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2425 Mayport Rd 2015 comm build out kangaroo (2) � CITY OF ATLANTIC BEACH It1 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 COMMERICAL ALTERATION/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-CINT-302 Job Type: COMMERCIAL INTERIOR BUILD-OUT Description: INTERIOR REMODEL KANGAROO CHGD CTR FROM NEWCO Estimated Value: $23,000.00 Issue Date: 2/19/2015 Expiration Date: 8/18/2015 PROPERTY ADDRESS: Address: 2425 MAYPORT RD RE Number: 169398-0000 PROPERTY OWNER: Name: ANDREWS ENTERPRISES INC Address: 1741 CLATTER BRIDGE RD OCALA, FL GENERAL CONTRACTOR INFORMATION: Name: FULCRUM CONSTRUCTION OF GEORGIA INC Address: 1945 The Exchange STE 400 Phone: 707-612-8005 PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $165.00 STATE DCA SURCHARGE $2.48 PLAN CHECK FEES $82.50 STATE DBPR SURCHARGE $2.48 Total Payments: $252.46 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ATLANTIC BEACH PERMIT RECEIPT PERMIT DESCRIPTION: interior remodel kangaroo PERMIT NUMBER: 15-CINT-302 ADDRESS: 2425 MAYPORT RD OWNER: ANDREWS ENTERPRISES INC FEES DUE: BUILDING PERMIT FEE $165.00 STATE DCA SURCHARGE $2.48 PLAN CHECK FEES $82.50 STATE DBPR SURCHARGE $2.48 • Totals: $252.46 �� BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 2W 2.5" /14Y fiNfLr_ 19M Permit Number: 16'-C-iA/T- 3D Z - 18 Legal Description08-25•29E' 2-jS4ET A&VT LeTt ZWO D/R 9r arcel# Floor Area of q t. Sq.Ft Valuation of Work$ cro Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): ommer ' Residential If an existing structure,is a fire sprinkler system nista a ircle one): Yes No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: PSS 12&WA& Dur&O(StA TW �i�PMtn7� Property Owner Information: Name: A4jZ*-GJS �`, ,, -TA)L Address: 1741 41grMfi_ /SRiG4ge- 12m City C3G414 Statefj.Zip I Phone g14- GI.tiS 317 E-Mail or Fax# (Optional) .IA60AI. CW01rZ e TNePA tTIZ)/. CoM Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: rIJ16904A 4ft)fr1bXrsbAJ 010640 -,q. "qualifying Agent: I L,H491 ARA&W Address: t City A7.1-WTq State Or.4 —Zip '�O 339 Office Phone '7Z-'?!S%1 Job Site/Contact Number F' Fax# 770 -41Z-81!S State Certification/Registration# G13C-06z S8C Architect Name&Phone# NSA Engineer's Name &Phone# /JIA Fee Simple Title Holder Name and Address MQMY _rWe,. Bonding Company Name and Address 'VIA Mortgage Lender Name and Address AMA Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six 6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, urnaces,Boilers,Healers, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORD moi'-OU N'O"'e" COMMENCEMENT. 8u� I herebycertify that I have read and examined this application and know the same to be true and correct. governing t is type of work will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or can the provisions of any other federal,state, or local law regulating construction or the performance of construction. t Signature of Owner Signature of Contracto Print Name Print Name (�K (1Z� GK�C rt;cM �..,� td Before me Before me this Day of 20 this Day of 20 Notary Public Notary Public Revised 01.26.10 February 18, 2015 City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, Florida 32233 To Whom It May Concern: I, Michael Arasin, authorize Luke Herinckx to apply and obtain a building permit for the Pantry #1401 located at 2425 Mayport Rd., Atlantic Beach, Florida. 32233 under my State of Florida license CBC058580. Michael Arasin Amy geli — Notary P4blic My cdmJission expires on 11/09/2016 BUILDING PERMIT APPLICATION F CITY OF ATLANTIC BEACH FILE U� i b 800 Seminole Road, Atlantic Beach, FL 32233 �A 3 Office (904) 247-5826 Fax(904) 247-5845 op Sol- Job Address: 2425 Mayport Road Permit Number: Legal Description 08-25-29E 2.28 / PT GOVT LOT 2 RECD O/R 9774-618 Parcel# 1 Floor Trea of Sq—.F—t.