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328 5th St pool permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 SWIMMING POOL MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814 30B INFORMATION: Job ID: 16-POOL-2443 3ob Type: SWIMMING POOUSPA Desc:ription: SWIMMING POOL Estimated Value: $42,000.00 Issue Date: 11/17/2016 Expiration Date: 5/16/2017 PROPERTY ADDRESS: Address: 328 5TH ST RE Number: 169834-0000 PROPERTY OWNER: Name: Paulk, Joseph Address: 9839 Hecksher DR GENERALCONT ACTOR INFORMATION: Name: THE BATTS COMPANY ,CPC037046 Address: 1602 NORTH THIRD ST QA JAMEST BATTS, III Phone: - - PERMIT INFORMATION: PUBLIC WORKS: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works(247-5834)for Erosion and Sediment Control Inspection prior to start of construction. All runoff must remain on-site during construction. Pool-Wellpoint(if used)must discharge into vegetated area 10' minimum from street or drainage feature(swale,structure or lagoon). A separate Pool Permit is required. Roll off container company must be on City approved list and container cannot be placed on City Right- of-Way. (Approved:Advanced Disposal,Realco Recycling, Republic Services,Shapell's,Sunshine Recycling and Waste Pro). Full right-of-way restoration,including sod, is required. All runoff must remain on-site. Cannot raise lot elevation. Public Works lot calculations are 49.1%. Pervious Pavers must be used on all walkways,decks,and driveways. PERMIT IS APPRO�D ONLY IN ACCO"ANCE WITH ALL CITY OF ATLANTIC INEACH ORDINANCES AND THE FLORMA oult:mIffl e0DE CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 FEES: PLAN CHECK FEES $130.00 BUILDING PERMIT FEE $260.00 STATE DBPR SURCHARGE $3.90 STATE DCA SURCHARGE $3.90 BD PLAN REV. 2ND $50.00 SUBMITTAL Total Payments: $447.80 PERAUT IS APPROVED ONLY IN ACCORDANCE WIM ALL I= OF A�ANTIC BEA" ORDINANCES AND ME FLORIDA BUILDING CODES. 5 City of Atlantic Beach APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 3 4) Phone(904)247-5826 Fax(904)247-5845 -mail: building 77, E -dept@coalb.us Date routed: City web-site: hftp://W�.�ab.us APPLICATION REVIEW AND TRACKING FORM _ek — Property Address: -DeparLMent review require Ye No ti:luildina J Applicant: <-7temning &Zoning--3 Project: i&AL 8A. L 2�a,, 000 L_ Public Safety Services Review fee $ Dept Signature Other Agency Review or Permit Required 'low=IBY Date Of Permit Florida Dept.of Environmental Protection R-o-nda Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants D�vislon of Alcoholic Beverages and Tobacco Other- APPLICATION STATUS Reviewing Department First Review: aKp�prlved. ElDenied. (Circle,�ne..) _tN ) PLANNING &ZONING Reviewed by: Date: TREEADMIN. Second Review: ElApproved as revised. E]D,nieW. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: —Date: FIRE SERVICES Third Review: DApproved as revised. DDenied. Comments: Reviewed by: —Date: Revised ONIV09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 1L-2cx.>L- 24 Phone(904)247-5826 Fax(904)247-5845 Date routed: LQ 60 � E mail: building-dept@coab.us City web-site: hftp:/1www.coab.us APPLICATION REVIEW AND TRACKING FORM 114 Property Address: 3 z S DeR; ant review required —y—es7—No-] Applicant: I H6- R>P`l'T_/_S Q9fAPa Q_ Ing &Zoning Project: P0_C, L_ Public WoFkr--_, -Lublic Utl!!Se�� Public Safety Fire Services Review fee $ Other Agency Review or Permit Required Review or Rec'e"" Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Amy Corp.of Erigmeers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other APPLICATION STATUS Reviewing Department First Review: BApproved. E]Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by Date: TREEADMIN. Second Review: E]Approved as revised. E]Denled. