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597 AQUATIC DR - ROOF I- , �:.�J`1-�- �n\sf CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD �J, / 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-1432 Job Type: ROOF PERMIT Description: WWO REROOF FL10124-R11 Estimated Value: $3,000.00 Issue Date: 6/19/2015 Expiration Date: 12/16/2015 PROPERTY ADDRESS: Address: 597 AQUATIC DR RE Number: 171818-5344 PROPERTY OWNER: Name: CIMINO, LORI S Address: 4041 EUNICE RD GENERAL CONTRACTOR INFORMATION: Name: RAPID RESPONSE TEAM LLC Address: 2250 N. ANDREWS AVENUE POMPANO BEACH, FL 33069 Phone: 904-900-2150 FEES: PLAN CHECK FEES $32.50 BUILDING PERMIT FEE $65.00 BUILDING PERMIT FEE $65.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $166.50 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: 517. AQ U A T 1 C be-tVf Ott 1. FL 3; Permit Number: Legal Description Parcel# Floor Area of Sq.Ft. Sq.Ft Valuation of Work$3000 Oct 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 Residential If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval # FL-1O1a`1 — Et 1 For multiple products use product approval form Describe in detail the type of work to be performed: eZvYIDVL OLD R_C. F- A RI?LIfCE Property Owner Information: Name:L(IV t PV C D►..(.(N S Address: 99 7 4QOA I1 G t t V City pfl &J'tIC_ ("5 trPcCt( StateQ,Zip3) 3 Phone RD`-1- 372 - 7,2", E-Mail or Fax#(Optional) Contractor Information: Company Name: RAPt t R2rAi Ste,,.. � C Qualifying Agent: MI V SAVsA'(a L Address: I City State Zip Office Phone qt`?t-1. ,30D. 2/Std Job Site/Contact Number qp'1,6 act.33O t'( Fax# 5( I. f6`j .64 t Y State Certification/Registration# GGC. 1'3 3 OS 1 Architect Name& Phone# Engineer's Name& Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address 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 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 ElectricalpWork, 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. I hereby certify 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 d type o1 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 Owner/7,24 l�.t 77i • 11,0k ///LL j Signature of Contract. __t g f . _ , ,. Print Name f/1�,'�/� M• ( ,��//�f.S Print Name QL ' 5rIONV& f} .1, Sworn to and subscribed before me Sworn toind subscribed before me ,. this /7ADay of c70// , , 20 IS this` 17 Da/yJ o v vN ,20/S * �i • `% , RICHARD DAVID POTTER Ad head •�1 4 Notary Public i, PUBIC Notary P �,,r ��D DAVID POTTER L 1- -STATE OF FLORIDA ".. NOTARY PUBLIC ��.`' ' -Conrn0 FF064141 STATE OF FLORIDA 01.26.10 Expires 1/16/2018 .~ ' Conti FF064141 Emlrea 1I1RJ n1a 6/17/2015 8:37:28 AM PST (GMT-8) FROM: 146440-TO: 19042475845 Page: 2 of 2 \N \N 0 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 5 T A,Q t)Ar T 1 C Rl t/_f_ Pt, , �L 331 Permit Number:IC-R Legal Description Parcel # Floor Valuation of Work $3000 "° Proposed ork he ted/cooled non-heated/cooled CIass of Work(circle one): New Addition Alteration Repair A,1„, n,sn,,,ICTion n■ c,1'cna winfltl\.4/(lour Use of existing/proposed structure(s)(circle one): Commercial �� If an existing structure,is a fire sprinkler system installed? (Circle one): Florida Product Approval#FL-101/ta.9 - Et For multiple products use product approval form Describe in detail the type of work to be performed:_ Q2.WIUV L it Fis°64-CLIETC _ __ Property Owner Information: Name:1- N 0-Pt C.401-1.4 N S Address: 59 7 4( C.)^ reAr , YU f\-k: City PkTrt-s40t IG 6 t 0N-C- t StateR—Zip,31..23"3 Phone RC` E-Mail or Fax#(Optional) AIJJ Contractor Information: I Company Name: k atfi1 (2r,fi.)S.j (f•1tW' i L.L. C.. Qualifying € uta C U v Address: City _e(1. .2 u i ant. 7-7 1 .Q-I t Office Phone �jt�c1. R��D. 21 61) Job Site/Contact Number qQy�(� 1-it7i>r State Certification/Registration# CGG I'3 3 OS I Architect Name& Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address _Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. f 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 l understand that separate permits must be secured for Electrkal 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. I hereby certify that I have read and examined this application 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 Owner di, 77i • ‘.10/,'/i1.4 j Signature of Contract. _ • • Print Name 2/A;7'74 f y'�. (U'////V-S Print Name CAU—. '17; 514V ” Sworn t&and subscribed