— Valuation of Work$CQ3.401016 Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition teration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)((circle one): ommercia Residential If an existing structure, is a fire sprinC�ler system mstalle irc a one): Yes No N/A Florida Product Approval# For multiple products use pro uct approva orm Describe in detail the type of work to be performed: PFS upgrade (Change out cabinets and fountain equipment) Property Owner Information: Name: Andrews Enterprises, Inc. Address: 1741 Clatter Bridge Road City Ocala State FL Zip 34471 Phone 919-600-9039 E-Mail or Fax#(Optional) jason.schultze@thepantry.com Contractor Information: Company Name: Oft KC`^lC-o COr4 54 r + Qualifying Agent: alt W'+M^ CIRom Address: l-1930 'Fm-+ St�e.� City MnoV---k- Prior, State FL Zip 32-757 Office Phone(352. 9-11 b328 Job Site/Contact Number e Fax# (3s21 '135- O?-4,I State Certification/Registration#ce'C \2603$1 Architect Name&Phone# - Engineer's Name&Phone# A Fee Simple Title Holder Name and Address QAT1 Bonding Company Name and Address Mortgage Lender Name and Address JIJIA Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void rf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of sixp6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces, Boilers,Heaters, Tanks and Air Conditioners,etc WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinance r'n c this type ojYwork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to vi to or cancel the provisions of any other federal,state,or local law regulating construction or the performance of construction. Signature of Owner Signature of Contracto Print NamePrint Name ......�i_1 +v...........��,,f0_W.. .............................. ........................................................................................................................................ Sworn to and subscribed before me Sworv,40 d subscri e ore e 2 this Day of 20 this ay of Notary Public P&�qo gate of F gide Shirley L Graham IRevised 01.26.10 �* My Commission FF oe®9+3o �or Expiros 02/14/2018 6 6 SNF sr� STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ` CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 :G»M `i 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 Ri✓cl VES' JL'.. ARASIN, MICHAEL WILLIAM FULCRUM CONSTRUCTION LLC 1900 THE EXCHANGE SUITE 195 ATLANTA GA 30339 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CBC058580 ISSUED: 06/04/2014 serve you better. For information about our services,please log onto CERTIFIED BUILDING CONTRACTOR www.myfloridalicense.com. There you can find more Information about our divisions and the regulations that impact you,subscribe ARASIN,MICHAEL WILLIAM to department newsletters and learn more about the Department's FULCRUM CONSTRUCTION LLC initiatives Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your IS CERTIFIED under the provisions of Ch 489 FS customers. Thank you for doing business in Florida, Expirationdate:AUG31,2016 L1406040001491 and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONALREGULATION CONSTRUCTION INDUSTRY LICENSING BOARD . � x CBC ---------------- 058580 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ARASIN, MICHAEL WILLIAM FULCRUM CONSTRUCTION LLC 1900 THE EXCHANGE ••� SUITE 195 ATLANTA GA 30339 • ISSUED: 06/04/2014 DISPLAY AS REQUIRED BY LAW 5EQ# L14000400014PI 2014-2015 BUSINESS TAX RECEIPT MICHAEL CORRIGAN, DUVAL COUNTY TAX COLLECTOR 231 E.FORSYTH STREET,SUITE130,JACKSONVILLE,FL 32202-3370 ID Phone:(904)630-1916,option 3; Fax:(904)630-1432 Websile:www.coj.net/tc;Email:taxcollector@coi.net Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This business tax receipt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772, for the period October 1, 2014 through September 30, 2015. FULCRUM CONSTRUCTION LLC MICHAEL WILLIAM ARASIN 1900 THE EXCHANGE ;; {3 STE 195 ATLANTA, GA 30339 ACCOUNT NUMBER: 222779 LOCATION ADDRESS: 1900 THE EXCHANGE STE 195 ATLANTA, GA 30339 DESCRIPTION: CONTRACTOR-ALL TYPES COUNTY RECEIPT DESC: CONTRACTOR-ALL TYPES COUNTY TAX: 11.25 MUNICIPAL RECEIPT DESC: MC 772.309 MUNICIPAL TAX: 31.25 TOTAL TAX PAID: 42.50 VALID UNTIL September 30,2015 ***ATTENTION*** THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receipt holder to violate any existing regulatory or zoning laws of the County or City. It does not exempt the receipt holder from any other license or permit required by law This is not a certification of the receipt holder's qualifications. ® i< TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION. PAID-3950588. 