94 W 3rd St screened enclosure permit CITY OF ATLANTIC BEACH
.:.> .:, .
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SCRN-2648
Job Type: SCREENED ENCLOSURE
Description: construct screened enclosure on existing concrete
Estimated Value: $8,143.00
Issue Date: 12/16/2016
Expiration Date: 6/14/2017
PROPERTY ADDRESS:
Address: 94 W 3RD ST
RE Number: 170832-0050
PROPERTY OWNER:
Name: SCHNEIDER, CHRISTIAN C
Address: 140 APPLEWOOD DR
GENERAL CONTRACTOR INFORMATION:
Name: SCHNORR HOME IMPROVEMENTS
,CRC041028
Address: 6928 N PHILLIPS PKWY DR CIA PHILIP DOUGLAS
SCHNORR
Phone: - -
PERMIT INFORMATION:
FEES:
ENG REV RESIDENTIAL BLD $100.00
PLAN CHECK FEES $45.36
UTIL REV RESIDENTIAL BLDG $50.00
BUILDING PERMIT FEE $90.72
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUMPING CODES.
CITY OF ATLANTIC BEACH
sj 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $290.08
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CRY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
-t City of Atlantic Beach APPLICATION NUMBER
n Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 I b -SCR-N-
Phone(904)247-6826 - Fax(904)247-5845
` oinv� E-mail: building-dept@wab.us Date routed: IIIas� Ib
Cityweb-site: hftp://www.mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 9 L4 W. 3 f� a - D
epartment review re uiRYes
ScJnt�o f rr.LL_
Applicant: _ l\U(t� thy( t-ova.nA Zoning
f or
Project: SUQL4� A to Li� o( t CUL( ¢ S hylti rks
Co nL f�t ities
ety
ces
Review fee $ Dept Signature
Other Agency Review or Permit Required Review
of Permit verified B or Receipt Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Any Corps of Engineer;
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: RApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date://-r)
TREE ADMIN.
Second Review: [-]Approved as revised. ❑Denie .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. [_]Denied.
Comments:
Reviewed by: Date:
Revised 05!94/09
BUILDING PERMIT APPLICATION
OFFICE COPY Cr1'Y OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 •— -- i
Office(904)247-5826 Fax(904)247-5845
Job Address: qt' W "3R(l SV Permit Number: 11,17-Sc-Q-0 -a140A
Legal Description ISl-34 n-a5-a9�-- Sc.r 4 DPA,,� c. {5wItxParcel# 1:�OR3Q -OOSO
Floor Areaof — Sq. t. Sit
Valuation of Work$R.11-13 Proposed Wo k he non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Mov Demolition pool/spa window/door
Use of existing(proposed structum(s)(circle one):, ommercial esidenti
If an existing stmcttuure,is afire spun er system Installed?(Circle one): es No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: 4,,eeri fDati-F a Ac-I,Isu.r e. A A
CoA c re+e
Property Owner Information: \\
Name: Address:_
City '(�r1',f�_—State ZIP bone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
. ,�-i�pt-r f{OMe-. (MPoVemeh hilip D.Schnorr
-I' r
Address: 6928 Phillips Pkwy. Dr. N. City Jacksonville, State FL Zip 32256
Office Phone 904 262-1517 Job Site/Contact Number Fax#904 262-1436
State Certification/Registration# CRC041028
Architect Name&Phone#
Engineer's Name&Phone
lu
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 workwill be pe armed to meet the standards ofall laws regulating construction in this jurisdiction. This permit becomes null
and void fwark is not commenced within six(6 months, or ifcomium ton or work is suspended or abandoned for a pertod ojsu(6)months at any time after
work is commenced. I understand that separate permits most be secured for Electrical Work,Plumbing,Signs, efis Pools, Furnaces,Boilers,Healers,
Tanks and Air Conditioners,era
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 YOPUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined Lits piicatlon and knave the same to be true and correct. All provisions oflaws and ordinances governing this
type of work will be complied with whether spem ned herein or not. The granting of a permit does not presume to give authority;tote hte or cancel the
provisions ofaty other federal,.�y�tt e,or local law re ting construction or the per
ofconrtruction.
