 . 00 Other Fee Total 4 . 06 4 . 06 . 00 Grand Total 139 . 06 139 . 06 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 3�oZ /aSf fla.„l��r�� -� Permit Number: .23-00'F I(v - aS- a9� Seva l�',ja Aui-ftJu Legal Description o 3 i a-1 S e lya.. Ma0, a U�l Parcel# / / oor rea o �K rt nan-heated/cooled Valuation of Work$ Proposed Work heated/cooled Class of Work(circle one): New Addition Alteration pair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial Residentia If an existing structure,is a fid sprinkler system installed. (Circle one): es No N/A , ! Florida Product Approval# /',L For multiple products use product approval orm a l a Describe in detail the type of work to be performed: M•G4i J roof-oVe+'' �a Property Owner Information: T ,/� Address: a �a X519- 893 Name: l 1 iaM tSo b h d City - 'L State FL Zip�,p33 Phone 9,0'/– E-Mail 0`l– E-Mail or Fax#(Optional) Contractor Information: t // Quali mg Agent: Company Name: t k City c+...�i1, (� State I/ Zip 3,24,0!, Address:3 y 9 AIIn/ F31 v Office Phone 35a- 7*7- 0ID) Job Site/Contact Number-4501-G W.-D 3018 Fax# State Certification/Registration# Architect Name&Phone# AIM Engineer's Name &Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address t no work or Application is hereby made to btain ry ll bepert9 meet the standards of all laws regulatincated I g onsatructithe on to this jurisdiction.ofsion. This the at any bllation has commence ecomerior s null eric issuance of a permit and that p p and void if work is not 1commenced within six understand that separate permits must be securedfor Electrical Work, Plumb ng, Signs,aWells, PoolsXFu�nacets,Boilers, Heaters, Heaters, work is comment Tanks and Air Conditioners,etc. A NOTICE OF WARNING TO OWNER: YOUR OUR PAYING WIFAILURE TOCEFOR IMPROVEMENTS H COMMENCEMENT MAY RESULT IN TO YOUR PROPERTY. IF YOU INTEND TO OBE RECORDING YOAIN UR NOTICE OF CONSULT W YOUR LENDER OR AN ATTORNEYCOMMsame to be ENCEMENT. nces this 1 hereb certify that 1 have r ed wand ith whethert eciaedlherein or not. Theegranting of to perue amitnd cdoescnot. �prll esume�to gons ive authotyf laws and rto�violategor cancel the type o7.work will be complied pp provisions of any other federal,st or local la ting construction or the performance of constructions— / Signature of Contractor Signature ofOwne /� '" r J Print Name D.0 ......................................................................................................... Print Name �C/i.. u...!rt... ..... ...:�.............�..b.! ... i._� Sworn to and subscribe before me Sworn to and subscr bed before me 20 I I Day of te 2 is 1v Day of f Q NOTARY PMIC NDS A N ary NOTARY PUBLIC ublic 35 STATE OF 1 J1FLOR3Revised 01.26.10 P ))L X16 Comm#EE046 E Expires 111712015 R 23 -- `� 1S- 4g- man METAL ROOFING February 5, 2014 City of Atlantic Beach Building Dept. 800 Seminole Road Atlantic Beach, FI. 32233 To Whom It May Concern: I, Donald L. Hickman, do herby give permission to the following person(s)to pick up, sign for and submit building permits in my absence: Rebecca Hickman James R. Wheeler Janice Edmonds Derek Hickman Chris Baker Thank you for your cooperation. Sincerely, Donald L Hickman Lic#CC-C057887 ' Donald L Hickman appeared personally before me this �O day of 1"-� M( cry_ 12014. N ' r : JANIOR o, NOTARY PUBLIC -ESTATE OF FLORIDA Comm#EE046113 1 Expires 1/17/2015 3499 NW 97th Blvd.,Ste.5 Gainesville,Florida 32606 Gainesville Tel:(352)377-2101 Jacksonville Tel:(904)779-5786 Toll Free:1-800-662-8897 Fax:(352)377-4656 www.hickmanmetal.com Feb 13 2014 5: 49PM HICKMANMETAL 3523774656 P. 1 D Doc#2014032046, 0R 8K 16687 Page 1146• Number Pages: 1 Recorded 02'122014 at 09:07 AM, "tC ;�:;..�•_,,_. . Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING 1 Permi umber ; o.ac� Parcel I umber ! 7/ o?7- � °,' s4 = NOT CE OF COMMENCEMENT State o FloridaMR .�=`1'�f-r�`:� ..• '..- °:.-;: � °: -:'�:=-�•-� .. •�.�.' .`.- _ ... _{ „_' +rs1Ria IS.R % t t►�t:c>llxaeTCeic�a7loti .. ._ THE Ugives no N SIGNED hereby tice that improvements will be rade to certain real property, and in accordance with Section 713.13 of the Florida as,the following information is provided in this NOTICE OF COMMENCEMENT. 1.Desc In of property(legal desc,rtpdon):23-00li /(*-;t S-j.9 E -rw vm M ri:y w VNO t NAI a 3 Shc va. /-!6r "'t U'V, L a)S Qob)Address: .55,2 12 1 5 , .G/. 37 3 3 3 2.Genera escdpdon of improvements: /yef�a r-ovpM 3.0wr r I ormation or Lessee Information if the lessee con for the impmvem a)Na and address:(t%;11►aA -r91&hCt"� ►+a s-f- 35a /a7S4re'i I77'��r1�lc A 3a b)Nam and address of fee simple titleholder(if different than Owner listed above) c}ktte in Property: to J,',ti v 1 e. _ 4.Contra Information .9 x W f Vd ZT; a}Na and address.- �,d � el,�u/ b)T no No.: 7 7- o"z/C' / Fax No.:(optional) 5.Sunty(' ppkable,a copy of the payment bond is attached) a)Na mid address: b)Teie No.: c)An of Bond: $ 6.Lender a)N and address: A1114 b)Tele e No.: 7.Person In the State of Florida designated by Owner upon whom not oes or other doicuments may be served as provided by Section 713.13 )(a)7.,Florida Statutes: a)N and address: -- b)Te' no No.: _ �— Fax No.:(optional) tl.a.ln add to himself or herself,Owner designates of to rete a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Stabules. b)Phon umber of Person or entity designated by Owner. �-- 9.Expirati date of notice of commnencement(the expiration date may not be before the completion of corlstrudon and kW payment to the contract , but will be 1 yearfrom the date of recordN unless a different date is ,20 WARNING OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDER IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13, FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING E FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY EFORE COMWEIV OR RECORDING YOUR NOTICE Of COMMENCEMENT. _ Under penal of perjury,I declare a re the foregoktg ' of commencement and that the fads stated therein are true to the best of my IrMoigrlahn Owner or Losm.or OwWs or Lessee's Aufw tzed ►Manager) (PMI Nerve and Pm*e 5lgn&Ws Tbe101aoe) The foregoi nt was ad Wedged before me this ve day of nt h r,,ca,,.,, 201. (d1 �- by : 1• oh, as O u2 M� — (type of ority,a.Q,Am.halve,attorney in fact) for '65 -- (Nerne of Person) _(type of e~ty,...e p.officer,trustee,aeomey Infect) for (name of rti►arrt>Iettelfaf wt»rn instrtnlierIt wm exeaftd). Personally Produced ID Type of 1D Notary Signature Print Hama :CMTS 1 N�Afk�'1+�JBLIC STA M OF rLdiQA . ConrrrO FF'I Er�irrs OrAM7