0002-0002 M01 07/17/2014 42 . 50 FULCRA OP ID:TB ,acoRo YYI CERTIFICATE OF LIABILITY INSURANCE ---113/20 5 0 02113/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Sandra Reid Snellings Walters Agency,Inc. PPHONEAX 1117 Perimeter Ctr West W-101 fcNoE.,,:770-508-3019 IA/C No):770-399-9880 Atlanta,GA 30338 E-MAIL sreid@snellingswatlers.com Stephen M.Harmon,ARM,AAI ADDRESS: INSURERS AFFORDING COVERAGE NAIC A INSURER A:Nat'l Fire Ins.Co.of Hartford 20478 INSURED Fulcrum Construction of INSURER 8:Cincinnati insurance company 10677 Georgia,Inc. Continental Insurance company 1945 The Exchange STE 400 INSURER C: 002118 Atlanta,GA 30339 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DUN' POLICY NUMBER MM UICY EFF MMD POLICY/YYYY LIMITS TR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 50960019921 10/27/2014 10/27/2015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) S 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE _ S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,00 POLICY FXIFCT _7"0- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIM Eaa cidenill S 1,000,00 C X ANY AUTO 5096011918 10/2712014 10/27/2015 BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S ND PER ACCIDENT A $ HIRED AUTOS AUTOSUTOS S X UMBRELLA LIAR I X I OCCUR EACH OCCURRENCE $ 10,000,00 B EXCESS UAB rl CLAIMS-MADE EXS0046992 10/27/2014 10/27/2015AGGREGATE $ 10,000,00 DEO I X I RETENTIONS $ WORKERS COMPENSATION X I WCSTATU- OTH- AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N 5096011921 10/27/2014 10/2712015 E L EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? F—] N/A CA UNDER SEPARATE POLICY (Mandatory In NH) E L DISEASE-EA EMPLOYE S 1,000,00 II yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY L:M1 S 1,000,00 A Equipment Float er 50960019921 10/27/2014 10/27/2015 Limit 50,00 Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1011,AddlUonal Remarks Schedule,If more space Is required) Project: FUGA project #7392 The Pantry#1401 2425 Mayport Rd Atlantic Beach, FL 32233 CERTIFICATE HOLDER CANCELLATION CITYOA7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Atlantic Beach ACCORDANCE WITH THE POLICY PROVISIONS. 800 Seminole Rd. Atlantic Beach,FL 32233 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD City of Atlantic Beach APPLICATION NUMBER Building Department (To be assi ned the BuildingDepartment.) 800 Seminole Road y_ /rte p ) Atlantic Beach, Florida 32233-5445 /V Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: ' / City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ko?S lziv , 44 _12epartLpent review required Yes No if Building Applicant: �� �Q ��f/7�rje�C�jOi� ing &Zoning Tree Administrator Project: fJ Public Works Public Utilities 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: roved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: a' 12- 15 OQ TREE ADMIN. Second Review: ❑Approved as revised. ❑De PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 STORE #1401 2425 Mayport Rd. Atlantic Beach, Fl. 32233 LNL9ITED INTERIOR REMODEL Scope of work Remove and replace cabinets and counter top at beverage bar. Remove and replace cabinets and counter top at coffee bar. Remove and replace old worn out beverage bar equipment. Remove and replace old and worn out Coffee bar equipment. Install new hotdog Island. Relocate existing hotdog equipment to new hotdog island. Plumber disconnect/reconnect equipment on beverage bar. Electrician disconnect/ reconnect equipment on coffee bar. No new walls or framing. No work in the restrooms. Existing doors and hardware to remain. Existing exit lighting to remain. Existing emergency lighting to remain. Existing fire extinguishers to remain. ANDREWS ENTERPRISES,INC. 1741 CLATTER BRIDGE ROAD OCALA,FL 34471 Date: To: Duval County/Atlantic Beach Building Division (PERMITTING) RE: Pantry Store# 1401 -2425 Mayport Road,Atlantic Beach,PL Duval County,FL Parcel I.D.: 169398-0000 TO WHOM IT MAY CONCERN: This letter shall constitute the property owner's authorization for a representative from The Pantry, Inc and/or it's assigned designee to act as Owner's Agent to sign and file applications