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Permit Roof 97 Levy Unit 141 2012
(7.0,-A.41,....--,...\\ T � CITY OF ATLANTIC BEACH \ , is3 800 SEMINOLE ROAD ;r ATLANTIC BEACH, FL 32233 INSPE CTION PHONE LINE 247 -5814 Application Number 12- 00000491 Date 4/26/12 Property Address 97 LEVY RD Tenant nbr, name 141 STORAGE UNIT Application type description ROOF PERMIT Property Zoning TO BE UPDATED Application valuation . . . 11250 Application desc REROOF UNIT #141 ONLY FL #102841 Owner Contractor ATLANTIC BEACH COMMERCE AND REAVES ROOFING INC. STORAGE CENTER, INC. PO BOX 3995 1101 CHANNELSIDE DR SUITE 247 JACKSONVILLE FL 32206 TAMPA FL 33602 (904) 354 -8201 Permit ROOF PERMIT Additional desc . REROOF UNIT 141 ONLY Permit Fee . . . 110.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 11250 Expiration Date . 10/23/12 Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 110.00 110.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 114.00 114.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: 97 J ip6 e ' e4 7 Permit Number: 2 `' ( / Legal Description Parcel # c.c. Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ 6 , Proposed Work heated /cooled non - heated /cooled 02/ Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door Use of existing /proposed structure(s) (circle one): Commercial Residenti. If an existing structure, is a fires riinkler system costa • 1 . Ire e one): Yes �. N /A Florida Product Approval # - /c:7 2 £ Y / For multiple products use product approval form , ^ S 7-Qr Describe in detail the type of work to be performed: / & — /P--6 1 0 . ,(1 / / / 6,0 C-y Property Owner Information: / Name: / G .- A- otefiecSRuy e I x�.r� 1 2 Address: 42 ` f 4 tc.e# s tle. City _ _ " e State! Zip ,� 17 Phone 904- ? _ ,2¢,,2, 8 E -Mail or Fax # (Optional) e, ' - 10 71-,21- .2 7 Contractor Information: � — • Company Name: X∎d/ • • Y /5-, G' Qualifyin, • tent: ` +^ eQ ✓ -'S Address: ‘ 203( gt S City _ _ y 1 ..) ^ e State / Zip s2 Office Phone yr' - . ' -'�- D Job Site/ Co tact Number 0' -6'3$`Dl a Fax # 9 75 State Certification/Registration # CG, 02 7 C. Architect Name & Phone # Aelib Engineer's Name & Phone # Ai `A Fee Simple Title Holder Name and Address �cviu Bonding Company Name and Address Mortgage Lender Name and Address "{VA Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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, Furnaces, 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. 1 hereby ertify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Signature of O Si wner , t( Si -e g � � � Signature of Contractor • ,e- g Print Name - :e..A ■ .. \TNI ■ K5 Print Name z / 674gif =' f Sworn to and subscribed before me Sworrt9 ibscribed.-before me / this / 0 Day of 20 ) this ay of ('./ i, . , 20 /�— / e , / „/, 11 R E• S / _ _ ' ; h.. `N y' .V. REAVES . _- � y11: iln_�tc Notary Public .: . t ary Public, Stele of rlor1de Nota I t' J • M Comm. Expires Dec. 27, 2015 �. r ■ MV COMMISSION # EE 057349 r EXPIRES: May 21 2015 Y . ' Commission N o. EE 1 5987 ��`''�` Public Un i 01.26.10 „ ' Pf go;rdu t Thru Notary Date: 4/26/2012 Time: 2:58 PM To: 2475845 Page: 1 .. ® DATE (MMIDDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 4/26/2012 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(ies) 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 Ileu of such endorsement(s). CONTACT Young NAME: Stacey g PHONE (904) -7310 FAX JP (904)268 -2801 JP Perry Insurance (A /C, No, Est): 3342 Kori Road EMAIL s oun err ADDRESS: y g @JPP y' oom PRODUCER 00002381 CUSTOMER ID 8: Jacksonville FL 32257 INSURER(S)AFFORDINGCOVERAGE NAIC INSURED INSURER A :Summit Consulting, Inc. INSURERB:United Fire & Casualty Co 13021 Reaves Roofing, Inc. INSURERC: 2031 E 19th Street INSURER