Signature of Owner Signature of Contractor
Print Name /� k_.. .�......_ t} -1.��17�_ Print NamePhili Schnorr
.......... .l..1_2 P
Sworrrr��,tt��and subscribe�d(b�QQ�}''om me Sworqq..j�gg and subscribed¢q ore me
this,�'Day of MF�f,N' .20 this pDay of MAY5:6 yy .20&
Inn#nh R �xrtiMrl9 M• �. .YWCaHA ac.ir ��Q !•M17,t JaaEPNa.BEPWNG
tart' NYfX1tRis5uN#EE21677P Notary Publi YCBI%BINgvmbEEY157iE—
No P tic " arY ", a E%PWES:Nerember7,P076
EXPIRES:November7,2016 '� A Nomy srdn
"+;;�aa ar�aaairru awx�xmr,sF-:,., 'Raw3ed bl'.°1B'.�P'
yr City of Atlantic Beach APPLICATJQNNUMBER
Building Department ------
`n 800 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach,Florida 32233-5445
Phone(904)2475828 Fax(904)247-5845 ]-C1
nft10� E-mail: building-dept@coab.us Date routed: (��e�,R'I I
Cityweb-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address 9 y �. 3 f �{
WSeNi.es
ent review required Yes No
` da (l0 f
Applicant: _ J t� ,mMyl,UthpAA &Zoningf _- orProject: SUQQ.uA tnLLcrLLfL cuu ¢ i .�� rksLo/vjp � litiesetyces
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineer;
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.
APPLICATION STATUS
FPLANNING
tment First Review: ❑ApApro,v'ed. ,kDenied.
Comments: Jtt e�� -
NINGReviewed by:�r.y1 L/lj-� Date: l
. Second Review: ZApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES /
PUBLIC SAFETY Reviewed by: Date:12 /VZ I`
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
s
ZONING REVIEW COMMENTS
City of Atlantic Beach
U Community Development Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
r ,I 91 Phone: (904) 247-5826 Fax: (904)247-5845 Email: dreeves@coab.us
Date: 12/5/16
Permit: 16-SCNR-2648 Applicant: Schnorr Home Improvement
Review: pt Address: 6928 Phillips Pkwy Dr N, Jacksonville,FL 32256
Site Address: 94 W 3rd St Phone: (904)262-1517
RE#: 170832-0050 Email: Not Provided
Correction Comments
1. Setbacks: Section 24-67(c) requires a site plan showing setbacks. Please provide a site plan showing
setbacks from all new elements to property lines.
2. Tree Removal: Section 23-21 requires a Tree Removal Permit for any trees removed within 2 years of
this project. Please submit a Tree Removal Permit Application if any trees are to be removed or were
removed in the last 2 years. If no trees are to be removed or were removed, then please fill out an
Affidavit of No Tree Removal. Both forms are available on the city website under "Planning and
Zoning"and at City Hall.
Derek W. Reeves
Planner
dreeves@coab.us
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Department of Community Development
Planning&Zoning Division
800 Seminole Road Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT 0
SECTION I-APPLICANT INFORMATION r Owner(s) 5e6gal Authorized Agent'
NAMEOFAPPLICANT N65}I0,/S .5LIInAelAP—r
NAME OF COMPANY 5r:V%Anrr l4nrAe TrvteroVemen+'
ADDRESS OF COMPANY 026 Piriji -gS PACK ortye N JACkWnV IIPfYL 3229e
PHONE (904)2(,2-1517 CELL EMAIL
CONTRACTOR CERTIFICATION NUMBER CRC ()41()2S
ATLBCH BUSINESSTAX RECEIPT NUMBER 7fN6 — CoM clot- ML 772 .309
SECTION 11-SITE INFORMATION
STREET ADDRESS OF PROPERTY q4 W. 3rd SrFreei'
I/anatldrcsf Mr notbnn assignrdrorhisPrWeaY•�at�rtheaaauildmg Departmmtm ryW/2<lsa]6rorcpuestanaEarcss.
LEGAL DESCRIPTION IV-34 Il_ZS�Z4E SPG�'tln H A�IAn+ic Beate.
LOT C BLOCK 80 SUBDIVISION O3i19
REAL ESTATE NUMBER IIOBit-OUSO LOT OR PARCEL SIZE: SQFT 47SJL AC
RESIDENTIAL Howe COMMERCIAL OTHER(SPECIFY)
I affirm that 1 have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation'of the Municipal Code of
Ordinances far th ity of Atlantic Beach,F and/or I have participated in a pre-application meeting with the Administrator of those
regulations. S t fe uently,I o�rm th o regulated treesynAFo regulated vegetation will be damaged,destroyed and/or removed
fromtheat, d ribedoradja t rdpertiesinc o'a cdon with thisproject.