with the appropriate governmental entities to obtain necessary approvals and permits for a(n): Equipment and Electrical Upgrades(the"Project") including site plan approval,water management district permits,Duval County/Atlantic Beach Development Orders and permits,and utility approvals,if applicable. This authorization is for thejP�roject,'and all permits and approvals necessary for completion. Title: /05 STATE OP �L COUNTY OF_ — ' The Areg ing instrument was acknowledged before me this I Gay of 201-c)- by ( I fr ,- 5q who is personally known to me or/❑ has produced as identification. Notary Public: Print Name: r� �- Commission Expires: I' / Permit Number: errs_ Parcel ID Number: 169398.0000 a USA MUSSEY MY COMMISSION#EE 181059 Prepared by: i •, <: EXPIRES:April 7 2016 r of h Bonded Thru Notary Public Underwriters Return to: _ rsrr NOTICE OF COMMENCEMENT STATE OF COUNTY OF ----- -- - The undersigned hereby gives notice that Improvement(s)will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,the following information is provided in the Notice of Commencement. 1. Description of property(legal description of the property,and street address if available) Pantry Store# 1401 2425 Mayport Road 0 Atlantic Beach,FL 32233 2, General description of Improvement(s) Equipment and Electrical Upgrades 3. Owner Information Telephone: 919.774-6700 Name: The Pantry,Inc. Fax Number: 919-775.5486 Address: 305 Gregson Drive Interest In Property: Leasehold Cary,North Carolina 27511 4, Fee Simple Title Holder(If other than owner shown above) 352.629-5709 ANDREWS ENTERPRISES,INC. Telephone Number: Name: Address: 1741 CLATTER BRIDGE ROAD Fax Number: OCALA,FL 34471 5. Contractor Telephone Number: Name: Fax Number: Address: 6. Surety(if applicable,a copy of the payment bond is attached) Telephone Number: Name: Fax Number: Address: Amount of bond $ 7. Lender(if any) Telephone Number: Name: Fax Number: Address: Owner upon whom notices or other documents may be served as 8. Persons within the State of Florida designated by provided by§713.13(1)(a)7.,Florida Statutes, Telephone Number: Name: Fax Number: Address: the following to receive a copy of the Lienor's Notice as provided in 9. In addition to himself or herself,Owner designates §713.13(1)(b),Florida Statutes. Telephone Number: Name: Fax Number: Address mencement(the expiration date is one year from the date of recording unless a different 10. Expiration date of notice of com date is specified: PIRATION OF E NOTICE OF AND AWARNNG TO OW,NR: ANY PAYMENTS RE CIONS DEREDEIMPROPER PAYMENNCEMENT TS DUNDER CHAPTER 713,PARTADE BY THE OWNER AFER E,SECTION 713 13,HFLORIDA ENCEMSTATUESE MUST BN RESULT IN RECORDED AND PAYING POSTED OWITHE CE OJOBMSITEVB FORE T EEMENTS TO YOUR FIIRSTPINSPECTION. IFOYOU INTENDTICE OF M TO OB AIIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. / �G� l ✓ 's or Lessee's Authorized OfficerDi / rector/Paynter/Manager Signature owner or Lessee,or Owner Title Date `LL/ h 20 by The trregoing inst umen was acknowledged before me this � day of has produced � �, (� t J� who ❑ s personally known to me or as identification. Siganture of Notary u lic notari eal to appear below) NOTICE OF COMMENCEMENT J STATE OF _ _ _ Q > COUNTY OF - __--_- _- -_ ip 0 The undersigned hereby gives notice that Improvement(s)will be made to certain real property,and in accordance with Chapter w H 713,Florida Statutes,the followinq information is provided in the Notice of Commencement. 2 K O 1. Description of property(legal description of the property,and street address if available) to U Pantry Store# 1401 O d j 2425 Mayport Road N U =D 0 U- 0 [T] 0 Atlantic Beach,FL 32233 fY io of 8 2. General description of Improvement(s) �jj 9_j O Equipment and Electrical Upgrades O 0 CJ ifl t N N to 100 M _Z 3. Owner Information Telephone: 919-774-6700 O d'B E>- Name: The Pantry,Inc. P I—O Address: 305 Gregson Drive Fax Number: 919-775-5486 Z Cary,North Carolina 27511 Interest In Property: Leasehold 0 = 9 O O W OZof(yULC 4. Fee Simple Title Holder(If other than owner shown above) Name: ANDREWS ENTERPRISES,INC. Telephone Number: 352-629-5709 Address: 1741 CLATTER BRIDGE ROAD Fax Number: OCALA,FL 34471 pq 5. Contractor V j/46W A 4�")"72uG '0A) c Name: �+,J r Telephone Number: (45-T3 43'7 �y6j Address:l,"J �h4 �` ��� 5 Fax Number: 6. Surety(if applicable,a copy of the payment bond is attached) Name: Telephone Number: Address: Fax Number: Amount of bond S 7. Lender(if any) Telephone Number: Name: Address: Fax Number: 8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by§713.13(1)(a)7.,Florida Statutes. Name: Telephone Number: Address: Fax Number: 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(1)(b),Florida Statutes. Name: Telephone Number: Address Fax Number: 10. Expiration date of notice of commencement(the expiration date is one year from the date of recording unless a different date is specified: — WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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-_A�TORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF / 40 Sig aturs of Owner or LessVoOwner's or Lessee's Authorized Officer/Director/Paynter/Manager yr 0 o a01 pRY SvP xP Title S \G �. 3� _ ►S- _� PUBS ?v Date �? �+♦�� Y ed before me this ?04'-da of B 2f t A R r 20 by The f�egoing instrument was acknowledg ✓2 `-. �1 G P(Lf�.SL,� who is personally known to me or has produced as identification. Sigan of N ary Public(notarial seal to appear below)�/ My Commission expires:� A L- -- CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 J v INSPECTION PHONE LINE 247-5814 ELECTRICAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-ELEC-457 Job Type: ELECTRIC ONLY Description: ELEC- COMMERCIAL BUILD OUT Estimated Value: Issue Date: 3/13/2015 Expiration Date: 9/9/2015 PROPERTY ADDRESS: Address: 2425 MAYPORT RD RE Number: 169398-0000 PROPERTY OWNER: Name: ANDREWS ENTERPRISES INC Address: 1741 CLATTER BRIDGE RD OCALA, FL GENERAL CONTRACTOR INFORMATION: Name: GLENN L PARKER ELECTRICAL CO Address: 2136 Conyers ST Phone: 404-316-8987 FEES: State Elec DBPR Surcharge $2.00 State Elec DCA Surcharge $2.00 Lighting Outlets, Including Fixtures $19.20 Trade Permit Base Fee $55.00 Total Payments: $78.20 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Mar. 03.2015 05:16 AM PAGE. 6/ 6 ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd,Atlantic Beach,FL 32233 Ph(904)247-58246 Fax(904)247-5845r ' JOB ADDRESS: �o, r_-�c�r ��� 1•G F,/PERMIT# )5-0 2- JEA INFORMATION REQUIRED ON ALL PERMITS _ wAMPS 246 110VOLTS PHASE VAL UE QF WOm$ NEW SERVICE ❑ Overhead � Undergro nd D Underground up Pole CResidential(Main) Service #of Meters 1.10-100 amps i i 101-150amps I.1151-200aimps _amps 1:ICommercial(Mahn) Service 10-100 amps 1 .1101-150amps 111.51-200amps I i amps 1.i CT Services amps Conductor Type _ Size LJ Multi-Family(Main)Service 00-100 amps 0101-150amps U 151-200amps ❑ amps #of Unit Meters n Temporary Pole F� amps SERVICE UPGRADE 0 amps 0 CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) 1:..1100 amps 1 1150amps 1 1200amps I I amps I ICT Service __ _. ..amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. outlets/Switches: 3 0-30amps 4 31-100amps 101-200a.mps Appliances: _0-30atnps 31-100amps d 101-200amps A/C Circuits: 0 0-60amps ,_,x_61-100amps Heat Circuits: # circuits @__&_.kw Number of Lighting utlets, Including Fixtures: OTHER ELECTRICAL PROJECTS KVA, t IMotors hp LSwimming Pool LI Sign USmoke Detectors Qty l...ITransform FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK$ Qty h�k volts/amps REPAIRS/MISCELLANEOUS LJReplace Burnt/Damaged Motor Can l:lSafety Inspection I]Panel Change I lOH to UG n Otkter: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned'fox six months, i hereby certlfy that I have read this application and know the same to be true and correct, All provisions of laws and ordinances governing this work will be complied with whether specified or not The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. LOO n :j Property Owners Name Phone Number U Electrical Company Ir Office Phone �' UXWM Co. Addre ,i���pt w 2212 City State.�Zip %300 IS E aSr � to �fieation/Registratuion#;Licensc Not�izeiei!i��tre'1vfcenxe Holder, e Sworn and subscribed beft�r�Qlvj ethis 2--.—dayof Mur 20 .XPe�'1b �il JQ�. �'-y��0,�;� .?,�:?4 ��,�`' SiLynature ofi Notary Public