D: INSURER E : Jacksonville FL 32206 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11 3 0 02 65 0 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. SR ADDL SI.BR POLICY EFF POLICY EXP IN TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ B CLAIMS -MADE I X I OCCUR 030501288042 12/31/2011 12/31/2012 MED EXP Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 — 1 POLICY ,FCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ B ALL OWNEDAUTOS 030501288042 12/31/2011 12/31 /2012 BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS PIP -Basic $ 10,000 Hired And Non Owned Auto $ 1,000,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 4,000,000 X DEDUCTIBLE $ B RETENTION $ 10,000 030501288042 12/31/201112/31 /2012 $ A WORKERS COMPENSATION TORY I I ATU- OT AND EMPLOYERS' LIABILITY FR ANY PROPRIETOR /PARTNER/EXECUTIVE N E.L. EACH ACCIDENT $ 500,000 (Mandatory in NH) ER EXCLUDED? PENDING 12/31/201112/31 /2012 E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory n If yes, describe under DESCRIPTION OF OPERATIONS below E . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION 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 Road Atlantic Beach, FL 32233 AUTHORIZED REPRESENTATIVE Joseph Perry, III /KLC - ACORD 25 (2009/09) © 1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (zooms) The ACORD name and logo are registered marks of ACORD APR -26 -2012 15:29 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1 Doc # 2012092329, OR OK 15926 Page 265, NOTICE OF COMMENCEMENT Number Pages: 1 Recorded 04/26/2012 at 03:50 PM, JIM FULLER CLERK CIRCUIT COURT E]UVAl / Z — 41/ COUNTY Permit No. RECORDING $10.00 Tax FOIio Nn. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal description): _ i a) Street (jab) Address: _ _, 4 vy . /C L I • / �- e,,, _4 - /7 <22 5 5 2.Gt ncral description of improvements: ,.. _ �c? ` 3,Owncr Information a) Nameandaddress: A, a /e- /—_ .i 4. f ' ei C e 9f s e a ,_ • b) Name and addr of fcc simple titleholder (if other than owner) �,rv t c) Int erest in p roperty _. 4 Contractor information _ ,.�* r a) Name and address: 4° �C 5 Tr ,OC ,.. 1 Y t� 2t t 4(74 5/ ., . F' •I tzei::: b) Telephone No.: ; ,.a1 ` Fax No. (opt -) -3 /D 5.Surcty information a) Name and address: ,,r! _.,._... b) Amount of Bond: c) Telephone No.: - Fax No. (Opt) 6..Lcridcr a) Name and address: Phone No. 7, Identity of person 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) —_.. - •• - -_ 8.1.11 addition to himself, owner designates the following person to receive a copy of the 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 datc 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 IMPROPi;R, PAYMENTS UNDER. CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWiCE FOR 11Y PROVI;MENTS 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA C0 D ` -p t, �I COUNTY OF 4R�kS .ix b u,.v q L__, iw„tie � «r !!l•••• `✓✓% � - -- Si nature of Owner orDwne s Authorized Officer/Director/Plainer/Manager �r, t6, - 1 ;1/,3 Print Name The foregoing instrumen was • /L ._ owledged before me this 2 4 day of,P4 , 20,1 , , by _ ,f. V ' • VES . _ . _— (type of authority, e.g. officer, trustee, it r " r Notary Public. State of Halide altorne t t .e4;1• __ (name of party • $ half of • • instrument was executed). ' Commission No. EE 155987 r i \ Personally Down OR Produced Identification Notary Signature . a ` _ •,,,,... , �� 4p i - (�y ! Type ofld n Pro 61 duced 4 9.2,0 Y .$lf "G Namc (print)'! ;. ,N_ 1 "01.4. i C 444/1 -_ DV''e c Nff OR Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, !declare that 1 have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. e POR,yrcrnloc„ v,d2oio _,.----- ',+,_ ti. x[' - �--� SIgnturc of Natural Person Sagiing (in line 1/ 1.0.) Above