317 SARGO RD ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-944
Job Type: ROOF PERMIT
Description: REROOF FL 1956 R-10
Estimated Value: $3,1100.00
Issue Date: 4/23/2015
Expiration Date: 10/2012015
PROPERTY ADDRESS:
Address: 317 SARGO RD
RE Number: 171702-0000
PROPERTY OWNER:
Name: WHITEHEAD, EDWARD J
Address: 317 SARGO RD
GENERAL CONTRACTOR INFORMATION:
Name: HIGH STANDARD ROOFING, INC.
Address: 8010 -lLELEMTURNERRD QA GREGORY TIMOTHY
WILLIAMS SIR
Phone:
FEES:
BUILDING PERMIT FEE $65.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $69.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
State of
Countyof Tax Folio No.
To Whom It May Concern
The undersigned hemby inficum;you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Smitutes,the following information is stated I fluts NOTICE OF CON04EN",
prop"being improved: as--zM- RTn Q
L,egal Description of PL OfAD 4Q k yy)s
Address ofproperty being improved: 31 1,7
General description offinprovements:
Owner: bil &1171 'C /" t Address-
Owner's interest in site ofthe improvement:
Fee Simple Titleholder(ifother than owner):
Name-
Contractor: //j 9
Address: q 7 ,Z-Y AY? eVe ;%�DE/
Telephone No, Lr Fax No:
Surety(if my)
Address:
Telephone No- Fax No: Doc#2015091OD2.011131<171,40 Page727,
Number Pages:I
Name and address ofany pension making a loan for the construction ofthe fial Recorded 0*2212DI5 911:30 AM,
Name Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Address RECORDING$10,00
Phone No: Fax No:
Name Oflimen within the State offlori&, other than himself, designated by owner upon whom notices or other documents may be
served: Name
Address;
Telephone No: Fax No-
In addition to hmnsel� owner designates the folloWU19 PenOn to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name
Addrc,ss:
Telephone No: Fax No:
Expiration date of Notice OfCommancemsmit(the expiration data is one(1)year fionn�the data of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
si!fnedme ne
Be . this p.—day m`nhs*U"' f1m I
OfFlmid,has nsmally
oun o .,San,
Personally Known:
Produced Identificadom�—
Notary Public
My commission expfic,;: ition ElUM
A 1,�Cw,*- �4E
ExpimArd5,2016
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: J/ 7 f,,,-ye Permit NumberAr-7-ROOF 014H
Legal Description Parcel 9
Valuation of Work Z Floor Area f Sq.kt
.ProposeNork ShqeiFt�d/cooled_ non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window1door
Use of existing/pro osed structure(s)(cimle one): Commercial Residential
If an existing structure,i. li
s a ire no er s s m installed?(Circle one): Yes No N/A
Florida Product Approval# —/P,
For multiple produetbs use net approva arm
Describe in detail the type of work to be performed: Xev/,��_jl
Proverty Owner Information:
Name: 6d/,lie /4*f Address:
city 04/ ,f� e4l; State,� Z�Phone Pe
�z zZip
E-Mail�_ _
I or Fax#(Optional)
Contractor Inforniation: CONTRACTOR EMAIL ADDRESS-
Company Name: J14�11?rqIX10110' -4�117 Qualifying Agent:—..
4 a r W city _§tatc�zip�_77rr
ione Job Site/Contact Nuraber 54�1,t Fax#
lification/Registration C,CC z v
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A h mode to olloo,a permit to do the work and installations to indicated I certify that no work or installation has commencedprior to the
nd beperformed to meet Ike standards ofall laws regulating construction in flubsiurisdiction. 71pupermil becomes null
Shea" 's
'4 ..nee- ape
..dw�
and"odf kis T thin sa(6f months,or itconstruction or work is su;pendonfor abandamedfora rind ofsix;6)month,at anytime
..,k,.ca�
.sac I. c"aetd, m, afer
ed ad eparate permits must be secaredfor Electrim TWf ork,Plumbing,Signs, iredis,Pools, urfiaces,Boilers,He an,
TanksandAir Conditioners,cle.