IGNA URE O SIGNATURE OF OWNER
Signed and sworn b remeonthisledayof {, 1(a ,by State of FLA'
Countyof 9uVA1-
Identification verified: pRsOctlS taCeOSE
Oath sworn: r yes r No
,'L)ggh R. fa n;m9
Notary Signature
REV-TVA-00.12 My Commission expires: �M�. h JOWHR61E040
OfR BMMGTN kg m1WtSaWr
Doc N 2009163672, OR BK 14935 Page 1333, Number Pages: 2, Recorded
07/10/2009 at 11 :12 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$16.5�0
Jh''DEED DOC ST $555.80
Preps d by Mary Beth Schulte OFFICE COPY
M employee of
Reis Seaiemem Services
5700 Smetana Drive,Suite 400
Mineetonite,Minnesota 55343
877-813-7316
Feet:860103
File a1158056834A
Retumto: Gmmee
SPECIAL WARRANTY DEED
State of Florida
County of DUVAL
THIS SPECIAL WARRANTY DEED is made this between HSBC
Bank USA,National Association,as trustee for the holders of fhec,ertificates issued by Deutsche
Alt-B Securities Mortgage Loan Trust, Series 2006-AB4,having a business address at: 8480
Stagecoach Circle,Frederick MD 21701 ("Grantor'),and CHRISTIAN C. SCHNEIDER and
RITA J. FILOWITZ,husband and wife,having a mailing address of 140 Applewood Drive,
Easton,PA 18045("Grantee"),
WITNESSETH,that the said Grantor,for and in consideration of the sum of TEN AND
NO/100 DOLLARS ($10.00)and other valuable considerations,receipt and sufficiency of which
is hereby acknowledged,has granted, bargained,sold,remised,released,conveyed and
confirmed onto said"Granted',its successors and assigns forever,the following described land,
situate,lying and being in the County of DUVAL, State of Florida,to-wit:
Lot 5,Block 80, SECTION "H" ATLANTIC BEACH,according to the Plat thereof as recorded
in Plat Book 18,Page 34,of the Current Public Records of Duval County, Florida.
Commonly known as: 94 W 3RD ST,ATLANTIC BEACH,FL 32233
Tax Parcel Identification Number: 170832-0050
SUBJECT,however,to all reservations,covenants,conditions,restrictions and easements of
record and to all applicable zoning ordinances and/or restrictions or requirements imposed by
governmental authorities,if any.
TOGETHER with all the tenements,hereditaments and appurtenances thereto belonging or in
anywise appertaining.
TO HAVE AND TO HOLD the same in fee simple forever.
Page 1 of 2
HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT
The purpose of this document is to make you awam of any limitations in the enclosure that is being permitted at your residence. The table
below,Su meran and Screen Enclosure Requirements provides a brief description of the various sunroom category requirements. Them
may be restrictions on the use of your present home depending on the category of sunroom you am installing. The property owner is hereby
notified that should they make changes to the sunroom which could include,but not be limited to,addition of any form of temperature mmrol
system or removal of the doonit windows separating the sunroom from the host structure,the room may become noncompliant with the
requirements as mandated by the Florida Building Code,the Florida Model Energy Code and State Statutes.
The Florida Building Code-Residential defines the following Sunroom Categories:
Category I:A thermally Isolated sunroom with walls that are either open or enclosed with insect screening or 0.5 mm(20 mill
maximum thickness plastic film.The space is defined as a nonhabitable, nonconditioned sunroom.Note: A Screen Enclosure by the
FBCR definition can only meet Category 1.
Category It:A thermally isolated sunroom with enclosed walls.The openings are permitted to be enclosed with translucent or
transparent plastic or glass.The space is defined as a nonhabitable,nonconditioned sunroom.
Category III:A thermally isolated sunroom with enclosed walls.The openings are pennided to be enclosed with tmnslucent or
transparent plastic or glass.The sunroom fenestration complies with additional requirements for air infiltration resistance and water
penetration resistance.The space is defined as a nonhabitable,nonconditioned sunroom.
Category IV:A thermally isolated sunroom with enclosed walls.The sunroom is designed to be heated and/or cooled by a separate
temperature control or system and is thermally isolated from the primary structure.The sunroom fenestration complies with additional
requirements for air infiltration resistance,water penetration resistance,and thermal performance.The space is defined as a
nonhabitable and conditioned sunroom.
Category V:A sunroom with enclosed walls.The sunroom is designed to be heated and/or cooled and is open to the main structure.
The sunroom fenestration complies with additional requirements for air infiltration resistance,water penetration resistance,and thermal
performance.The space is defined as a habitable and conditioned sunroom.
OWNER
Ihavereed this completeform and unde1rstend Iamrxeonnga Category J Smmromn.(I-V)
I'rintW Name cr7'IQy�J 1'�I��bm.-1LAddass IH (A) �9A 5"2 p /
Before me this day of is the Camey ofDuvd,Std ofFlwida be personally appeared
harm by himselOMrself and affirms dl
narmanis and declm =home are true and accursN.
JOSEPH R.BEPNBIG
Notary Publicdl,ange,state of FLP' Corayof DUAL NY COMMBSION I BE 2181-0
Personally Ko� wap or Predue IdentiOudon® \\AA,,,,..���� ,�n,p^�� 1 EXPIRES:November 7,201%
N IYPe l�j1 1- .IMI ha, yn,1� a`"r,. Wald Ew Novembler Saes:
Suriname and Screen Encloaurs Requhwmme
Cate0mP I 11 III IV V
Habitable Space No No hO yea
Fourdadon Walls-*W can Walls<200pff can Walls<200pu can have Walls<20opff can have Walls<200pff can have
have 12'V/x12"D hg have 12MA2"13 fog 12"INx12'Dftgor30 12"Wx12HDftg 12-Wx12'Dftg
or 31/2"slab N no or 31/2"slab N no slab N no concentrated
concentrated load concentrated load bad>75fmb
>750N >7501b
Exlstlng indenter
Relocate to exterior N Relocate N exterior RBNrate to exmdor N Rebm,to e#arior N Relocate to e,enm'rf
GFI Breaker enclosed 'd enclosed enclosed enclosed enclosed
Exit Lighting Not Required Required Required Required Required
Manor Elamite Nat Required Not Ouuete Required Not Required Required Required
Emergency Egress hon exist. Egress and Ext Egress and Edt must Egress and Grit most Egress and Exit must
Escape Openings structure allowed it new meet code. meat code. meet coda. meal Coda.
open to atmosphere
and has screen door
leading away from
mesdames.
Misc.Window Walls an prom n Wells ora enclosed Wails are enclosed Feasiretion must Fenrestration must
and Door enclosed with with translucent a with translucent or comply with at comply with at
Requirements screen or maximum transparent olasuc transparent plastic or Infiltration resistance. Infiltration resistance
Seem thick plastic or glass. Widows alas. Air imlNre ion water penetration water penetration
film. Host structure most be resistance and water resistance,thermal resistance.thermal
windowefdoors shall removable. Host penetration performance and verf.mom sand
not be reri structure mouirements apply, structural Calan stroaural dalan
windows/door;shall Plastic windows mustessssure, pressure require enb
not be remained. be removable.Host rwuiremems.Hat Host structure windows 8
structure windows and structure windows 8 doors may be removed-
doors shall not be doors died not be
removed removed.
Energy Shale Not Required Not Required Not Required Required
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OFFICE Copy 9®4343-33052
///f 01111111
Beam fSMBI and Post(SB) Sizes for Pool / Patio Enclosures 9014 FBC Category I.
Beam Sias for wind speeds up to 130 mph. '
Spacing 5'O.C. 6'O.C. 7'O.C.
2"x 5"=18'-r7' 20x2"purlins 2'x 5"=17'-0" 2"x2"purlins 2"x 5"=16'-0" 2"x2"purlins
2"x 6'= 21'0 2"x 6"= 19'-W " 2"x 6"
2"x 7"=25'-0" " 2"x 7"=23'-0" « 2"x 7"=22'-0" «
2"x 8"=34'-0" 2"x3" purlins 2"x 8"=31'-0" 2"x3"purlins 2"x 8"=29'-0" 2"x3"purlins
2"x 9"=41'-0" " 2"x 9"=37'-0" 1. 2"x 9"=35'-0" "
2"x 10"=48'-0" 2"x4" purlins 2"x 10"=44'-0" 2"x4"purlins 2"x 10"=41'-0" 2"x4"purlins
Post sizes for wind speeds up to 120 mph.121 to 140 mph use next larger size.
Post must be within two sizes of beam regardless of beam regardless of height.(EX:2"x 7"beam
and 2"x 5"post.2"s 5"max.height at 7'spacing is 12'-0",if higher,post chart must be used.)
