857 Bonita Int Demo Submittal Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
V800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 857 Bonita Road,Atlantic Beach,Florida,32233 Permit Number:
Legal Description Lot#10, Block#3,Royal Palms RE# 171150-0000
Valuation of Work(Replacement Cost)$ 128,000.00 Heated/Cooled SF 1,315 Non- 'a/ IF
• Class of Work: ❑New ❑Addition VAlteration ❑Repair ❑Move VIDemo ❑Pool ❑Wi w/J111V 4 2 4 2021
• Use of existing/proposed structure(s): ❑Commercial VResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes IZ1No BY.
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ViNo
Describe in detail the type of work to be performed:
demolition of interior-interior floor plan modifications
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Dan&Linda Dunn Address 857 Bonita Road
City Atlantic Beach State Florida Zip 32233 Phone 619-994-2754
E-Mail drdunn3@att.net
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Hagerty Construction&Roofing,Inc. Qualifying Agent Quin J.Hagerty
Address 12850 Winthrop Cove Drive City Jacksonville State Florida Zip 32224
Office Phone 1-904-992-9960 Job Site Contact Number 1-904-591-4354
State Certification/Registration# CCC 057779 E-Mail hagertyinc@yahoo.com
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer Zurich-American Insurance Company OR Exempt❑ Expiration Date 12/31/2021
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 the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating 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 FINANCING, CONSULT WITH YOUR LENDER • ' AN i TTORNEY BEFORE
REC DINGXOUR-N TICE OF COMMENCEMENT. •
/Mir LA AA
(Signature of Owner or Agent) G ature of Contractor)
22
Signed and sworn to(or affirmed)before me this 22 day of Signed an. orn to(• affirmed) before me this day of
June , 2021 , by • i j J. Ha.I'rty June , 2021 by Tiffany Sral
VA1 41Ai
( gn�f Notary)
rte_. �._..........:. •- - - - - - - -��, _ _—
�,� DUN HAGERTY
� dotar P.• is-State of Florida �r� TIFFANY GARDNER SRAL
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" V Commission 0 HH 106930 • •_° ¢`: Notary Public-State of Florida
[ ]Personally Known OR My Commission Expires
[ ] Produced Identificatio June 26, 2025 [ ]Produced Identification[ ] Personally Known OR , ;� c` Commission a HH 041479
ior,
'.'?•or r` ` My Comm.Expires Sep 10,2024
Type of Identification: " ' ._-. .` Type of Identification: PHYSIChiLrLdR 4k 4/ational Notary Assn.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 171150 0000
State of FLORIDA County of DUVAL
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMENCEMENT.
Lot#10, Block#3, Royal Palms
Legal description of property being improved. y
Address of property being improved 857 Bonita Road, Atlantic Beach, Florida, 32233
General description of improvements: demolition of interior- interior floor plan modifications
Owner Dan &Linda Dunn
Address 857 Bonita Road,Atlantic Beach,Florida,32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Hagerty Construction&Roofing. Inc.
Address 12850 Winthrop Cove Drive,Jacksonville, Florida, 32224
Phone No. 904-992-9960 Fax No. 904-992-9961
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,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,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): 72 o
>' 8a, m
THIS SPACE FOR RECORDER'S USE ONLYOVI►. .Q
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Signed: � \ DATE.�
Before me this day of , I 1 in the • 0ow
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County of Duval.S ate of Fiorida, as•• • ally appe,red Q
DAN DUNN herein by =V)+t )
Doc#2021155421,OR BK 19773 Page 670, himself '�herself and affirms t all statements and declarations herein o'E
are true and accurate / a
Number Pages: 1 E
Recorded 06/24/2021 08:23 AM, r� - ,E U
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
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RECORDING $10.00 z
Notary Public at Lar., IDA County ofDUVAL
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