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 0
one. o.in this
vtiolate or. the
EVELYN.S.EVA
Notiry Public Expim Apdl 5,201 N,,J*aq..Wr`IIcJENIffl`ERWA_0
.�T.F* 10 t r I ON
isycoieASSI #FF0114.
EXPIRES:A,1 24, evised 01.26.10
DO NOT WRITE BELOW- OFFICE USE ONLY
Uocles: 2U]U PLOKIDA BVITDMT�
Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date:
Development Size
Habitable Space Non-Habitable
Impervious area
Miscellaneous Information
Occupancy Group -
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone
Conditions/Comments:
800 Seminole Road
IS
Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5805
djllsq)
Construction Site Management Plan Compliance
A construction site management plan conforming to Atlantic Beach City Code Sec 6-18
has been approved as a part of this building permit. The Construction site management
plan was approved based upon the following information.
1. Puking plan—puking plan showing how site will be accessed and all onsite
and abutting street puking areas.
2.
3. Location of construction trailers,loading/unloading area and material storage
area.
4. Location of chemical toilet area.(chemical toilets must be kept out of City
right-of-way and not further than 15 feet from structure under construction)
5. Location of dumpster. Duinpister must be from an approved waste company
(in accordance with Chapter 16 City Code)as of 2009 the permitted
dumpsters are Advanced Disposal,Realco Recycling, and
Shappells.Dumpsters will have tarp covers or rigid coven on windy days.
Dumpisters must be removed prior to issuance of Certificate of Occupancy.
6. Traffic control plan, showing access with dimensions,area to be stabilized,
narrative on phasing of construction with adequate parking and delivery of
materials.
7. Site cleanliness. Contractor must have the entire construction site clemed by
Friday of each week. This means removal of scrap lumber,concrete remnants
and other such construction debris including cans, metal,plastic and paper.
8. Erosion and Sediment Control. Contractor must maintain all elemmts of the
approved Erosion& Sediment Control Plan(silt fence,catch basin filters, etc.)
until sod or other stabilization has been placed and approved by Public Works.
9. Other activities,where special conditions are identified by the Building
Official.
Failure to comply with the Construction Site Management
Ordinance may result in a Stop Work Order being issued in
accordance with City Code Sec. 6-17 (3)
Revised 5/2009
2014-2015 BUSINESS TAX RECEIPT
MICHAEL CORRIGAN,DUVAL COUNTY TAX COLLECTOR
231 F FORSYTH STREET,SUITEI 30,JACKSONVILLE,FL 32202-3370
Phone.(9041)630-1916.option 3; Fax:(904)6�1432
0 Webste.�.Gojnej/tc,Email.t@xwllectorpcoj.net
Note-A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business.
This business tax receipt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772,for the period
October 1, 2014 through September 30, 2015.
HIGH STANDARD ROOFING INC
GREGORY T WILLIAMS
6728 E RHODE ISLAND DR
JACKSONVILLE, FL 32209
ACCOUNT NUMBER: 95140
LOCATION ADDRESS: 6728 E RHODE ISLAND DR
JACKSONVILLE, FL 32209
DESCRIPTION; CONTRACTOR-ALL TYPES
COUNTY RECEIPT DESC: CONTRACTOR-ALL TYPES COUNTY TAX: 12.38
MUNICIPAL RECEIPT DESC: MC T72.309 MUNICIPAL TAX: 34.38
TOTAL TAX PAID: 46,76
VALID UNTIL September 30,2015
***ATTENTION***
THIS RECEIPT 15 FOR BUSINESS TAX RECEIPT ONLY.
CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING.
This is a business tax receiptonly. It does not permit the receipt holder to violate any existing regulatory or zoning avws of
the County or City. It does not exempt the receipt hoider from any other license or permit required by law. Thisisnota
certificaition of the receipt holder's qualifications
TAX COLLECTOR
THIS BECOMES A RECEIPT AFTER VALIDATION.
