331 & 333 4th St 2014 Roof CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
j � ATLANTIC BEACH,FL 32233
J
INSPECTION PHONE LINE 247-5814
to)
Application Number . . . . . 14-00000598 Date 4/17/14
Property Address . . . . . . 331 4TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 17750
-----------------------------------------------
Application desc
reroof
----------------------------------------------
Owner Contractor
-
------------------------
-----------------------
HEWITT, DIANE M HICKMAN METAL ROOFING
150 EXECUTIVE CIR PO BOX 5515
STAFFORD VA 22554 GAINESVILLE FL 32627
(904) 779-5786
---------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 140 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 17750
Expiration Date . . 10/14/14
---------------------
-------
Other Fees . . _ STATE DCA SURCHARGE 2 . 10
STATE DBPR SURCHARGE 2 . 10
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
---------- ---------- -
Permit Fee Total 140 . 00 140 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 20 4 . 20 . 00 . 00
Grand Total 144 . 20 144 . 20 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Apr 17 2014 8: 43AM HICKMANMETAL 3523774656 p• 2
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
office (904) 247-5826 Fax(904) 247-5845
.�1�' ` �� ho-rid,, 3 3 Permit Number:
Job Address: 31 I _ � f �� II
Legal Descrip 'on S- q� />r�lc.��-ic / Parcel # 1G V3 00
oar Area o
Valuation of or $
Propos
osed Work heated/cooled non-heated/cooled
Class of Work irc�e one): New Addition AlterationRepa' Move Demolition pooUspa window/door
Use of existin #osed.structure(s) ((circle one),• Commercial Residential
tf an existing s re, s a fire spnnlZler system installed? (Circle one : O �
Florida Produc Approval #
For multiple od cts use product approval form rr
Describe in de U a type of work to be performed:_g4�Lixf Re- rao T
,�0 : l ProOwn I ormation:
Name:—Dv" l tw +N Address: ' -�"
City 4 StateF/ Zip 3;,a 33 Phone So,q- G 5 R-,3D 8 y
E-Mail or Fax ( tional)
Contractor In rm tion:
Company Nam . rn /y � Qualifying Agent: 11PAJ&4d A�,Cj''no-j
Ci La��.+��s�; t l -e-- State Zipj trot
Address:A44 W t✓ �
Office Phone - 77•Al 01 Job Site/ Contact Number 3 501 •Cv7a-D 3.� �' Fax#
State Certificategistration# y .. 05-7 S 8 7
Architect Nam &hone# N 1A _
Engineer's N e &Phone #
Fee Simple Tit H lder Nae and Address N
Bonding Corn y m
lame and Address IV 10
Mortgage Len r Name and Address Al L
llation
rior
issuanation is her Ymade ad al obtain
will beit to do the performed toork mee�a stanldatons as rds of all lawsted I regulating construction.in this jurat no work or aisdiction This permit becomes
sc
issuance of a p A'
and void rf work i of commenced within six(6)mnnths, or if construction or work is suspended or abandoned fora erlod of sis L6) months o any time c
work is comment dunderstand that separate hermits must be secured for Electrical Work, Plumbing,Signs, ells, Pools, I'urnaees,Boilers, Heap
Tanks and Air Co ditid�`ers,etc.
ARNING TO OWNER: YOUR FAILURE TO RECORDAN NOTICE OF
ENT
COMM EMENT MAY RESULT IN YOUR PAYING TWICEFOR
TO YO R ROPERTY. IF YOU INTEND E� � �� NCING CONSULT H
YO L NDER OR AN ATTORNEY ORCG Y4UR NOTICE OF
COMMENCEMENT.
e true
nd
t.
ons of laws
nces
I here certify!1 e comae lied with whether pt e i the ilon or not.
o��he a Ing of a peamtt doescnoi plresumietto gry authoritytoviolate ategor tante
type
provisions
o. w p
provisions of any her,�rederal,state,or local lax'rageslating construction or the performance of construction.
t
Signature of ne Signature of Contractor s=
j�
Print Name _.. ...:f. h, ...._........Rf.tAl,.!_!.l-..._.._..._._.,.._._....___.._.._.._..
Print Name a.r�w �✓........l.T .....................