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. ElDenied. Comments: Reviewed by: Date:— Revised 05114/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233,5,;45 ,�CEFI 00 Phone(904)247-5826 Fax(904))247-5B45 E-mail: building-dept@mab.us Nov a routed: (�:7 Cityweb-site: hftp:/A��coalbus R 12, ME By. APPLICATION REVIEW AN—D—rRAGAG FORM Property Address: 3ZE D2Raftent review require —Ve—s——No I 2"Wo�L__ Applicant: bir= tLSIP"—, Pnam��"<_Z�Lrning&Zoning.:> -7ree-Adm—_jnRsTmTo_r Project: iAAr,_A1i_( k2G Poo 4— '2`ub_lc`Wo�� Public Utilifiii�ir� Public Safety Fire Services Revie�w fee Dept Signature Other Agency Review or Pernrit Required "re.Wt=pty Date of Pe 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 Mher APPLICATION STATUS Reviewing Department First Review; JApproved. ElDenied. (Circle one.) Comments: J& o*dd 4aq4 BUILDING PLANNING &ZONING Reviewed by: TREEADMJN. SecondReview; ElApproved as revised. E]D 101. emed. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DAppmved as revised. E]Denied. Comments: Reviewed by: Date: Revised OVIN09 City of Atlantic Beach Building Department 800 Seminole Road 7z Atlantic Beach, Florida 32233-5445 CEIvi Phone(904)247-5826 Fax(904)24t5 119, E-mail: building-dept@wab.us NOV Cityweb-site: hftp://w".wab.us 01 2016 APPLICATION REVIINWAM TRACKING FORM Property Address: 3ZE) D2gartirgent review required Yes No Applicant: ning &Zo ing--_-,> ministrator Project: ao I AM-AA ( A 2C, 00 C_ Public Public Utilffia�> P blic Safety Fire Services Review fee $ Dept Signature �M Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of-fransportation St.Johns River Water Management District Any Corps of Engineers Division of Hotels and Restaurants Chvision of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: 2AP—mved. [-]Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by:?N�76V' Date: TREE ADMIN. Second Review: []Approved as revised. DDenied. Comments: �tOR '4�USL�IC LITI'Erl�IES PUBLIC SAFE'FY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. F]Denied. Comments: Reviewed by: Date: Revised 05/14/09 Y OF ATLANTIC BEACH ECE VE 800 Seminole Road Atlantic Beach,Florida 32233 0 Telephone(904)247-5800 E I MY - 7 2016 FAX(904)247-5845 RE SION REQUEST SH T OR OFFICE COPY CORRFE:CTI Date: It 1-7 tie. Received by: Resubmitted: Permit�N�bev 2 44� Original Plains 6�uw. H I v�c �'(� ProjectNarne: FAQU� Pmjcct Address: 92il '-T" S:T� A��Dc Contractor: (�s -r. i3ATr� Contact Name: Vi— W-Cqz�v ContactPhone : Contacte-mail: 6P t1w1s"Itt' met Revision I Plan Check/Permit Fee(a)Due: S 50-05 Description of PrODosed Revision to Ei"Permit: 2-) GC� So�,I� 4<cQocxr Additional Increase in Building Value: $_ Additional S.F. Site Plan Revised: Public W/U Approval: By signing below.I @imia.LKI- 14111�v affinn that the above revision is inclusive ofthe proposed changes. 444� — I I /,///. Signature ofConaractor/Agent(coivmwinisst sip ifimco�insi,lisiitim) Date ofr.U.Wy NistiffiA by:_ Plan Review Comments: npent review �ul Yes 'No ksn�g Planning&Zoning ans Examiner Tree Administrator Public Works 6 Public Utilities Public Safety Date Fire Services BUILDING PERMIT APPLi OFFICE COPY CATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 Office:(904)247-5826 - Fax:(904)247-5845 Poc)L- Z443 Job Address: ?;I-S 5-r� sr- N�NAv%' -ac�14 Permit Number: Legal Description L.rS I t I :K 3�cj, C. RE# Valuation of Work(Replacement Cost) $ _±2 Hcated/Cooled SF_NOR-Iffested/Coaled • Class of Work(Circle one): New Addition Alteration Repair Move Deme, (_EwDl Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 4Esjdm�t, • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes _J;� N/A • Submit a Tree Removal Permit Applimnon if my toces are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information Nanie:�5470e5A�,-,.