Exposure 8
Spacing S'O.C- 6'O.C. p O,C,
2"x 4"=12'-0" 2"X2"guts 2"x 4"=11'-0" 2"x2"girts 2"x 4"=10'-0" 2"x2"girts
2"x 5"=14'-0" " 2"x 5'=13'-0" " 2"x 5"=12'-0" "
2"x6..= 17'-0" 2"x 6"= 15'-0" 2"W= 14'-0" «
2"x7"=19'-0" 2"x7«=17'-0« « 2"x7"=16'-0" "
2"x 8"=29'-0" 2"x3"girts 2"x 8"=24'-0" 2"x3"girts 2"X 8"=23'.0" 2'x3"girts
2"x 9"=33'-0" " 2"x 9"=30'-0" " 2"x 9"=28'-0" "
2"x 10"=38'-0" 2"x4"gins 2"x 10"=35'-0" 2"x4"girts 2"x 10"=32'-0" 2"x4"girts
Emsomem
spacing S.O.C. 6'O.C. 7'04
2"x 4"=10'-0" 2"x2"girts 2"x 4"=9'-0" 2"x2"girts 2"x 4"=8'-0" 2"x2"girts
2"X 5"=11'-0" 2"x 5"=10'•0" " 2"x 5"=9'-0" 1.
2"x 6"= 14'-0" " 2"x6"= 13'-0" 2'x 6"= 11'-0" "
2"x 7"=16'-0" 2"x 7"=14'-0« " 2"z 7"=13'-0" "
2"x B"=22'-0" 2"x3"girts 2'x 8"=20'-0" 2'x3"girts 2"x 8"= 19'-O' 2"x3"girts
2"x 9"=27'-0" 2"x 9"=25'-0• " 2"x 9"=23'-0" "
2"x 10"=32'4" 2"x4"girts 2"x 10"=29'-0" 2"x4"girts 2"x SO"=27'-0" 2"x4"girts
NOTES:
One pair of 1/8"stainless steel cables for every 300 sq.ft.load bearing wall area.
One 1/8"cable on side walk extending more than 19'0 from host.
36"high chair rail girt required and maximum girt spacing Is 7'-01'.
2"x 2"wind brace required for every roof section adjacent to exterior screen walls in roofs over 900 sq ft.
Aluminum alloy 6005-T5.Minimum SMB wall thickness.044".
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1.NOTM S IS A BOUNDARY SURVEY.
2. NORTH PROTRACTED FROM PLAT.
3. INTERIOR ANGLES ARE A FOLLOWS I
A=90'08'49"
8=89'49'19" I '
C=89'35'41"
0=90'26'11"
4. NO BUILDING RESTRICTIONS PER PLAT.
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN
100D ZONE "X" (AREA OUTSIDE OF THE 0.2% THIS SURVEY WAS MADE FOR THE
4NNUAL CHANCE FLOODPLAIN) AS WELL AS CAN BE OF STEVEN R. ELLINGTON; TITLE
:STABLISHED FROM THE FLOOD INSURANCE RATE INSURANCE MPANY OF MINNESC
JAP No. 12031CO408H, REVISED JUNE 3, 2013 FOR
)OVAL COUNTY, FLORIDA.
OT VAI in WITHNIT THF SIrNAnIRG ANn nnuu neTWRtruT ocu
OFFICE COPY R dumber d t'o'OR BK 177qy page 1�
Ronnie Fu 10/11"2016 at 12:08 pM,
COUNTY CLERK CIRCUIT CO
RECORDINGSIO.00 URi DUVAL
NOTICE OF COMMENCEMENT ------
Permit No. Scry1 — a6y�
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 ofthe Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
I.Descriptionad roperty(legal crip�d n): 1
I a)Street(job)Address: q / Q
2.General description of improvements.
3.Owner Information
a)Name and address: S-(-
b)Name and address office simple hdeholde
c)Interest in property Fe,a S' olds
r(bother than owner)
4.Cont actor Information
a)Name and address: Rdlip D. Sd'iku' 6518 RA11iPS 2@71r. Dr- N. Ta.3,emyillor FL 37156
b)Telephone No.: 900212-1517 Fax No.(Opt) -
S.Smety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt.)
6.Iender
a)Name and address: -
Phone No.
7.Identity Nperson within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt)
S.In addition to himself,owner designates the following person to receive a copy ofthe Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes: _
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date ofNotice 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 1,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,COMYOU OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OFSrATROFFLORMA
COUNTY OF PINELUS 10. ORca/Direrbr/PerNer/Mvneger
GMX>lF Os,.3 1J sr__I
(p�PrintNsme
instrument
The foregoing instrument was acknowledged before me this 1 D+day of I"wtftt 20A_6_by
as (type of authority,e.g.officer,trustee,
attorney in fact)for (name of party on behalf of whom instrument was executed).
Personally Known_OR Produced Identification X Notary Signature J hp
Type of Identification Produced C1Q� ft- �1- Name(print) �""i'� I' be n(irlq
OR
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
FOPMSMOC.rvedalll
Signature ofNamrel Person Signing(in liu q 10.)Above
JOSEPN R KERNING
x MY COMMISSION M EE 216772
EXPIRES.Nuember7,2016
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