_...._
Sworn to and bsc ibed before me Sworn to and subsc 'bed fore me 20
this 1 Day f L 201 this j(o Day of
I30of ►.taTARY PUBLIC
Apr 17 2014 8: 43AM HICKMANMETAL 3523774656 p. 3
I EVALUATION REPORT OF
METAL SALES MANUFACTURING CORPORATION
'26 GA. IMAGE I1 PANEL'
FLORIDA PRODUCT APPROVAL
FL 11560.4-Ri
ROOFING,
METAL ROOFING
I
Prepared For:
Metal Sales Manufacturing Corporation
545 South 3`d Street,Suite 200
Louisville,KY 40282
Telephone: (502)855-4300
Fag: (502) 8554290
Prepared BY:
Bala Sockalingam, Ph.D., F.E.
Florida Professional Engineer#62240
1216 N Lansing Ave.,Suite C
Tulsa,OK 74106
'Telephone: (91 S)492-5992
FAX: (866)366-1543
ff
This report consists of
Evaluation Report (3 Pages including cover)
Installation Details (I Page)
4p" SOCXAL
i��ttsw+ttt�ii
w No 62240
1 Report No. C1800-.19 #
u
Date: 12.9.1.1 Z STATE OF -Z
OR
,e
Apr 17 2014 8: 44AM HICKMRNMETAL 3523774656 p• 4
FL 11560.4-R1
C1800-19
12.9.11
ll Page 2 of 3
nui�acturer: Metal Sales Manufacturing Corporation
dint Name: Image II
P el scription: Max. 16" wide coverage with 1" high ribs
to ais: Min. ga0 d el Galvanized (ASTM coated steel A755).
Galvalumecaste {ASTM A79or painted steel
k escription: Min. 15/32" thick plywood for new and existing constructions.
Designed and installed as per FBC 2010.
ck ttachment: 8d x 2.5" long ring shank nails or#8 x 2" long wood screws @ 6" o.c.
in the plywood field and @ 4" o.c.at edges
wI Jnderlayment: Minimum underlayment as per FBC 2010 Section 1507.4.5
isti g Underlayment: One layer of asphalt shingles over one layer of#30 felt.For reroofing
( pti nal) construction only.
pe 2:12 or greater in accordance with FBC 2010 Section 1507.4.2 and
1504.6
Uplift Pressure: 84.25 psf @ fastener spacing of 24" o.c.
si p
act r of Safety=2)
er Pattern: #14 pancake head screws along panel seam. Fastener shall be of
sufficient length to penetrate through the deck a minimum of V
st tandards: Roof assembly tested in accordance with UL580-94 (Rev 98) `Uplift
Resistance of Roof Assemblies' and TAS 125-03 `Standard
Requirements for Metal Roofing Systems'.
de Compliance: The product described herein has demonstrated compliance with FBC
2010 Section 1507.4
od ct Limitations: Design wind loads shall be determined for each project in accordance
with FBC 2010 Section 1609 or ASCE 7-10 using allowable stress
design. The maximum fastener spacing listed herein shall not be
exceeded. This evaluation report is not applicable in High Velocity
Hurricane Zone. Fire classification is not within scope of this
Evaluation Report. Refer to FBC 2010 Section 1505 and current
approved roofing materials directory or ASTM E1081UL790 report
from an accredited laboratory for fire ratings of this product.