�(� PX�"� Addr�s: c?0-TI, —,9,4c City _A� State Rk Zip ��(61rhone Q31 -45 L I E-Mail OwnerorAgent (ffAgmt,P0waofAamzamA9=cs1soa WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MA I Y 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 NOT0E OF COMMENCEMENT. Contractor Information: Name of Company: -1-14- 3�3 c.. 11ifyingAgmt: -T�� -r- G: Address: I Gs� 14. 2"_�. Qu _________city _M� S atc(Zi�, _�5- OfEcePhone Job Site/Contact Number 7Mt4 , I�F�—I State Cerfifica—tion/Registration# c9� o�7�4� —E-Mail Architect Name&Phone# Engineer's Name&Phone# � c4w,�&a�T6 ?-�F —�T i-i�3 Worker's Compensation Application is hereby made to obtain a Ittod th k and 11affammuteficated. letalify that.wockorl.t.11atio.has commenced 0 ewo ' 51.1 to the issuance afain,nut and r tallnook ill epre meet the samdard9 al'all laws regulating construction in thisjurisdiction. his,aeranitbecomestimlla aidi is not men sur g ,.tied or abandoned 4Wd oumths or ifevostruction or work is sesr gg(p,months at any three. rk is e. mam th at sep a re re p erm in to us t b c se cu mdfo r� ledrica I Work,into mkma, ells, oo1sFurmrccsBo*e ters, san didaars,et. Signatme,ofProperty Owner: Signature ofContractor: lv"� Before this May of Before me this ufiD Notary Publi JANN GARNER mn#FF19W, EXPI mM Mach 24,419 I h ereby cc re ijfyv th a t ad and exa me to be true a rect. Allp I ww... ordinances governi� 0 hg this type g work 'ed herein or not. Yhe granlitilp presume to give out crity to via age or cancel thapro isions ofany otherfe cral,state, or local law regulating construction or the performance ofconstruction. Rev.3/14/16 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 (904)247-5800 OFFICE COPY BUILDING DEPARTMENT REVIEW COMMENTS Date: 11.02.2016 [t­6OOL-2443 Applicant: The Batts Co. 32;P5. =,ll—C, 13285- St.,AB Site Address: 1602 N.3rd St.,Jab Beach,FL Review: Phone: 246-2455,2N-9414(Jim Batts) RE#: Email: battscompany(a),gmaiLcom Homeowner: Joseph& Sabrina Paulk Correction Comments: These comments are from 1 of 4 Departments that are reviewing this application. tpfication is ifisapproved for the followmig issues: 1. Submit 2 copies of a legal survey. Survey needs to show the surveyors license and . natu 4 re. Mike Jones Building hispector/Plan Reviewer City Of Atlantic Beach 800 Seminole Road Atlantic Beach, Fl, 32233-5445 Oic (904) 247-5844 Fax (904) 247-5845 er�V-11401 11 -2-16 /?n TREE & VEGETATION AFFIDAVIT I 0 Of Atlantic B� COPY 't M ent of Comm " In &Z'nIng Dna' 0 le Road At City of Atlantic Beach OFFICE COPY "no 4 _5 00 904 Department of Community Development Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL. 32233 (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION I-APPLICANT INFORMATION r- Owner(s) P'-'LLegal Authorized Agent- NAMEOFAPPLICANT Z3 P'-es -r. NAME OF COMPANY 7� ADDRESS OF COMPANY I �07 "�I' PHONE 2_q(._Z_.4SS CELL 219— 0,.qI4 EMAIL — anj a CONTRACTOR CERTIFICATION NUMBER C VC -?—.4 ATUBCH BUSINESS TAX RECEIPT NUMBER SECTION I]-SITE INFORMATION STREET ADDRESS OF PROPERTY S.