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432 IREX RD - ROOF C,r �" `\ '`, CITY OF ATLANTIC BEACH ,) 800 SEMINOLE ROAD J =,i 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-1487 Job Type: ROOF PERMIT Description: FL 10674-R8 FL2533.1 Estimated Value: $5,285.00 Issue Date: 6/23/2015 Expiration Date: _ 12/20/2015 _ PROPERTY ADDRESS: Address: 432 IREX RD RE Number: 171422-0000 PROPERTY OWNER: Name: LOGAN. MARK A & SANDRA. " Address: 432 IREX RD GENERAL CONTRACTOR INFORMATION: Name: JOHN GILMORE ROOFING. INC. Address: 11647 GWYNFORD LN QA JOHN CHARLES GILMORE Phone: - - FEES: BUILDING PERMIT FEE $76.43 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $80.43 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: Li 3l Tct R Permit Number: Legal Description Pf14( NI1/S C1Ila I n;#- ap R/p JD*-S Ne. 1 I Parcel # 171 172,2. 0600 6 Floor Area of Sq.Ft. S172,2.q.l�t Valuation of Work$ S2g C. Proposed Work heated/cooled non-heated/cooled •reao Class of Work(circle one): New Addition(Alteration Repair Move Demolition pool/spa window/door Use of existing/pro osed structure(s)(circle one): Commercial Residenti If an existing structure,is a fir sprinkler system installed? (Circle one): s No N/A Florida Product Approval# 1 O 1a-7 Crytd ivied F L g6 3 3. For multiple products use product approva orm Describe in detail the type of work to be performed: Re!AMC P1.15171'l9 SFurt (.S ahc, rr ch I/ A1( Neu} Ski Le S . - 2 Ply drj io also )rtskil b 5Q Flab R nc� Cis vj. • Property Owner Information: n Name: c-\, k I I LO1YI(S Address: f(�}.a bole. 1-{- I% I t. City State eiZip 34(1-7ZPhone - 4341 - 2.q-(0`7 E-Mail or Fax#(Optional) Cl Contractor Information: CONTRACTOR EMAIL ADDRESS: Rt ck cx h l 1 340 6:),AO>• C O(1'\ . Company Name: • �,,��c Qualifying Agent.. rl e--;�h'10'� Address: I bq 'r n , c& :� i ' f'to City q CK. vil\<. State ft_ Zip 5z27 Office Phone Job Site/Contactiumber ' - "1 Fax# State Certification/Registration# C'OC 7 (o 1 '1 W./� ,3r1 _ O �d 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 f 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. 1 understand that separate permits must be secured for Electrical!Fork, Phunbing,Signs, Wells,Pools, Furnaces, Boilers, Healers, 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 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 %L 2 'L1'M2— Signature of Contractor j�1( A_ _/.e_ ..L._' Print Name n/./ 4- jyk1-- Print Name j A At S{Ar 01—z �aanluuIutt Besore2 e V ����o�`yp.N ENS �• Befo• ne D(a of S ne. $ � ':....... thi Da of at .. 20 3 Cga t e,�4 $ r - jt ' ' ACENEETT RIVAS Notary Public 7,:z,?*i �•� * - iota,Pi. .lic e • o • w k #FF 168900 i ec= N.Q. EXPIRES:N , , 2015 z `p a iaowau TARP P. , 9....-S-9/td IV`JU;/�.� ` v r w�i I i �'�,A ''•, k•F° i��/1UeCIC TA't''*(4.%• we#k Lu i 5 i ast i 3,OR BK 17209 Page 1843. Number Pages:1 Recorded 06/2312015 at 01:48 PM, Ronnie Fu N1,))TICE OF COMMENCEMENT COUNTY sell CLERK CIRCUIT COURT DUV; RECORDING$10.00 State of County of To Whom It May Concern: Tax Folio No. • The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with S the Florida Statutes,the following information is t d in this NOTIC • Legal Description of property being improved: I- COMMENCEMENT, Section 713 of t�ff,�� i� Address of property being improved: _ _ P. , A p6 /% irr /i General description of improvements: - R IA n Owner: it k �Y Address: + , (r Q ' Owner's interest in site of the improvement:1 • .% 41: -C l ' 41 Fee Simple Titleholder(if other than owner): Name: Contractor: ter •.: - ._Isiah. * tb,i ------ -_Address: tS� Obn Telephone No.:ci � s_._ Fax No: Surety(if any) 1— "—="� Address: Telephone No: Amount of Bond$ 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 do served: Name: _ currents may be Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a co 713.06(2)(b),Florida Statues. (Fill in at Owner's option) copy of the Lienor's Notice as provided in Section Name: Address: Telephone 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 MIS SPACE FOR RECORDER'S USE ONL OWNER ,,, ,orutNuNiyuii y�,N ENS, Signed: / �� )%Z%hi(g—, Q�� ; ssif4`t..W./,4� Before me this_ day of Date: !