PAID-684374 . 0001 -0001 F05 10/10/2014 46 - 76
2014-2015 BUSINESS TAX RECEIPT
MICHAEL CORRIGAN, DUVAL COUNTY TAX COLLECTOR
231 E FORSWH S�Eiir.SUITEI M.�CKSONVJLLE,FL 322D2-3370
Phone:(90,1)630-1916,option 3� Fax: (9U)630-1432
webs".iininu mineft,Email.taxotiedor@ml.net
Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your piece of business.
This business tax recelpt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772, for the period
October 1, 2014 through September 30, 201
WILLIAMS, GREGORY T
HIGH STANDARD ROOFING INC
6728 E RHODE ISLAND DR
JACKSONVILLE, FL 32209
ACCOUNT NUMBER: 951"
LOCATION ADDRESS: 6728 E RHODE ISLAND DR
JACKSONVILLE, FL 32209
DESCRIPTION: QUALIFYING AGENT, CONTRACTORS
COUNTY RECEIPT DESC: QUAUFYING AGENT, CONTRACTORS COUNTY TAX: 0.00
MUNICIPAL RECEIPT DIESC: MC 772 325 MUNICIPAL TAX: 11000
TOTAL TAX PAID- 110�00
VALID UNTIL September 30,2015
***ATTENTION***
THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY.
CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING.
This is a business tax remipt only It does not permit the receipt holder to violate any existing regulatory or zoning laws of
the County or City. It does not exempt the receipt holder from any other license or perimit required by law. This is not a
certification of the receipt holder's qualifications.
TAXCOLLECTOR
THIS BECOMES A RECEIPT AFTER VALIDATION.
PAID-684374 . 0002-0002 F05 10/10/2014 110 . 00
MZ
9 02
IK
0
0
z W
0 <S
WOE
W 0 Ow M�-z
00 R
W ;5w >-o
won
oa:z
W %6 ww%W L4
�w .(D (DOW=! b
Zw �, M>
00 0< -7-oz
aw�i .- 0)
MO
Otw
0�� O
It
E�Z=)w
Ali CERTIFICATE OF LIABILITY INSURANCE Gni/2112015
li.�
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 Z�EPOUCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
r;ION
IMPORTANT- 0 the centificat. Imider 1...ADDITIONAL INSURED,the polic,(ves)must be endorsed. If SUBROGATION IS WANED,subject to
the terms and conditi...of the policy,cartain policies in"reshe ma End......I. A statement on this certificate does not confinic rights to the
cofficaus holder in lieu anui,h Madiensioneng.)
.N.T
Scan Claude
�Nkqn Contractors In...LI-C EME (8841)652�513
P.0 Box 34M WR6N. indo@cushanicientractoranninucan...
Sediona,AZ 86340
Phone (M)8524513 I=:(M)274-7438 it Comr-scuss Insamence Co. MAXis
High Stmeard!Roofing Inc.
l�MR D
6728 Rhode Island Or E l�MRE
JACKSOWILLE FL 32209- IMSLIREIRF
COVERAGES CERTIFICATE NUMBER. REVISION NUMBER:
THIS IS TO CERTFY THAT WE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO WE INSURED NAMED ABCAT MR WE POLICY PERIOD
INDICATED. NOTIAWSTANDING MY REQUIREMENT,TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIMICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY WE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL WE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHCAM4 INY HAVE BEEN REDUCED BY PAID CLAIMS
IOUICYEFF MMyrnP
NIMMIR TYPEOFINNU NCIE ENNaOYrYYI
L
A 7- NM-.EN.,-AaiaTTY PC97338 1100612014 10106,2015 anicroccuRRENcE $ 1.0DD.DD0
x OcCUR INEMM-1U.) s %000
5 5,000
PERSONAL&AIN I"RY $ 1,000=0
GEM��MUMM�ESMR: GENERAL AGGREGATE a two'"
=[—],—T Ducc PRODUCTS C�W� S 1,000'"
COMBINED EiRGLE LIMIT
It,I—..l $
my"To BOD111slU.111n,pirom 3
ALI 0MVIE) �MORM)LUED s"Day"URY(Perionin't) 5
Ann.
..S RR. E -ilMAGE
..a
HIRED. ALMOS
MNNNEULA AN rUR EACH OcctIRRENCE $
I.I.: Unnes. ADERE. $
DED I ITNEUENTIONS Orn a
�c��. III= 0 —
AND En't-o"Ear"A'a"Lar" YIN
PRoPRI�RTNDuE"E`um`E
OFFICERAMENIMER EXCLUDED? E]MIA
nlwnda�in MR)
know E.L DISEASE-RIDUCY UNIT I S
CERTIFICATE HOLDER CANCELLATION
CIWOF ATLANTIC BEACH SHOULD MY OF WE DESCRIBED POUCIES BE CANCELLED BEFORE
ROD SEIIIINOLE ROAD we� DAM THEREOF. NOTICE WILL BE DELIVERED IN
ATLANTIC BCH..FL 3Z233 ���E Namil WE FROUCY PROVISIONS.
AUTUDINEED REPRESENTINTIME
1 0 1988-2014 ACORD COR I rights nesereed
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORID
CERTIFICATE OF LIABILITY INSURANCE 4/22/2015
pmd,M,, Symouth Insurance Agency This candincate is issuest as a matter of information calvand centers.
2739 U.S. Highway 19 N. TboOstincatedoessernmoodexthoul
Holiday, FL 34691
(727)938-5562 Insurers Aftoling Coverage NAIC a
lbalared: South East Personnel Leasing, Inc. &Subsidiaries lraunr� Lion Insurance amnTanh, 11075
2739 U.S. Highway 19 N. Inews,a
Holiday, FL 34691 I.r C
Imu.D
Inever E
Coverages
Th.W.-.— d.h.l.ivv,h i.....av"A`"'Roh,'an ar, h', hr h,
nhh,oha.�odh se..h.......�hhh�
I....,.....In,..ne—
MR ADDL Pon,Effect. pas"Y Ehlashon Limits
�m ..no Type of Insuranne Policy Ncirber v,, case
(MWDD") (MMIDDNY)
GENE�I-LABILFITY 0--he
Cr ial General Liability
omme"'
t111
ITS Made [:] Occur
Porsernal Adv Injury
General aggregate limit applies par:
E] cone.,
:1 11 1 prvhua� �A,,
AUTOMOBILE LIABILITY �.nl n,.Lhha
evJhN hyv,
(po,poohn)
cov,huh.1ho
--N van,
(rr�o
R`oPeft
("e.)
EXCESSJUMBRELLAL1,I&1II_� .Onnhounce
H.— Anne-
A Workers Compensation and WC 711149 01MIM15 Olffila(316
Emplo,harn-Liability xlz= I 'ER
A, Offear/oRrIbcT EL EachAoudend
NO E L.Dia�-Ea Emph,ve
mo,
If Yes,deames urdshr speoal ponh=ns chno� F1 s1mr con
Oliver Lion Insurance Company is A.M. Rest Company rated A-(Excellent). AMB#12616
Descriptions of O��on�Location�ehicies)Exclusions added by Enclonement/Special Provisions: Client In M�5�07
Cossa,,e onv aWhas to act�enoomhes)of Souffn Chat Penonnel oaRo,,,Inc.&Socsklcaft�flost are heavdI to the milovorc,'Ohent Ompay'
lain standard!Rossfing,1.
Cohor,e orl,aWlits to Mures inconed by Send,East Peravian Leanin,Inc.&Sutaidaras active thapichyesi hwMW sorkini;in:R_
coar,,R dnes not aWly W autcatry mpbVeqs)or Thdapenlent contramorp)of de Ciant GnoWny or an,oder thafty.
A lh�rf re,scag,a,phose(�)Medi to Ina aint,Cooler,can oh,entered to,fed,a recoest to(727)W-2138 or In,call,(727)OM%2.
andect ilasur
ISSUE 04-n-15 W)
bihid. Ind. VIi
CINTIREATE MLC%�ATLANTIC BEACH c,RIcEUATjoW
belfalumho
BUILDNG DEPARnW1ERT ho-.11 in,ve n.ann,ahr.ia.h,.e, —1.1—
MR,$I�MKIOIJE RD.
ATILhAITICBEACH, R. =3