�s lfmaddmshmwtbwnOssignedtothisProPero4wntaatheaauildingDe�"mtat(�)247-5U6w��tanaddre, LEGAL DESCRIPTION LOT it 1 (3 BLOCK 'i3...L c. SUBDIVISION REAL ESTATE NUMBER LOT OR PARCEL SIZE: SO Fr AC RESIDENTIAL t�� COMMERCIAL OTHER(SPECIFY) I affirm that I have reviewed the provisions Of Chapter 23, "Protection of Tmes and Native Vegetation"of the Municipal Code of Ordinances for the City of Atlantic Beach,FL andlor I have participated in G Pre�palicotlon meeting with the Administrator of those regulations. Subsequently,I affirm that no regulated tt�s and no regulated vegetation will be damaged,destroyed andlor removed from the above-described oradjacentproperties in conjunction with thisprojW. SIGNATURE OF�OWNER NUMAI URE OF OWNER Signed and sworn before me on thIsol day of by State of Countyof Identification verified: Oath sworn: Yes [7 No Notary ure IANNEA Coft r ilak 19PS7 m! Expla M=h 24,21) 9 RE11-TVA-00.12 My Co s onp res: wjh24.12B�0� 4 -J?C�f 1217 s "ac-- _Z11 VVAO 91rj( All-a Jid N Zf /I X /I y /-z N- k2 Comp. By: SRW Date: 6113/2016 Public Works Department City of Atlantic Beach Permithlo I&SIFIR-1213 Address 328 Sth Street Reguired Storgae volurn Crili Section 24-66 Of the City of Atlantic Beach's Zoning,Subdihamon,and Land Development Regulations requires that the cifference between the pre,and postdemlopment w1urne of stomn�ter runoff be MOMd On see. Volume of Runoff is defined as folinns: V=CAR/12 Where: V=Volume of Runoff C=Coefficient of Runoff A=Area of lot in squant fast R=25-yr/2�hr rainfall depth(9.3-inches for Atlantic Beach) Predewtopment Runoff Volume: Lot Area(A) = 15,000 it' Runoff Coefficient Am Lot Ants Description ve) (it) C. Md'C' Impervious 7,350 15.000 1.00 0.49 Peious 7,650 15,000 0.20 0.10 Runoff Coefficlont JC)- 0.59 Runoff Volume V= 0.59 x 15,000 x 9.3 1 12 V= 6,882 ft, Postcurvelopment Runoff Volume: Lot Area(A) = 15,000 W Runoff Coefficient Area Lot Am 4o C. ill Mn Pf3 q6 ---To-oo.49 %ISA 49 1 Pe,ious 7.634 15,000 0.20 0.10 Runaff Coefficient(C)- 0.59 Runoff Volume V= 0,59 x 15.000 x 9.3 1 12 v- 6.1192 ft, Required Storage Volume DV= Posdevelopment Runoff Volume-Predevelopment Runoff Volume DV= 6.892 6.882 DV= 10 Ill, 14NYTERWAMRR�M W1=01f COMP. By: SRW Date: 6113/2016 Public Works Department City of Atlantic Beach permit NO: 16-SFR-1 213 Address. 328 Sth Street Provided Storage Elewdlon Area Storage (ft) (te) (ft') 0 BOTTOM 0 TOB Ele,ndlon Area Storage — (ft) (fe) (ft�) 0 BOTTOM 0 TOB EI.Wdlon Area Storage — 09 (te) (ft.3 0 BOTTOM 0 TOB Inground Stora9,wA*d*pf A=Area= (10 d=depth to ESHWT= 6�5 pf=pore faaor= 0.3 Inground Storage= 0.0 ft� Within the 400 SIF innit NO water Retention required Required Treatment Volume- 0 ft� Supplied Treatment Volume- 0 ft3 Reefto� MASTER WATER RETENTON 611M." 32" Channel Drains VGB-2009 Compliant CMP 25506-32X C095TTOM MOLDED PRODUCCTS ")ris anydigit 0-9 to denote color Read and keep these instructions for future reference. Always plumb and install all suction fittings according to all building codes that apply in your area. WARNING:When using two or mote suction fittings on a common suction line,suctions must be separated by a minimum of 3 ft or they must be located on two different planes(Le,one on floor and one on the wal 1). WARNING:DO NOT locate suction outlets on seating areas or on backrests for such seating areas. The maximum flow rating for this suction fitting with the center port plugged and outer ports open Is 308 GPM(Floor)and 212 GPM (Wall)when using 2.5"plumbing and 268 GPM(Floor)and 192 GPM(Wall)when using 2'plumbing. The maximum flow rating for this suction fitting with the outer ports plugged and the center port open is 200 GPM(Floor)and 168 GPM(Wall)when using 2.5" plumbing and 184 GPM(Floor)and 176 GPM(Wall)when using 2"plumbing. This suction fitting is designed for installation on side wall or floor of hot tubs or pools. DO NOT adapt suction fitting to any pipe size smaller than ASTM 2"SCH 40 PVC Suction fitting and fasteners