Apr 17 2014 8: 44AM HICKMANMETAL 3523774656 p• 5
FL 11560.4-R1
C1800-19
12.9.11
Page 3 of 3
S po ing Documents: TAS 125-03 &UL580 Test Reports
Hurricane Test Laboratory, LLC
HTL Report#: 0103-0714-09,Reporting Date 9/1109
F
npr 17 2014 8: 44AM HICKMRNMETRL 3523774656 P• 6
00£4—SSS—ZOS sKs�et 9M %v� zew ur aye 3Naaco rive
1 �-r���c m«z Ho vs�tu
7oZot M 'g 1 UASInOl uns' ''MEW N
m� {kms 311(15 ''1S QM£ K'M)S QK 1 z g
dtlt7� JNRIni)`I3nWA S31VS 1V13W 3'd ,a-Hd '/MVNfR D.OS. WR S a
1J3Hf11a/l11NNN
1i4 13NVd 11 39"1 NOUY7LillH30
3:Y0 J8 NDlldg�53D NDISW3Y VN
L
2N y
O ~OZ6 ta
¢ P HP R<p
_
m -
3 � aTE O w O p o
wa w-t ir Z =�i,~ �sUpO
N
ce
LA itQ Ul lJ
U1
X0 S
piv d W w in U-6 Pw
4 � PA—
LEI
m,a Z
zPi
�� � o
J n cn ~ aoLLJi `�zZmGa
Waw U � wn
rn rnos�rzq�iti�ra��4
�d
V) 2 r to
� Np�o � mdOWp2wZV�O�
f.DU d
C; Z UpoWw L5d`-5WWW
z� ¢
o, o WHR W.<0
aO
at�U
cr
m010.i1 'b
C )
Z
W
ry� U_
CL O
n
� a
ZC �
N ZZ�O
ZS fn O
w u
r
� J
�o z
t a Cc)
3 N
ce
a
z
La z
C
o ?o
-- �
L off,
Q
i
0
0
CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
r� ATLANTIC BEACH, FL 32233
v INSPECTION PHONE LINE 247-5814
,.
�f JiI � ?
Application Number . . . . . 14-00000599 Date 4/17/14
Property Address . . . . . . 333 4TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 17750
---------------------------------------------
Application desc
reroof
--------------------------------------------
Owner Contractor
------------------------
_ _
FOGLTON, DANIEL S & SUSAN HICKMAN METAL ROOFING
333 4TH ST PO BOX 5515
ATLANTIC BEACH FL 32233 GAINESVILLE FL 32627
(904) 779-5786
------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 140 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 17750
Expiration Date . . 10/14/14
---------------------
Other Fees STATE DCA SURCHARGE 2 . 10
STATE DBPR SURCHARGE 2 . 10
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ----------
---------- --
Permit Fee Total 140 . 00 140 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 20 4 . 20 . 00 . 00
Grand Total 144 . 20 144 . 20 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Apr 17 2014 8: 44AM HICKMANMETAL 3523774656 p• 7
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
minole Road, Atlantic Beach, FL 32233
ice (904) 247-5826 Fax(904) 247-5845
AV 0 �IaA
. 3"33 Permit Number:
Job Address: �gq _Legal Descrip 'on', �o /& `A - • � �i�C Parcel # 10934-01
d pWork)UZZI 01 heatedlcooled_: non-heatedlcooled
Valuation of ort S 4Proposed,
Class of Work irclI one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existin ro osed structure(s)((cucle one): Commercial esi
If an existing s cure,is a fire sprinCder system installed? (Circle one): es No N /A
Florida Produc Approval # lI!5-76n
For multiple oducts use proVuct aPproval loan
Describe in d '1 e type of work to b=:- performed: tom..{ re- - r
l3-
Propyty Own I f rmation: s-cc ,
- Address:_ ..33.3 -.
NamD4 iaw /� - 3 .' Phone— d_ D
City 4t&,J a J�te►�-1-- StatdFIZip���3
E-Mail or Fax (Otional)
Contractor In rm�tion: ,
�„� Qual'fying Agent 'JoAd t'
Company Nam : ? v d City Z4 Y,t 1 State .__ZiP 44l
Address:-3 �7�-03e?$ Fax#
Office Phone - 3'x'7- 1 0! Job Site/Contact Nurnber35a-Cr
State Certifica egistratic n# �?5 SS
Architect Nam & hone
Engineer's N e4 Phone# n�14
Fee Simple Ti H lder Name and Address
Bonding Com ny am and Address! 101V
Mortgage Len r N e and Address_ 77T
k or installation has commenced
Application is er tan that all work will bed performed toork and meet the stanlations as dards of all laws regulating construction onat no rin this jurisdiction. This permit becomerior s
issuance of a per pe pe r
aI Work Plumbing, Signs,
Wells, Pools, Puraaces,Boilers, Hea
and void if work t of ommeneed within six (6)months, or if construction or work is sus tided or abandoned for a rood of six 6)moot at any time�
work is comment understand that separate permits must be secured for Electric ,
Tanks and Air C dhi ners,etG OTICE OF
A�ING TO OWNER: YOUR YOUR PRY O RECORD
OR IMPROVEMENT'
COMM CEMENT MAY RESULT CONSULT
TO YO R ROPERTY. IF Oil INTEND EOURE RECORD NG YOUR NOTICE OF H
YOU L NDER OR ArTTOOMMENCEMENT.
1 here c rk will to h mve read lied w�examined
tel= dlheretn or not The granting of a pew the same to be true a�cdoescnot. Aprll esumde1lo gns wfekdautlwrity tows and d ialatences gorvcance
type of wo P pp
provtstons of any they ederal, state, or local[ar *,Mating construction or the performance of construction.
Signature of Contractor
Signature of gn
E L. r,t--100 Print Name ,�r ` ► a._......./.../..."-�''.'t"!a`...................._......_..._.._._
PrintName �41'`J 1 ....,. ...._ ......_. .. _..._.._......._..._._...._......._.....
Sworn o and bs ri efore me Sworn'tp and subs bed before me 20
this�Day 2 E this �Day of
No
o
PLOJO liNMARYPUBLIC_
Apr 17 2014 8: 44AM HICKMANMETAL 3523774656 P• e
i
EVALUATION REPORT OF
METAL SALES MANUFACTURING CORPORATION
'26 GA. IMAGE 11 PANEL'
FLORIDA PRODUCT APPROVAL
FL 11560.4-R1
ROOFING
METAL ROOFING
)
i
Prepared For:
Metal Sales Manufacturing Corporation
545 South 3'd Street,Suite 200
Louisville,KY 40202
Telephone: (502)8554300
Fax: (502) 855-4290
Prepared By:
Bata Sockalingam, Ph.D., P.E.
f. Florida Professional Engineer#62240
1216 N Lansing Ave.,Suite C
Tulsa,OK 74106
Telephone: (918) 492-3992
FAX: (866)366-1.543
9
This report consists of
Evaluation Report (3 Pages including cover)
Installation Details (1 Page)
E At
No 62240 Z
� Report No. CIS00-19IV
t
Date: 12.9.11 .10-'t • STATE OF
� .Op1 .
x
F:
Apr 17 2014 8: 45AM HICKMANMETAL 3523774656 P. 9
FL 11560.4-R1
i C1800-19
12.9.11
Page 2 of 3
nu cturer: Metal Sales Manufacturing Corporation
du t Name: Image 11
P el escription: Max. 16" wide coverage with l" high ribs
ter als: Min. 26 ga., 50 ksi steel. Galvanized coated steel (ASTM A653) or
Galvalume coated steel(ASTM A792)or painted steel(ASTM A755).
ck escription: Min. 15132" thick plywood for new and existing constructions.
Designed and installed as per FBC 2010.
ck ttachment: 8d x 2.5" long ring shank nails or#8 x 2"long wood screws @ 6" o.c.
in the plywood field and @.4 o.c.at edges
w nderlayment: Minimum underlayment as per FBC 2010 Section 1507.4.5
isti g Underlayment: One layer of asphalt shingles over one layer of#30 felt.For reroofing
( pti nal) construction only.
pe 2:12 or greater in accordance with FBC 2010 Section 1507.4.2 and
1504.6
si Uplift Pressure: 84.25 psf @.fastener spacing of 24"o.c.
( a r of Safety=2)
to er Pattern: 410 pancake head screws along panel seam. Fastener shall be of
sufficient length to penetrate through the deck a minimum Of V4
st I tandards; Roof assembly tested in accordance with UL580-94 (Rev 98) `Uplift
Resistance of Roof Assemblies' and TAS 125-03 `Standard
Requirements for Metal Roofing Systems'.
de Compliance: The product described herein has demonstrated compliance with FBC
2010 Section 15
od ct Limitations: Design wind loads shall be determined for each project in accordance
with FBC 2010 Section 1609 or ASCE 7-10 using allowable stress
design. The maximum fastener spacing listed herein shall not be
exceeded. This evaluation report is not applicable in High Velocity
Hurricane Zone. Fire classification is not within scope of this
Evaluation Report. Refer to FBC 2010 Section 1505 and current
approved roofing materials directory or ASTM E108/UL790 report
from an accredited laboratory for fire ratings of this product.
