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183 Poinsettia St RERF19-0165 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER " ``� RERF19-0165 CITY OF ATLANTIC BEACH V.4W! 800 SEMINOLE ROAD ISSUED: 11/19/2019 " ' ATLANTIC BEACH. FL 32233 EXPIRES: 5/17/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 183 POINSETTIA ST REROOF SHINGLE SHINGLE ROOF $6975.00 TYPE OF REAL ESTATE BUILDING USE ZONING: SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170641 0020 SALTAIR SEC 03 COMPANY: ADDRESS: CITY: STATE: ZIP: Tadlock Roofing, Inc. 1408 Capital CIR NE Suite#3 TALLAHASSEE FL 32308 OWNER: ADDRESS: CITY: STATE: ZIP: KERR PAUL G 12625 HIGH BLUFF DR SUITE 315 SAN DIEGO CA 92130 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $85.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $89.00 Issued Date: 11/19/2019 1 of 1 ` r Building Permit Application Updated 10/9/18 '1.4 City of Atlantic Beach Building Department .*ALL INFORMATION • 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ♦ .1ttf"tj IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: '183 POINSETTIA ST Atlantic Beach FL 32233 Permit Number: ReRF l 9 - 6 1 (0S Legal Description 1 10-16 21-2S-29E 2 SALTAq SEC 3 3 S1/2 LOT 694 RE# 170641-0020 Valuation of Work(Replacement Cost)5 6975.00 Heated/Cooled SF Non-Heated/Cooled • Class of Work: VINew OAddition ❑Alteration ❑Repair OMove ❑Demo OPool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial VIResidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo • Will tree(s)be removed in usociauon with or000sed oroiect?Yes(must submit separate TrQe Removal Permit) i7JNo Describe In detail the type of work to be performed: U cul'-C i Q-4 c e (`4 I 607. ( , t Re-roof Slope3/12 with 15 sqs of Owens Corning Shingles Florida Product Approval#F110674 1 for multiple products use product approval form Property Owner Information Name KERR PAUL G Address 12625 HIGH BLUFF DR SUITE 315 City San Diego State Fl Zip 92130 Phone (904)742-6423 E-Mail kerrjaxmic®gmail.com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Michael Kerr Contractor Information Name of Company Tadlock Roofing INCQualifying Agent Dale Tadlock Address 7999 PHILIPS HIGHWAY UNIT#211 City Jacksonville State Fl Zip 32256 Office Phone 904-236-5200Job Site Contact Number 904-236.5200 State Certification/Registration# CCC1328417 E-Mail Judy®tadlockroofing.com Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt 0 Expiration Date 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 the laws regulating construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT, I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. 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 RECOR NG 91 U N T CE OF COMMENCEMENT. i (Si ri•tvrs of Owner Or At{gnt) CJ (Signoturs o Contractor) S ed and sworn to(or offirmeq)before me thi• 47d4y of Signed and swornryto(or affirmed)before me this 3 L day of Q e/ ,Lli1 . . k a . r k ! ( \Ji Siwe,_,2cel. . by_PULL _ Ir: • , . . / 1, naturo of Nataryj 1.0;14z.,,, JUDY I.BRANTLEY 1 Commission#GG 243364 vJUDYLSAM. ' V Yj Personally Known OR or Expires July 31,2022 panonally Known oRtJ. Colmwaion�oo243334 Producod Identification ,g%(;.."'' BordedTM'TroyFainInsrance$OO485-7O1S( )Produced Identification Juh3f,)Ott fypn of Identltication: . know Thy WI re,I,si,s,�oo.�nII oil of Identification •eco ort ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ___Sip----- 11/15/2019 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 have ADDITIONAL INSURED provisions or 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 NAME: Franceska M Drinkovic Hendrickson Insurance Services PHONEovej,4 (aso)67s-5600 I raw*(860)5424298 414 N. Meridian St. _ p mss; iranceskaehisins.net Tallahassee, FL 32301 _INSURER(SLAFFORDINGCOVERAGE NAICa INSURER A: GeminLinsurance Company 38318 INSURED INSURER B: Travelsts Casualty Insurance_Clg poany of Amsrka ,19046 Tadlock Roofing,Inc. INSURER Ev_aneton Insurance.Company Non-Admitted 502 Capital Circle SE Ste Cl INSURERD: Tallahassee, FL 32301 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000342-10500407 REVISION NUMBER: 284 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 APOUCYEFF-_—POLICY EXP -_.