1101 MAIN ST RERF20-0192 10/6/2020 Permit-Rainer@Main.jpg
Building Permit Application
City of Atlantic Beach Building Department **All INFORMATION
800 Seminole Road,Atlantic Beach,FL 32233 H*GHUGHTEDIN GRAY
Phone: (904)247-5826 Email:B:lill:ir) I?r t cuab.us ISRfuulREo.
lad Adcress: II 01 :mei r Strectr1atlKtia Bl a_P'sr_P13'1 Permit Number:__R C R F ZC7' C)I I Z
Leg�I pescriptinn it-3.f ,7-23•2rIS-222./Mladic 1:cosh See ti 1.414 tax N 1Gl'L REN I 110 1.- 0000
'/2 e4.S4reee kit rat S 44 ueoe r.r.[or-4 or-4 r re,-Ls s• o ldt K 14e
Valuation of Work i'Reprarement Costi S 9 ?Od,ale Pleated/Cooled SF Nan.Heated/tooted
rereeP
• Class of Work: :New ❑Ad&t,en 71Ahe-aticn ll tRepair r.More 7Demc ❑Pool CVfndow,°Dcor
• Lw of existing/proposed structurcfsl: IYnmmerc,al INResiaentiel
• If an ex,stng structure,it a fire sprinkler system mctallea': ::Yes p(No
• Will tree's)be removed in association with or000sed oroiectl Lives(must sutret separate I roe Removal Permit! leNo
Describe In detail the type of work to be perforn•.eo; rarerc Q.sJ ref lace 31 t4 ct Chrrpt et roof:�g
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Florid N'odu:tAppro'al I „ 15214 FL 1-P3 ss--. (t-a...tr o
�1.,,,el for m.,hlpla products use prod,.,ct approve:form
Property Owner Information Cwd:.a4o y.err} -
Narnc C'.'.4-1`o.c ntr Address 1101 MQi i S?rrtt
Ciro rttlawt;r_ 'BtQck State FlLp_3z•a 33 Phone
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Owner or Agent:if Agent.Power of Attorney or Agercy Lotter RegL-'redi Qwv\t rrataineterldecaalko
Name atcompany 1,g1Kt prj-_f,;,g_r.att+..e aSw" Qualifying Agent .r ,.s. L r.+e.lc- o e
Address.ejBBo r:.brr .ve f1ylb4.S1ft il-t state F . Zip 32277
Office Phone spat-994-3d4c lob Stec Contact Number Qrh-9944-3646
State Certification/Kegistratior;CRC opzAq,if E Ma.l LEN L-0=11.4 rars-CaSt.ritGr
Architect Name&Phone V
Engineer's Name&Phone N _ I
Workers Compensation insurer -- OR Exempt l�`,Emiratwn Date411
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Application is hereby made to obtair a permit to do the work and Instatatwns zs militated,l certify mat no work or instal at,on has
commenced prior to the Issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this unsd.ction.I understand that a separate permit must be;scone&far ELECTRICAL WORK,Pr.Ukd&NG,SIGNS.
WELLS,POOLS,FURNACES,ROI teeS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:to addition to the reouire-nsenta of the
permat,there may be additional restrictions applicable to this property that may tie found in the public records of this county,and
there may be additional permits required from other eoyernreentai entites scch as water management districts,state agencies.c
federal agencies.
OWNER'S AFFIOAV;T:I certify that all the foregoing information is accurate and that all work will be done in compforce with all
applicable laws regulatirg construction and zoning.
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 NANCING,CONSULT WITH YOUR LEND R OR AN ATO BE
REC 1 Y U ,NQ,TICE OF COMMENCEMEN
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https://mail.google.com/mail/u/0/#inbox?projector=1 1/1
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No. J
State of Florida County of Duval
To whom it may concern: r,
0
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The undersigned herebyinformsyou that improvements will be made to certain real roe 0
g p property,rty,and in accordance o_
with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
0)Legal description of property being improved: 18-34 17-2S-29E.222 Y a
Atlantic Beach Sec H Lot 6(ex N 10 ft), Ccr°
2 O J
N CL Street lying S thereof recd ord#65-84-10 Blk 199 0 0 0 0
0
Address of property being improved: 1101 Main Street — N w o
N
Atlantic Beach, FL 32233N in o cn c7
N0 0 0 z
General description of improvements: remove and replace roofing N au
$w
Owner Clifford Rainer o E 3 o o 0
CC
Address 1101 Main Street,Atlantic Beach,FL 32233 o z 0
Contractor Lockhart Construction and Roofing Services LLC
Address 5380 Timberline Drive.Jacksonville.FL 32277
Phone No. (904)994-3865 Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements:
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself or herself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes. (Fill in at Owner's option.)
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different
date is specified):
THIS SPACE FOR RECORDER'S USE ONLY // OWN R
/ ,
Signed: r Date:/0 06/ab •n '
Before me this day of ( •7O"irk 9O Z
in the,Count f D In✓ 'i/t�� ,State of Florida,has personally appeared
�TY iI^�i�- C
1_,F- nb herein by = g n
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self/ ers•If- d affirms that all statements and declarations herein are Z C;i.-
tr •an. ac r A•.
9 ^, 11
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No :ry Public at Large,State of L Cyt t+f County of ,'L1/" L D o
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commission expires: D. REM
Personally known or
Produced identification F Lt' i'$4 -1=1)