Apr 17 2014 8: 45AM HICKMRNMETAL 3523774656 p. 10
FL 11560.4-RI
01800-19
12.9.11
Page 3 of 3
S po ing Documents: H�r icane TeS 125-03 st bogs oratory, LLC 0 Test Reports
HTL Report#: 0103-0714-09,Reporting Date 911!09
Apr 17 2014 8: 45AM HICKMANMETAL 3523774656 p. 11
9wc-j -sem 7-4 ucc-M"16 u+a+j .sdO?mz.Icq ISOPo9s Y
CM? SSB—ZOS go�e NO wru
5 LOZOi 1JI TnL SInOl a acne 3vr OKISIW w air+ o2
OOZ aun5 -is oa£ HUIOS
Ywa
•daoo o unjo rdnrnw S3lvs lvi3n d "(314a '►vvor+„»+ syl
aadn;zyjn an
l3M1Nd 1 3`JdWI NCitt�ijua3�
yp �9 NaW�1`.94 rasLl3h 'OM
W O
a 3x r=-
zaoo
W
Z V) OU �+100U' OJ�J
/
tj
Jz�0 u �' j N U C7 �� m77
�W OyZ
OVO�8 cO�j1
ZWN=Z.T C
HN] d Fis�a Y
N z Z^ > p W 6 3 8 Z W
W O = W
Jtdi+v n a cgi Lj OwNO �
mN �� ,9imTd
3
�(J,,)��y yJ ,Mid f�q
Z
O Q JyJT�m y+1=g Z 1 g t AmCl
(� / Z`�J J `W O W a
W C) 4a chaT, '-v,NEsm
ZBCW] -ji •z z�yj~ o� �
o �� ioapoa' o t
occ c�Liwz a�05Z dZZZrraa'�
O ` 0 4 W a a C Q m K K m
o � O c��arn'&'
N O r N
itl x
[V-0�+ K
x�U
a En
a
c
Z
S
Z U
Q H
Q
ac �y
In
U Nl
W
Ix
Ix v
2 Y p o
U Q 7)— ►
ZO ca�
ZO NO_
uo
f
x" z W
N 4
{y� Z
Z
- w ?O F
2
W WW>v Q
Z \_
a
a-
Apr 21 2014 8: 46AM HICKMANMETAL 3523774656 p• 1
Doc#12014084992.OR 8K 18753 Page 506,
Number Pages: 1
Recorded 04t171Ml4 at 03:14 PM,
,. Ronnie Fussell CLERK CIRCUIT COURT DUVAL
5- d.. ...
RECORDING$10.00
Permit tuber _ZAI -0�5g�?
Parcel ID mbar
NOT CE OF COMMENCEMENT = = `
State of Iorida
T .".s R00afflpFbACLEtKOFTHE00ORTC8nts0b6R
THE UND SIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the
Florida'Sta tes,the following information is provided In this NOTICE OF COMMENCEMENT. //��
1.Descrip n of property(legal description): /G - S -AqE Af/4.64r-��h e,31,01 19�f � /��I-
a)S Uob)Address: 33f -s/c'St. �la,.r F 3aa33
2.General escrip8on of 1mpr(rvements: Z-- rac J -
3.Owner I enation or Lessee Information if the Lessee contracted for the Imps mant:
a)Nam and address-, tp.i,l _ � Gt,,t� ,� i 5 o f x G -iVe. ;r c�A. Ve, • as _—
b)Narn and address of fee simple titleholder(IF different than Owner fisted above)
c)Into t in property: ct I
4.Contract Information GG(( � tt� 3 7.... '-la
S
a)Nam and address: 1 t riflf.tLT1�t:L nlE.ci rt ��i.MAy-i tl tF1.371so(p
b)Tele one No- 3-77-C2 fol Fax No.:(op onaq
5.Surety(if pplicable,a copy of the payment bond is attached)
a)Nam .and address: A)Idq
b)Tele one No.:
C)Ams t of Bond: S _,
6.Lender
a)Nam nd address: `
b)Tele ne No.:
7.Persons hin the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.13( (a)7.,Florida Statutes:
a)Nam nd address: _ —
b)Telep ne No: _ Fax No.:(optional)
8.a.ln addl n to himself or herself,Owner designates of _
to recei a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
b)Phone umber of Person or entity designated by Owner:
9.Expiratio date of notice of commencement(the expiration date may not be before the completion of construction and final payment to the
contract butwill be 1 year from the date of recording unless a different date is specified): 20
WARNING OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDE IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR
PAYING TW E FOR IMPROVEMENTS TO YOUR PROPERTY,A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON
THE JOB S E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY EFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penal of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my
knowledge a belief. ?�
`l 1 Q V, tr. e'u)1
(Signature er or cr Owners or Lessee's(Aulhorized OrticerMIlrectomPartnertManager) (Print Nan►e and Provide Slgnatoryrs 71UdloAce)
foregoin rlstrurnent was acknowledged bt%,:.4 me this day of Apr►\ ,201L}
by o..�--}} �.3 p tr,t (type of authority,e.g.cmcer,trustee,ftmey in fact)
for _ as
(Name of Person) (type of authodty,...e.g,omcer,trustee,attorney In Tad)
for (name of party on behel Whom Ingioulient executed).