-- __._. LTR TYPE OF INSURANCE INSD W VD POLICY NUMBER IMMND/YYTY) IMMDD/YYYY1 UMTS A X COMMERCIAL GENERAL mammy VGGP004595 11/1812019 11/18/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES ) $ 100,000 MED EXP(My one parson) $ 5,000_ PERSONAL&ADV INJURY $ 1,000,000_ GEM_AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I X i J r i LOC PRODUCTS-COMP/OP AGG $ 2,000,690 OTHER: S SINGLE B AUTOMOBILEIJABaJTY BA2P855996 11/18/2019 11/18/2020 ,(EOMBINED UMIT $ 1,0000_ X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident $ ___ AUTOS ONLY X AUTOS �, HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per acodent) $ C X UMBRELLA LAB X OCCUR MKLV2EUL102942 11/18/2018 11/18/2019 EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I RETENTIONS $ WORKERS COMPENSATION PfrR 2414- H- AND EMPLOYERS'UABIUTY YIN p'A ac ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ __ OFFICER/MEMBER EXCLUDED? n N I A -- (Mandatory In NH) EL DISEASE-EA EMPLOYEE,$ If yes,describe under "– DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT S 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 For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RE RESENTATNE I (FMD) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by FMD on November 15,2019 at 05:02PM Doc # 2019250092 , OR BK 18985 Page 1195, Number Pages : 1 , Recorded 10/30/2019 10 :54 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10. 00 { Permit No fix rouo No, 170641-0020 NOTICE OF COMMENCEMENT State of FLORIDA DUVal County of The undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713, Florida Statutes, the following information Is provided In this Notice of Commencement. 1. Description of property: LEGAL DESCRIPTION: 110-1t3 21-25.29E 2 SALTAIR SEC 3 S1/2 LOT 694 STREET ADDRESS' 183 POINSETTIA T Atlantic Beach FL 32233 2 Genera(description of irnrovementc _ 3. Owner information or Lessee information if the Lessee contracrcdTor theirnprpvernent: a. Name and address: ,KkRJ� PAUL G .12625 HIGH BLUFrQR.5 IJ i A f5( AIA.. . ii b. Interest in property; _ C. Name and address of fee simple pUefiot+ier(if different from Owner listed above L. a. Crxitractor TTA6C CI hOOFING, INC SQ2 CAPITA( CIRCLF,5E,UNIT C t,Cl FL 32301 b. Contractor's phone number: 850.877-5516. S. Surety(if applicable, a copy of the payment bond is attached): a. Name and address: b. Phone number; G. Amount of bond:$ 6. a. Lender: b. Lender's phone number: -- • 7. Persons within the State of Florrdardesignated by Owner upon whom notices or other documents may be served as provided by Section 713.I1 1J(a)7., Ronda Statutes: 4, Name and address: b Piionr nu,'ib—S or deSigiNtrd Url�ten`� d, A. In ifddrtton to htmsCir or herself,Owner designates of _ to receive a copy of the L.lenor's Notice as provided in Section 713.13(ty(o), Florida StatutcS; b. Phone number of person or entity designated by owner: P. Expiration date of notice of commencement(the expiration date wilt be I 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 IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713,t,j, FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE or COMMENCEMENT MUST BE RECORDED AND POSTED ON THE J0( SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMME CNfG 0.4'. 0' RE •ROING YOUR NOTICE OF COMMENCEMENT, (Sigriture 6fowner .r Lessee or Owner's or Lesse '1 Authorized Officer/DIroctor/Partner! Manager) (Signatory's Title/Office)The fir.•oi •iins tat s•s owledged before me this 2`� day of ,,U(' 1��Q , 201/ as Arefiffit11114TAMOV/41.11111 foe arson re of Nott.is •ubl=�_a of Plod :At !cot,, GO 357798 b' 4R Pr• aCrldidentifl ion • .: Type of IdenttfiCatlon Produced �_--f 1 -; A' �'F J�Yn+ !!°� kraal ?a Irv/Fr'M hwr+ncs i00.3b6ai9 y i x ^inn i eiy�',�4 ?, Permit Inspections City of Atlantic Beach ., "'�.s ; Permit Number: RERF19-0165 Description:SHINGLE ROOF Applied: 11/19/2019 Approved: 11/19/2019 Site Address: 183 POINSETTIA ST Issued: 11/19/2019 Finaled: 12/12/2019 City,State Zip Code:Atlantic Beach, Fl 32233 Status: FINALED Applicant: <NONE> Parent Permit: Owner: KERR PAUL G Parent Project: Contractor: <NONE> Details: LIST OF INSPECTIONS SEQ SCHEDULED DATE COMPLETED DATE TYPE INSPECTOR RESULT REMARKS ID 12/3/2019 12/3/2019 ROOF DRY IN Rick Bell PASSED Notes: 516-673-3463 12/12/2019 12/12/2019 ROOF FINAL** Rick Bell PASSED Notes: Kane:850-728-0768 Permit packet by front door Printed: Monday,06 January, 2020 1 of 1 • /,f_ • r:' CITY OF ATLANTIC BEACH BUILDING DEPARTMENT 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 CERTIFICATE OF COMPLETION RERF19-0165 REROOF SHINGLE ISSUED: JOB ADDRESS: REAL ESTATE NUMBER: ZONING: 12/12/2019 183 POINSETTIA ST 170641 0020 DESCRIPTION OF WORK: SHINGLE ROOF OWNER: CONTRACTOR: KERR PAUL G Tadlock Roofing, Inc. 12625 HIGH BLUFF DR SUITE 315 1408 Capital CIR NE Suite #3 SAN DIEGO, CA 92130 TALLAHASSEE, FL 32308 APPROVED: �•V 'JA CHIEF BUILDING OFFICIAL VOID UNLESS SIGNED BY BUILDING OFFICIAL