should be observed for damage or tampering before each use. Missing,broken,or cracked suction fittings shall be replaced before use. Loose suction fittings shall be reattached or replaced before use. Mount suction fittings on the walls,in the foot wells of hot tubs or pools. Do not mount directly under seats. Follow all winterizing instructions and recommendations of your pool and spa professional. Open area of the suction cover is 38.79 ln�. Tools Needed: Head I.o. Phillips Head Screwdriver (Pa.10�) 40 INSTALLATION INSTRUCTIONS I Install sump provided or construct sump per ASME At 12.19.8-2007 Figure 2(see below) 20 2. If mounting frame is provided,secure it in concrete or plaster. 3. Use mounting screws to secure cover to frame or sump. 0 so 20 320 Fl.(GPM) ---- –---------- A Replacement Parts 25506-32X-000 25506-32X-100 cover 25506-32X-020 cover 255D&32X-020 Sump 25506-320-010 Prune 2SS06-320-110 rn�oiarjyu� Plug 25520-05o020 Sc. 61008-042-022 �—ddegradn�� 71' . So. 61008-042�022 �rd.rrae. optional Debris Guard optional Framesupport .r 25506�320-030 2SS20-05�120 NOrrE-.In the event that one suction outlet is completely blocked,the remaining suction outlets)serving that system MUST have a flow rating capable of the full flow of the pumps)for the specific suction system. NOTE:Increasing size of the pump may increase flow rate of suction beyond rated Safety limits causing entrapment or death. CAUTION:Hair or body parts blocking the spa or pool suctions may become trapped and held against the suction fitting. Entrapment against the suction fittings can result in drowning or other severe injury. Never sit on or lean up against suction fittings.Never exceed the maximum allowable flow rate stated on the suction fitting. The suction fitting and fasteners should be inspected for damage or tampering before each use of the facility. Missing,broken,Or cracked suction fittings shall be replaced before using this facility. Loose suction fittings shall be reattached or replaced before use of this facility. W1. WARNING:To reduce the risk of drowning from hair and body entrapment,install suction fittings with a marked flow rate in gallons per minute that exceeds the flow rate of your system by at least 25%. Always use multiple suction outlets. If the fitting/cover breaks,is damaged,or is missing,shut the system down immediately. Do not use the system until damaged parts have been replaced. WARNING:Keep hair and clothing a minimum of 12 inches from all suction fittings and drains at all times.persons with long hair should secure hair to a minimal length or wear swimming cap. Children should never be left unattended at any time in a swimming pool,spa, or bathtub. Be sum the temperature of the water never exceeds the manufacturers recommendations. CUSTOM MOLDED PRODUCTS, INC. 0 140 CELTIC BLVD. 0 TYRONE, GA 30290 CARTRIDGI FILTIR C[amp ring F2-quick a--ces- to ca-Miges -Ni Single-piec-fin-i-gass rein'ir-ed p3ir�croipyare rank C ,or strengm a.11 comrssiorr 2 plumbing ficr max mim fow Easy access 1 dra n Model Number Fitter Area Vertical Fitter Feve Rate GPM Turnover Capacity Golons) Sq.Ft. Clearance' Diameter Res, Comm, 8 fund. 10 hirs. 12 his. cc 50 50 30 55 50 19 24.U11 .000 36,ODO CC 75 75 75 28 3 6 000 4U5.000 54 000 cc 100 100 61 5 5 �00 38 4 60,000 72,000 cc 150 150 76 �55 50 56 7z.uu. 90,000 i 108 DOO cc 200 200 76" 15 5' 150 75 72,000 90,000 1 108,000 Re,.,r,d tican,rom to remove f i It or i Maximum ftvN rare CAREFREE BY DESIGN Like all Pentair cartridge filters the Clean&Clear filter features - Ph drain and washout for quick and convenient maintenance an easity-cleaned cartridge for the ultimate in carefree poet filtration. and winterization. The fithergass-ineinforced tank halves am secured with a clamp - Lock-ring requires only half of a revolution for a beak-proof seat. ring—just Loosen the ring and remove the top half for easy cartridge - 2'plumbing for maximum flow. access and rinsing.Fitter maintenance doesn t get any easier. - Single-piece base and body designed for maximum durability. - One-year Limited warranty.See warranty for details. AVAILABLE FROM: `0 PENTAIR 1620 HAWKINS AVE.SANFORD,NC 27330 800.831.7133 WWW.PENTAIRPOOL.COM At Inc anduo,oviontaxaccompares 8-—ansiodal—dridiii,mondace,rir arvi and derades,Pennor radervainhe right to choose con—oradons venhour anor i ovencornai pumps-filters-heaters- heat pumps-automation- lighting -cleaners-samitizera-waterfeadures- maintenance products 61131'armlitiol 121C2013iverovitictorfirSystions An rights reserved Permit NO, /15 —,iPod— NOTICE OF COMMENCENIENT, 'elt15 State Of Florida, County of Duval OFFICE COPY Tax Folio No. ME UNDERSIGNED hereby give notice that the improvement will be made to certain real Property in accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement. 1. Description of property(legal description of prope_ dress if available): '�" �� "3 2 ,:d ta� 9" ST-" -Tr� 2. General Description of�Pro mr., ..le S� C 3. Owner Information: a)Name and Address: �s—o k- s&Tg.,b, ?,,,, 3 iggg V 0 b)Interest in property: c)Name and address of lm—ple—ttle—hol—der—(if—oth—er—Iha­no�—er)-- ---� Contractor Information: a)NameandAddress: _CL (Vit. vo�x b)Phone Number: 5. Surety Information: D..#201623857ORBK177� PgelO5. a)Name and Address: 4 & Number Pages:1 Recorded 1011812016 at 08:39 AM. b)Phone Number; �Of-- T'-15y R.N.Fussell CLERK CIRCUIT COURT DUVAL C)Amount of COUNTY 6, Lender Information: RECORDING$10.00 a)Name and Address: b)Phone Number: 7. Person 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: a)Name and Address: b)Phone Numbers of Designated Person; 8. In addition to himself/herself,Owner designates4HTK NDSM of W7= ;bfMk receive a copy of the Lienor's Notice as provided in Section 713-13 (1)(b),Florida Statutes. a)Name and Address: GmTriblial, s4paillit - I Val&I Art*l"77f- pJA52 b)Phone Number of person or entity designated by owner: M(,-1+1 OD 9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of Construction and final payment to the contractor,but will be one(1)yew from the date of recording Unless a diffluent date is specified: WARNING To OWNER� ANY PAYMENTS MADE BY THE OWNER AFTER TBE EXPIRATION OF THE NOTICE OF CONBIENCEMENT ARE CONSIDERED 11"ROPER PAYNMNTS UNDER CHAPTER 713,PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR ROPROVEMENTS TO YOUR PROPERTY. A NOTICE OF CONMENCEWNT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE CON]IMENCING WORK OR RECORDING YOUR NOTICE OF COMNIENCENIENT. Under penalty of pedury, I declare that I have read the foregoing notice of commencement and that the fiacts stated therein are true to the best of my kn dge and belief. 0S -- Signature of OvyA2�or Owner's Authorized Officen/Director/Partner/Manager signatory�s Printed Name&Title/Office The foregoing instrurricartwas acknowledged before me this_1� dayfr be�obe4—:' 20 au)ri e4z' aS for (Nabob ot-Ferson) klype or Alate[WAY,i.e.officer(AMIT& U,.am pury 1,,b,,,aent wn Executed for) I I NNKN` - - - - - - - - - - '0017T� DIANA PIKE /(4zh Notary Public-State Or firlift NO ARY P LI S.V!k FEZ) My Comm.EXPI(Al not 2!]!.�2MM Corliani'law#FF Print Name; 1, ip. . 6 tv�kv� 1� 4 �' "%";: . �kPersorauy *-%Oqoqw%w% 0 Identification/Type: (Affix Notary Sesa Above) Revised 3/15/12