Personally ❑ Produced(D
Type of ID Notary Signature
Print name A
STATE OF FLORIDA
Car u*F1a6T'164
Apr 21 2014 8: 4GAM HICKMANMETAL 3523774656 p• 2
Doc#2014084991 OR B K 16753 Page 505,
Number Pages:1
Recorded 0411712014 at 03:14 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
i-4 y?Ct
�' RECORDING$10.00
Permit tuber Jr
Parcel ID mber 1(,g93 O9LoQ
NOT CE OF COMMENCEMENT ,.
E.•
State of l o rid a THiji: IS�v Foci C. OF THF-.C4U. T CERTreiaATtav
THE UND SIGNED hereby gives notice that imprmments will be made bo certain real property, and in accordance with Section 713.13 of the
Flodda'Sta es,the following information is provided in this NOTICE OF COMMENCEMENT.
1.Descrtpt n of property(legal descrlpffon). 4 J 1b ,1S a� !��1a.11tt � o 3 i 4 l
a)Stre (job)Address: .3 `-e � /�'�-)a,��-+ � , F -3 33
2.Genernal scription of Improvements: L�3�T r`vo
3.Owner I rmation or lessee informatlon if the Lessee contracted forthe improvement:
a)Nam and address: �_ i2a c3 a� �• rnal�u�► 333 • of lar► t"� � 3a�3.3
b)Nam d address of fee slmple titleholder(ff different than er listed above) w
c)Int in property. Fu 3yJq At -7 lu�S
4,Con>ftct Information
a)Nam and address:
i.i WfE. ts(ucG ! t-�c �t� � n9 f 1� ��L +r i(t; R. aG°('
b)Tele ne No.: - .3-7-7 -d-1 n I Fax No:(optional)
S.Surety(if icable,a copy of the payment bond is attached)
a)Nam nd address: A; M
b)Tel No.:
C)Arne t of Bond: ; -- --—
B.Lender
a)Nam nd address: / 1//4
b)Telep no No.:
T.Persons in the State of Florida desiLrlabed by Owner upon wham notices or other documents may be served as provided by Section
713.13( {a}7.,1=1orida Statutes: —
a)Name nd address: --
b)Tele a No.: Fax No.:(optional) �^ _
8.a.ln add n 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 Statutes.
b)Phone umber of Person or entity designated by Owner.
9.Expiratio date of notice of commencement(the expiration date may not be before the completion of construction and final payment to the
contract butwill be 1 year from the date of reoordlng unless a different date is ecife :
WARNING 01fL'f1ER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT AP
CONSIDE 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 JOBS E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY EFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under peva of perjury,I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my
kncwlegge a belief. N
(Solawre r or Leasee,or rs or Lessee's(AaAhorizeQ dMearloiredodParinerrManager) (Print Nome and Prov,de Slgnatory'a TdIe/0ffioe)
The foregoin ns mment was acknowledged before me this 141day of Aoci 12011 —
by as QS':)+ri e-r (type of authority,a g-officer,trustee,atbrney in fact)
for ,as —
(Name of Person) (type of autharity,...e.g.office►,to atee,attomey in fact)
for (none of party on half of~Instrument was executed).
Personally_ n P ID
Type of 10 Notary Signature -----
PIrintname CHEIS
N4TiftY P'l�llC
STATE OF FUNW A