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445 Sargo Rd roof 2013 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD s) J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Ir Application Number . . . . . 13-00002884 Date 6/14/13 Property Address . . . . . . 445 SARGO RD Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 6100 ---------------------------------------------------------------------------- Application desc REROOF ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BAKER, BEAUTY M REESE' S ROOFING 445 SARGO ROAD 1324 CORMORANT COURT ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32259 (904) 772-7663 ---------------------------------------------------------------------------- Permit ROOF PERMIT Additional desc . . Permit Fee . . . . 85 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 6100 Expiration Date . . 12/11/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 85 . 00 85 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 89 . 00 89 . 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 rs Office (904) 247-5826 Fax (904) 247-5845 } Job Address: �, �� Qy� .Permit Number: l y� Legal Description Parcel# oor ea o q. t. q. t Valuation of Work$ btj Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial esidential If an existing structure,is a fire s r. ikler system installed. (Circle one): e o N/A Florida Product Approval# For multiple products use pr duct approval ori Dcribe in detail the type of work to be performed: Property Owner Information: Name: Address: City State L ip Phone E-Mail or Fax#(Optional) Contractor Information: 1 � �, ��N\ Qualifying Agent: Company Name: �ee �- -'4cn Q,, city �, State —Zip Address: 1•iQn C W' Job Site/Contact Number Fax Office Phone # State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address that no work or installation the Application is hereby and that obtain btll a work wjll bejperformed toomeet the standards of all lark and installations as jws regulatincated I construction in this jurrisdiction.his permit bcommencedecomesrior onull issuance of a permit or and void is o work is com menced ommenced within six understand that sepaime after rate permits must be secutred for Electrical WorklPlumbtng, Sigor ns,or aWells,P ols,X urnacemons,Boilers,hs at tHeaters, worTanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAIL RE TO RECORD E O EF OR T ROVEMENTS ICE OF COMMENCEMENT MAY RESULT IN YOURCONSULT TO YOUR PROPERTY. IF YOU INTEND TFO� CORDING YOUR NOTICE OF H YOUR LENDER OR AN ATTORNEYCOMMENCEMENT. 1 hereb certify h t have 1 ed with examinespecified this lhertein or not. Theegranting of same to be to peon doesnd cnot. �prll esumej�o gns o e authority to f laws and j violatences gor cancel this type of work P provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Contractor Signature of Owner Print Name ' .. .. .......... ...... .... .....�,,2../`1....1 - Print Name ( e� `.` - ...... 4s... ........................................ '3 Before e ��.� ,20 I� this Before ay of this Day of (� Notary Public , . RACHAEL T14OMPSON :y' RAH L �N�M 8 Y ed 10.24.12 MY COMMISSION#EES54271 . FAY COMMIES EXPIRES NwwrA er 27.2016 EXPIRES No"Mber 27.20`16 '•''• , AM (407)310.0183 eojn t•o7►388-0183 06/14/2013 13:24 9417464138 MIKEGEEINC SEIPELIN PAGE 01/01 DATE(MMIODIYWYI ��a CERTIFICATE OF LIABILITY INSURANCE 6/14/2013 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GEE, x0. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MICHAEL 7353 IGEE, NL PLACE #301 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. SARASOTA, FL 34240 (941) 907-0914 INSURERS AFFORDING COVERAGE NAIL# INSURED REESE r S ROOFING, XNC. INSURER A FIELD EMPLOYERS INS CO 312 7 INSURER B: 1324 CORMORANT CT. INSURER C: JACKSONVILLE r FL 32259 INSURER D: (904) 772-7663 INSURER E: COVERAGES 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 DOCUMRNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY HE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLICY EFFECTIVEPOLICYDCPIRATION LIMITS LTR RD POLICY NUMBER F M D DATE MNW EACH OCCURRENCE GENERAL LIABILITY ! COMMERCIAL GENERAL LIABILITY PREMISES £q eeouronee Is CLAIMS MADE CI OCCUR MED ExP(Anyone person) S . PERSONAL&ADV INJURY' $ -- GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPlOPAGG $ POLICY 7 22 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es accident) ANYALTO ALLOWN£DAVTOS BODILYINJURY $ (Pet paron) SCHEDULED AUTOS HIRED AUTOS I30DILYINJURY 4 NOWOWNEDAUTOS PROPERTY DAMAGE $ (Perxddent) AUTO ONLY-EAACCIDENT It GARAGE LIABILITY ANYAUTO OTHERTHAN EAACC Is AUTOONLY: AOL;1$ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S —1 OCCUR ,CLAIMSMADE AGGREGATE IR $ t DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND x RYtIM1T3 ER EMPLOYERS LIABILITY EI„P„ACHAGGIOENT $ 100,000 ANY PROPRIETOF/PARfNERlEXECUTIVE OFF"MMSMSFR EXCLUDED? #830-33546 2/12/13 2/12/14 E.L.DISEASE-EA EMPLOYE $ 1_00, Nyes deealbeunder E,L,DISEASE.POLICY LIMIT $ 500,000 SPE6tm PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF ATLANTIC BEACH DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MARO DAYS WRITTEN 800 SEMINOLE PM. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ATLANTIC BEACH, FL 32233 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS DR ` FX#(904)247-5845 REPRI;sI:NTATIVSs, AUTHORIT,ED R£PRES£NTATIV£ + ACORD 25(2001108) 0 ACORD CORPORATION 1988