before me Sworn tqq,,��nd subscribed before me ,-. this I7� Day of Old , 20/5— this 1, 7"I)ay o v✓N _ ,2003 rI/WI/ 1/ ,,. RICHARD DAVID POTTER �� r 4W f Notary Public .r' NaTARYPueuc Nota P pal-r c, =STATE OF FLORIDA ry R1C46AR0 DA1AD :'s" :. Comm.FF0e414i N°TARY PUBLIC Revised 01.2.6.10 �..,,N PEOPTRU-02 CHATURVEDIRN ACORO DATE(MMfDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 6/18/2015 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 lieu of such endorsement(s). PRODUCER CONTACT Willis s Certificate Center__ Willis of Florida,Inc. PHONE - FAX c/o 26 Century Blvd (A/C,No,EMI:(877 945-7378 1 WD,No ):(888)467-2378 P.O.Box 305191 ADDRESS:certificates@willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC t INSURER A:Lloyd's B7874 INSURED INSURER B:Liberty Mutual Insurance Company 23043 Rapid Response Team,LLC INSURER C:Underwriters Lloyds Insurance Company 37559 2250 N.Andrews Avenue INSURER D:Liberty Mutual Fire Insurance Company 23035 Pompano Beach,FL 33069 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE INSD SWVD POLICY NUMBER (MM/DYIYYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [ X 1 OCCUR PGIARK02222-02 08/20/2014 08/20/2015 PREMISES Nmo .$ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO 2,000,000 JECT LOC PRODUCTS•COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY l A (Ea accident) COMBINED SINGLE LIMIT $ 1,000,000 i B X ANY AUTO S6-Z91-462935-014 08/20/2014 08/20/2015 BODILY INJURY(Per person) $ ALL OWNED —SCHEDULED BODILY INJURY(Per accident) $ AUTOS — AUTOS ON-O PROPERTY DAMAGE (Per $ EO HIRED AUTOS AUTOS _ AUTOS $ UMBRELLA LIAB X OCCUR 1 EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAIMS-MADE PGIXS00106-01 08/20/2014 08/20/2015 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION ERH AND EMPLOYERS'LIABILITY X I STATUTE YIN D ANY PROPRIETOR/PARTNER/EXECUTIVE WC2-Z91-462935-035 03/2812015 03/3112016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Atlantic Beach 67444 /800 Seminole Road Atlantic Beach,FL 32233 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD RAPID RESPONSE TEAM To whom it may concern: I Michael Savage , roofing qualifier for Rapid Response Team with License number CCC1330581 give permission to Carl Shumway to pull roofing Permits in The City Of Atlantic Beach Building Department on my behalf. Michael Savage Director CCC1330581 4e4a4611 ISQ444Witri Notary Signature p ,/CNArc/ WC/ /1p rrei Notary Printed Name SEAL 1 RICHARD DAVID POTTER • : NOTARY PUBLIC ' STATE OF FLORIDA Camttz FF004141 Expires 1/16/2018 7 , _ ,l\J Fir, J ;f. J \\ _ , STOP WORK „D„,9,. ADDRESS: ... 7 r vary; r ITY OF ATLANTIC BEACH BUILD->NJG AND ZONING DEPARTMENT NOTICE This building has been inspected and: . General Construction Mechanical Concrete and Masonry Electrical Plumbing Gas Piping IS NOT ACCEPTED CORRECT S NOTED BELOW, BEFORE ANY FURTHER WORK _ / n DO NOT REMOVE THIS NOTICE Building Official: /7 Date: 6 -17-/S- Failure to respond i Notice within 10 days will result in this violation being forwarded to the CODE ENFORCEMENT BOARD. The postirk. •)f this Placard by its contents shall serve as due notice. PERMIT NO.: NOTICE OF COMMENCEMENT To whom it may concern The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713.13 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Description of property ( 597 A•QV ii f G \ ki`AAT(C 4(5I PCir` c COQ Al\- , 3a�3� General description of improvements REMOVE AND REPLACE ROOF Owner jsl)A04-COL(_(IN) S Address SCt 7 1f Q 41-1 C ��r✓ t\Ci t o \f (C 65 AC z t Owner's interest in site of the improvement FEE SIMPLE Fee Simple Title holder(if other than Owner) Name Address Address Contractor 1\P Q a,Cy ) 5 L S 4=rr• \ t C- , Address 31a t Of v\I PC)1 I )NBC(/,Lc.,f.))//. t/(LC t f � -S.Z2.( t}- Surety(if any) Address Amount of Bond Name of person within the State of Florida designated by owner upon whom notices or other documents may be served Name /-(f k)()Pr L�rC( L- -f Address_ �s+!(/ l( De.kALL_._ A -6 4AYT(c_ (wNct- ttEt.,_32am 3 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 _ �---- Notary Seal: / � �'!_—,1 / 7 t .-h��I1 Owner Signature />iVr,ti M,1 . Cn ' �'<� 'r xke. Notary Pudic State of Florida Print Owner Name `r, Michael W Savage Sworn to and subscribed before me this 17+s� My Commission FF x41439 day of _.► ,201$ `a w Expires 0741/2017 .tr t-c_x_.._) c _ Notary Public •