�'_I j 5 ��..sP o�L,t5,5,, 4,>,s Of Florida,has personally appeared 1,-\ t in the County of Duval,State wle . Personally Known: "a`v S. *t ..•,... 1*a Produced Identifi =z 1 #FF 168900 ? .1.,"(4 n: <<�' or ca+ ,p`r� Notary Public: , 99 a��d�d IN` c. :/ r My commission ,pires: '� - '���'���IC STAjt� , . 06/23/2015 2 : 04 : 10 PM FAXCOM Anywhere PAGE 1 OF 1 Issue Date: 6/23/2015 FLORIDA ROOFING.SHEET METAL&AIR CONDITIONING CONTRACTORS ASSOCIATION, INC. RSA SELF INSURERS FUND 1-800-767-3772 •FAX (407)671-2520 CERTIFICATE OF INSURANCE ISSUED TO: COPY PROVIDED TO: City Of Atlantic Beach John Gilmore Roofing, Inc. 800 Seminole Road 11650 Montez Lane Atlantic Beach, FL 32233 Jacksonville, FL 32223 Attention:To Whom It May Concern John Gilmore Roofing, Inc. This is to Certify that: 11650 Montez Lane Jacksonville, FL 32223 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL&AIR CONDITIONING CONTRACTORS ASSOCIATION SELF INSURERS FUND, 4099 Metric Drive, Winter Park, FL 32792. COVERAGE NUMBER: 870-032960 LIMITS Workers' Compensation: Statutory -State of Florida EFFECTIVE DATE: 1/1/2015 Employers' Liability: $100,000.00 Each Accident EXPIRATION DATE: 1/1/2016 $100,000.00 Disease, Each Employee $500,000.00 Disease, Policy Limit REMARKS: Non-cancelable, without 30 days prior written notice, except for non-payment of premium which will be a 10 day written notice. This certificate is issued as a matter of information only, is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be constructed as extending coverage not afforded by the policy(ies) shown above or as affording insurance to any insured not named above. This provides coverage for Florida policyholders and Florida domiciled employees only. By: By: ,d,‘„,. 06-23-15;02:03PM; ;9042621444 # 1/ 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMfon/YYYYI 06/23/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TI-US 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 pollcy(les)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 cortiflcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Vick!Zelen Zelen Risk Solutions,Inc. PHONE 904-282-8080 '(Aic,(o),904-262-1444 7964 Devoe St Avlcky©zolenrlsk.cam �1NSURER(SI AFFOROINO COVERAOE NAIL C. Jacksonville FL 32220 INSURER A: Canal Indemnity Company INSURED -INSUREg 9• John Gilmore Roofing,Inc. • INSURER C: John& Donna Gilmore INSURER 0; 10950-60 San Jose Blvd.PMB#196 INSURER E: Jacksonville FL 32223 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 ADDLSUBR' ' POLICY EFF POLICY EXP I LIMITS LTR INSR WVD POLICY NUMBER (MMtOD!YYYY)JMMIDDIYYYYI OENERALLIABIUTY l EACH OCCURRENCE '$1,000,000 A '. X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED 5O 000 I X- I OCCUR GL103609 09114/2014 09/14/2015 MED EXP(Apvoneperson) $5,000 PERSONAL S ADV INJURY $1,000,000 T PRODGENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: UCTS-COMP/OP AGG S 2,000,000 X !POLICY PRO LDC S AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT IFA Arri.oc S ANY AUTO BODILY INJURY(Per person) S ALL OWNED ^ SCHEDULED BODILY INJURY(Per eccidant) $ AUTOS ,_. AUTOS NON•OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Pat errHrIPr tl $ — S UMBRELLA UAB _ OCCUR I i EACH OCCURRENCE IS EXCESS UAB CLAIMS-MADE I AGGREGATE $ DED I I RETFNTON$ I E WORKERS COMPENSATION WC STAeU. a R-I AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N!A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If ye 9 RIPTIOe under E.L.DISEASE•POLICY LIMIT $ DESCRIPTION 4F 4aERAT10N5 Del Ow .. _ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Fax:(904)247-5845 CERTIFICATE HOLDER CANCELLATION Atlantic Beach Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 800 Seminole Road ACCORDANCE WITH THE POLICY PROVISIONS. Atlantic Beach,FL 32233 AUTHORIZED REPRESENTATIVE \j /(7), KSC} 011988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD