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Permit Teller Navy Federal 961 Atlantic 2011 UNIVERSAL ENGINEERING SCIENCES, INC. 3532 Maggie Boulevard Orlando, FL 32811 Phone: 407-581-8161 Fax 407-581-0313 E-mail: BIDinquiry©UniversalEngineering.com 011 1:-1' f.R City of Atlantic Beach Building Department TO: DATE: December 7, 2011 I ORDER NO.: NIA Attention: Michael Griffin, Building Official 800 Seminole Road Atlantic Beach, FL. 32233-5445 Re: Navy Federal Credit Union-Permit# 2011-2929 961 Atlantic Blvd., Atlantic Beach 32233 WE ARE SENDING YOU 0 Under separate cover via • Attached, the following items: D Shop drawings 0 Prints D Plans 0 Samples 0 Specifications DESCRIPTIONS OF ATTACHEMENTS Notice to Building Official Alternative Inspections Service Agreement Insurance Certificate Licensing information on our Standard Inspectors, Plans Examiners, Code Administrators and Professional Engineer THESE ARE TRANSMITTED as checked below: O For approval 0 Approved as submitted 0 Resubmit copies for approval IIII For your use 0 Approved as noted 0 Submit copies for distribution Please find attached the requested documents. Please let me know if any more information is needed. COPY TO: File SIGNED: REMARKS Please Sign: Docs No.: 933959 UNIVERSAL ENGINEERING SCIENCE, Maggie INC. 3532 Boulevard 1 P ��ando,FL 32811 64 �ui|ding Inspection Department Manager; PhUip W. Sutherland Phone: 407-581-8161 Fax: 407-581-0313B|Dinquiry@ue6od.00rn Notice to Building Official of Use of Alternative Provider Project Name: Navy Federal Credit Union'Interior RenPvations-Pernmit# 2011-2929 Parcel Tax iD.: 961 Atlantic Blvd., Atlantic Beach, FL. 32233 Servces to be Provided: Plans Review Inspections X | |leanaMinabUe. Navy Federal Credit Union the fee owner, affirm | have entered into a contract with the Private Provider Indicated below to conduct the services indicated above. Private Provider Firm: Universal Engineering Sciences, Inc. Private Provider: R. Kenneth Derick, PE, Senior Vice President Address: 3632 Mamie Blvd. Orlando. FL. 32811 Telephone: 407-581-8161 Fax: 407-581-0313 E-mail Address (Optional): bid /nmuin/Aueood.cmm Florida License, Registration or Certificate No,: Professional Engineer- Florida Liconse No. 37711 | have elected to use one or more alternative providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application, as authorized by S.553.791, Florida Statutes. | understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. |nstemd, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, | acknowledge that | have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. | agree to imdemnify, dmfend, and hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the buliding that 15 the subject of the enclosed permit application. | understand the Building Official retains authority to review p{ans, make required inopmotiono, and enforce the applicable codes within his or her charge pursuant to the standards established by 5.553.791, Florida Statutes. If | make any changes to the listed private providers or the services to be provided by those private providers, | shall, within 1 business day after any change, update this notice to reflect such changes. The building plans review and/or inspection services provided by the private provider is limited to building code compliance and does not include review for fire code, land use environmental or other codes. Page 1 of 2 Pages The following attachments are provided as required: 1. Qualification statements andlor resumes of the private provider and all duly authorized • representatives 2. Proof of insurance for professional and comprehensive liability in the amount of $1 million per occurrence relating to all services performed as a private provider, including tail coverage for a minimum of 5 years subsequent to the performance of building code inspection services. C 0 -- rn#ivfdaat" r (Min.-4 Corporation Partnership Print Corporation Name Print Partnership Name �. .i c�'■t at ~ice By: , By: sr: na e) (signature) (signature) Print Print Print Name: V,4 Auo«nrwrd Name: Name: Address: X 41 Address: Address; 1.44 !/A 2 Z!R'o Telephone Telephone Telephone No.: To3 -moob -a4 S''f No.• No.: Please use appropriate notary block. STATE OP COUNTY OF ci • t Ono-r'htf d _Jn dI 1-- CfeCti# 'G Corporation Partnership Before me, this 1' day of Before me, this day of Before me, this day of . � 20.41.,, personally ,, 20_„ personally , 20_, personally appeared - 1", llorrkg0 appeared appeared J of , Partner /agent on behalf of A Corporation, on behalf of the state. corporation A partnership, who executed the foregoing who executed the foregoing who executed the foregoing instrument, and acknowledged instrument, and acknowledged instrument, and acknowledged before me that same was before me that same was before me that same was executed for the purposes executed for the 'purposes executed for the purposes therein expressed. therein expressed. therein expressed. Personally known . or produced Identification Type of identification produced ObkaKACO 1 b' 1.1(1j Signature of Notary Print Name Notary Pubile: NOTARY STAMP BELOW N,,� / �0,��� ,•'•'NEXW auauc OTjWY My commission expires: s Doc No. 933837 = _� AEG, # � ;MY COMMls cJ RE5 Z ~" ?s ''�• 013112015 . 2 ,•` �� ,wEai.TH., F oS Page 2 of 2 Pages Client #: 1405231 131UNIVEENG ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM! YY) 2011 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(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 certificate does not confer rights to the certificate holder in Iieu of such endorsement(s). PRODUCER CONTACT BB &T - J. Rolfe Davis PHONE — — ._..._._. -. ..__.. ...__. PO Box 4927 eci ` Ext }u 691 -9600 AIC, No): 888 - 635 -4183 ____. Orlando, FL 32802 -4927 -- p ° s � roj - -- - - -- 407 691'9600 ,CUSTOMER ID #: —, _ __. __.___.._.—___.. - _- —. _..._.__ ...___ — _-- ____,_,_,____,,_ „ -_., _ INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: End American Specialty In 41'718 Universal Engineering Sciences Inc - - - -•- 3532 Maggie Blvd. INSURER B : Navigators Specialty Insurance -- _ _ _ 36056 -- INSURER C : Charter Oak Fire Insurance Comp 25615 — Orlando, FL 32811 __.. -._M _ .__._.. __—....._.._..._ �.._ _ INSURER D: The Phoenix insurance Company 25623 INSURER E : Travelers Indemnity Co of Am 25666 INSURER F : COVERAGES CERTIFICATE NUMBER: 11/12 Master GL - BALI REVISION NUMBER: 2 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 ADDL 'UBR 'POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MM!DDIYYYY) (MM!DDfYYYY) LIMITS A GENERAL LIABILITY X ECC10100846402 01/01/2011 01/01/201 EACH OCCURRENCE $5,000,000 X COMMERCIAL GENERAL LIABILITY 15gEKT PREMISES (Ea occurrence) $300,000 — 1 CLAIMS -MADE I� OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $5,000,000 T GENERAL AGGREGATE RAL AGGREGAT x5,000,000 —� GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $5 000,000 i POLICY X 7CT F- LOC $ C AUTOMOBILE LIABILITY X 810544M2006 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ — BODILY INJURY (Per accident) $ SCHEDULED AUTOS _ HIRED AUTOS PROPERTY DAMAGE $ _^ (Per accident) NON -OWNED AUTOS $ $ B UMBRELLA LIAB X OCCUR CHIIEXC627992IC 01/01/2011 01/01/2012 EACH OCCURRENCE $9, 000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $9,000,000 DEDUCTIBLE X RETENTION $ 0 $ D WORKERS COMPENSATION X UB544M2006- Florida 01/01/2011 01/011201 X WCSTAU• O7H- AND EMPLOYERS' LIABILITY Y / N TORY t IMITS EF�_ E ANYI PRIIETORPEARTNERE ECUTIVEI N] N/A UB1787X809- Georiga 01/01/2011 01/01/201 E.L. EACH ACCDENT $1,000,000 (Mandatory In NH) H yes, describe under E.L. DISEASE - EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below' E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional & ECC11100846502 01/01/2011 01/01/201 Each Claim $8,000,000 Pollution Liab Aggregate $8,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Navy Federal Credit Union - Interior Renovations at 961 Atlantic Blvd., Atlantic Beach, FL 32233. Additional Insured status is granted with respect to General Liability if required by written contract per (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Atlantic Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 800 Seminole Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Atlantic Beach, FL 32233 -5445 AUTHORIZED REPRESENTATIVE _ l ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S7820314/M7166431 PSBE DESCRIPTIONS (Continued fro 1) endorsement Additional Insured- Owner, Lessees or Contractors - Automatic Status When Required in Construction Agreement with You Form #CG2033 07/04. Primary and Non - Contributory with respects to General Liability if required by written contract per "Automatic Primary and Non - Contributory Insurance Endorsement, Designated Work or Project(s) Form# FEI- 548,ECC0708. Additional•Insured status is granted with respect to Automobile Liability if required by written contract per endorsement Auto Extension Endorsement Form #CAT353 0609. Also included is an Auto Liability Excess Policy (North River Insurance Company, Policy #5317451613, policy term 1-1-2011 to 1-1-2012), which provides an additional $1,000,000 excess liability layer above the underlying $1,000,000 liability limits provided by primary auto policy with Charter Oak Fire Insurance Company. The $9,000,000. Excess Liability policy is excess above the underlying and excess layers. AMS 25.3 (2009/09) 2 of 2 #57820314/M7166431 UNIVERSAL ENGINEERING SCIENCES, INC. • 3532 Maggie Boulevard Orlando, FL 32811 Phone: 407-581-8161 Fax: 407-581-0313 E-mail: BIDinquiry@UniversalEngineering.com Alternative Inspection Services Agreement Project: Navy Federal Credit Union-961 Atlantic Blvd. Permit# 2011 Private Provider Firm: Universal Engineering Sciences, Inc. Private Provider Name: R. Kenneth Derick, P.E., Senior Vice President Address: 3532 Maggie Boulevard, Orlando, FL 32811 Phone: (407) 581-8161 Fax: (407) 581-0313 Name: License/Certificate No.: License/Certificate Type: R. Kenneth Derick 37711 Professional Engineer Mark C. Israel 47070 Professional Engineer Alfredo Austria BN523, PX244 Standard Inspector, Plans Examiner Bill Pancake BN2957, PX1711 Building Inspector, Plans Examiner BU1344 Building Code Administrator Leslie S. Rutherford BN4564, PX2845 Standard Inspector, Plans Examiner, BU1437 Building Code Administrator David R. Benoit BN4870, PX2544 Building Inspector, Plans Examiner Philip Sutherland BN650, PX311 Standard Inspector, Plans Examiner, BU968 Building Code Administrator Names, License/Certificate Numbers, and License description of provider and duly authorized agents whom will be providing services for this project. As the private inspection services provider for this project, I have read and agree to be bound to the provisions of State Statute 553.791. I further agree and understand that only the above listed personnel may perform inspections on this project and that if for any reason the inspection personnel should change, or if any person listed above should discontinue to quality as a duly authorized agent, you will be notified in writing immediately. Printed name of Alternative Provider: R. Kenneth Derick Signature of Alternative P •Ee State of Florida, County of Orange, Sworn to (or affirmed) and : • cribeio• -fore me this • 7th day of December, 2011, by R. Kenneth Derick, who ". - so - I P ow to m Arthur Love 40 Printed name of Notary ifgnature of Notary Notary Public Stamp: ARTHUR LOVE :* MY COMMISSION r • _, . DD872163 Doc No 933959 , • s- CXPIRES March 19, 2013 (407) 3 80i c corn U N I VE RSAL LOCATIONS: • Atlanta • Daytona Beach • Fort Myers ENGINEERING SCIENCES • Fort Pierce • Gainesville Consultants In: Geotechnical Engineering • Environmental Sciences • Jacksonville Geophysical Services • Construction Materials Testing • Threshold inspection • Kissimmee Building Inspection • Plan Review • Building Code Administration • Leesburg • Miami • OCala • Orlando (Headquarters) • Palm Coast • Panama City • Pensacola • Rockledge • Sarasota • Tampa • West Palm Beach LICENSES CERTIFICATES 3532 Maggie Blvd. • Orlando, Florida 32811 • (407) 423-0504 • Fax (407) 423-3106 WVON.UniversalEngineering.com F it/Le Griffin, Michael C � From: Arthur D. Love [ alove ©universalengineering.com] Sent: Wednesday, December 07, 2011 4:06 PM To: Griffin, Michael Subject: N2BO -Navy Federal Credit Union, your permit# 2011 -2929 Attachments: 20111207170645. pdf Greetings Mr. Griffin, Universal Engineering Sciences, Inc., has been retained to conduct Alternative Private Provider Inspections for Navy Federal Credit Union, your permit# 2011 -2929. Attached is an advance copy of our Notice to Building Official packet, minus all the certificates and licenses... it too big for a email. The original documents are being sent to you today, for delivery tomorrow. As you are aware, we have been asked to conduct Saturday inspections for this project. Should you have any questions or concerns, please contact me. Thanks in advance for all of your assistance. Arthur Love Universal Engineering Sciences, Inc. Supervisor- Building Inspections Department 3532 MaggieIlvd. Orlando, FL. 2811 Office: 407 - 581 -8161 Fax: 407 - 581 -0313 ALove(UniversalEngineerinq.com This email has been scanned by the Symantec Email Security.cloud service. For more information please visit http: / /www.symanteccloud.com 1 UNIVERSAL ENGINEERING SCIENCES, INC. 3532 Maggie Boulevard Orlando, FL 32811 Phone: 407 - 581 -8161 Fax: 407 - 581 -0313 E -mail: BIDinquiry@UniversalEngineering.com City of Atlantic Beach Building Department TO: DATE: December 7, 2011 ORDER NO.: NIA Attention: Michael Griffin, Building Official 800 Seminole Road Atlantic Beach, FL. 32233 - 5445 Re: Navy Federal Credit Union - Permit# 2011 -2929 961 Atlantic Blvd., Atlantic Beach 32233 WE ARE SENDING YOU ❑ Under separate cover via • Attached, the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications DESCRIPTIONS OF ATTACHEMENTS Notice to Building Official Altemative Inspections Service Agreement Insurance Certificate Licensing information on our Standard Inspectors, Plans Examiners, Code Administrators and Professional Engineer THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval • For your use ❑ Approved as noted ❑ Submit copies for distribution Please find attached the requested documents. Please let me know if any more information is needed. COPY TO: File SIGNED: REMARKS Please Sign: Docs No.: 933959 UNIVERSAL ENGINEERING SCIENCE, INC. 3532 Maggie Boulevard 1164 Orlando, FL 32811 B uilding Inspection Department Manager: Philip W. Sutherland Phone: 407 - 581 -8161 Fax: 407 - 581 -0313 BlDinquiry@uesorl.com Notice to Building Official of Use of Alternative Provider Project Name: Navy Federal Credit Union - Interior Renovations - Permit# 2011 -2929 Parcel Tax I.D.: 961 Atlantic Blvd., Atlantic Beach, FL. 32233 Services to be Provided: Plans Review Inspections X I Ileana Mirabile, Navy Federal Credit Union the fee owner, affirm I have entered into a contract with the Private Provider Indicated below to conduct the services indicated above. Private Provider Firm: Universal Engineering Sciences, Inc. Private Provider: R. Kenneth Derick, PE, Senior Vice President Address: 3532 Maggie Blvd. Orlando. FL. 32811 Telephone: 407 - 581 -8161 Fax: 407 - 581 -0313 E -mail Address (Optional): bidinouiry(a�uesorl.com Florida License, Registration or Certificate No.: Professional Engineer- Florida License No. 37711 I have elected to use one or more alternative providers to provide building code plans review and /or inspection services on the building that is the subject of the enclosed permit application, as authorized by S.553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and /or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by S.553.791, Florida Statutes. If I make any changes to the listed private providers or the services to be provided by those private providers, I shall, within 1 business day after any change, update this notice to reflect such changes. The building plans review and /or inspection services provided by the private provider is limited to building code compliance and does not include review for fire code, land use environmental or other codes. Page 1 of 2 Pages The following attachments are provided as required: 1. Qualification statements and /or resumes of the private provider and all duly authorized • representatives - 2. Proof of insurance for professional and comprehensive liability in the amount of $1 million per occurrence relating to all services performed as a private provider, including tail coverage for a minimum of 5 years subsequent to the performance of building code inspection services. , .. .tJ 'AI C"'.- PAv r z£f7 1i iiyi rt' C 4 r r r tbr%t t c, Corporation Partnership Print Corporation Name Print Partnership Name MOW i By: By: signal il e (signature) (signature) Print Print Print Name: 7A -AG'+ Jtio•+l"' o Name: Name: Its: its: Address: ? 1,24) .'" / 64-4 Address: Address: 104 .,r f fr ; : : 2 / o Telephone Telephone Telephone 10 3 - &6 S No.: No.: Please use appropriate notary block. STATE OF COUNTY OF VSO C ino-e d C1^Elt k Xibt1 Corporation Partnership Before me, this ' day of Before me, this day of Before me, this day of 201,1 personally , 20_, personally 20_, personally appeared Trot. kAo appeared appeared of , Partner /agent on behalf of A Corporation, on behalf of the state corporation A partnership, who executed the foregoing who executed the foregoing who executed the foregoing- instrument, and acknowledged instrument, and acknowledged instrument, and acknowledged before me that same was before me that same was before me that same was executed for the purposes executed for the purposes executed for the purposes therein expressed. therein expressed. therein expressed. Personally known X or produced identification Type of identification produced Signature of Notary Print Name s ,�� ,,,1 ,1 M , !!!N Notary Public: NOTARY STAMP BELOW , „.sot 0 t j ' NOTARY 1 4, My commission expires: . f. REG. 417500470 Doc No. 933837 Tr. MY C0MMISS1Ot+i« 6! '• EXPIRES ■ 01/31/2015 .• 4r ,, 4. .11 twitk '11‘ l3��� >-• Page 2 of 2 Pages ' ' J!u „u Client #: 1405231 131U NIVEENG ACORDT, CERTIFICATE OF LIABILITY INSURANCE DTE(MM ) 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 NAME: BB &T - J. Rolfe Davis PHONE (A/C 407 691 -9600 FAx 888- 635 -4183 PO Box 4927 (NC, No): E-MAIL No, Ext): ADDRESS: Orlando, FL 32802 -4927 —PRODUCER CUSTOMER ID #: 407691 -9600 INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Endurance American Specialty In 41718 Universal Engineering Sciences Inc INSURER B: Navigators Specialty Insurance 36056 3532 Maggie Blvd. INSURER C : Charter Oak Fire Insurance Comp 25615 Orlando, FL 32811 INSURER D: The Phoenix Insurance Company 25623 INSURER E : Travelers Indemnity Co of Am 25666 INSURER F : COVERAGES CERTIFICATE NUMBER: 11/12 Master GL - BAI/ REVISION NUMBER: 2 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR J NSR NVD POLICY NUMBER ,MM /DD/YYYY) (MM /DD/YYYY) LIMITS A GENERAL LIABILITY X ECC10100846402 01/01/2011 01/01/2012, EACH OCCURRENCE $5,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREM SES occu ence) $300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $5,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $5,000,000 7 POLICY X PF r LOC $ c AUTOMOBILE LIABILITY X 810544M2006 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON -OWNED AUTOS _ $ B UMBRELLA LIAB X OCCUR CHI1EXC627992IC 01/01/2011 01/01/2012 EACH OCCURRENCE $9,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $9,000,000 DEDUCTIBLE $ X RETENTION $ 0 $ D WORKERS COMPENSATION X UB544M2006- Florida 01/01/2011 01/01/2012 X W TO C RY LIMIT S OTH- AND EMPLOYERS' LIABILITY FR I /N E ANY PROPRIETOR/PARTNER/EXECUTIVE UB1787X809- Georiga 01/01/2011 01/01/2012 E.L. EACH ACCIDENT $1,000,000 I OFFICER/MEMBER EXCLUDED? N N/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 A Professional & ECC11100846502 01/01/2011 01/01/2012 Each Claim $8,000,000 Pollution Liab Aggregate $8,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Navy Federal Credit Union - Interior Renovations at 961 Atlantic Blvd., Atlantic Beach, FL 32233. Additional Insured status is granted with respect to General Liability if required by written contract per (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Atlantic Beach 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 -5445 AUTHORIZED REPRESENTATIVE • ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD #S7820314/M7166431 PSBE DESCRIPTIONS (Continued from Page 1) endorsement Additional Insured- Owner, Lessees or Contractors - Automatic Status When Required in Construction Agreement with You Form #CG2033 07/04. Primary and Non - Contributory with respects to General Liability if required by written contract per "Automatic Primary and Non - Contributory Insurance Endorsement, Designated Work or Project(s) Form# FEI- 548- ECC0708. Additional.Insured status is granted with respect to Automobile Liability if required by written contract per endorsement Auto Extension Endorsement Form #CAT353 0609. Also included is an Auto Liability Excess Policy (North River Insurance Company, Policy #5317451613, policy term 1 -1 -2011 to 1 -1- 2012), which provides an additional $1,000,000 excess liability layer above the underlying $1,000,000 liability limits provided by primary auto policy with Charter Oak Fire Insurance Company. The $9,000,000. Excess Liability policy is excess above the underlying and excess layers. AMS 25.3 (2009/09) 2 of 2 #S7820314/M7166431 UNIVERSAL ENGINEERING SCIENCES, INC. 3532 Maggie Boulevard Orlando, FL 32811 Phone: 407 - 581 -8161 Fax: 407 - 581 -0313 E -mail: BIDinquiry@UniversalEngineering.com Alternative Inspection Services Agreement Project: Navy Federal Credit Union -961 Atlantic Blvd. Permit# 2011 -2929 Private Provider Firm: Universal Engineering Sciences, Inc. Private Provider Name: R. Kenneth Derick, P.E., Senior Vice President Address: 3532 Maggie Boulevard, Orlando, FL 32811 Phone: (407) 581 -8161 Fax: (407) 581 -0313 Name: License /Certificate No.: License /Certificate Type: R. Kenneth Derick 37711 Professional Engineer Mark C. Israel 47070 Professional Engineer Alfredo Austria BN523, PX244 Standard Inspector, Plans Examiner Bill Pancake BN2957, PX1711 Building Inspector, Plans Examiner BU1344 Building Code Administrator Leslie S. Rutherford BN4564, PX2845 Standard Inspector, Plans Examiner, BU1437 Building Code Administrator David R. Benoit BN4870, PX2544 Building Inspector, Plans Examiner Philip Sutherland BN650, PX311 Standard Inspector, Plans Examiner, BU968 Building Code Administrator Names, License /Certificate Numbers, and License description of provider and duly authorized agents whom will be providing services for this project. As the private inspection services provider for this project, I have read and agree to be bound to the provisions of State Statute 553.791. I further agree and understand that only the above listed personnel may perform inspections on this project and that if for any reason the inspection personnel should change, or if any person listed above should discontinue to quality as a duly authorized agent, you will be notified in writing immediately. !2 - 7w 1t Printed name of Alternative Provider: R. Kenneth Derick Signature of Alternative Provider State of Florida, County of Orange, Sworn to (or affirmed) and : gibe• • -fore me this 7th day of December. 2011, by R. Kenneth Derick, who • - so own to me Arthur Love Printed name of Notary fr nature of Notary r a ARTHUR LOVE Notary Public Stamp: : MY COMMISSION # DD872163 Doc No. 933959 ~*t`, c'XPIRES March 19, 2013 (409 388 OK3 (lorldallotaryService.com RIP UNIVERSAL • � Beach ENGINEERING SCIENCES • Fort Myers • Fort Pierce Consultants In: Geotechnical Engineering • Environmental Sciences • J a kso n v ill Geophysical Services • Construction Materials Testing • Threshold Inspection • Ki m Building Inspection • Plan Review • Building Code Administration • Leesburg • Miami • Ocala • Orlando (Headquarters) • Palm Coast • Panama City • Pensacola • Rockledge • Sarasota • Tampa • West Palm Beach LICENSES Er CERTIFICATES 3532 Maggie Blvd. • Orlando, Florida 32811 • (407) 423 -0504 • Fax (407) 423 -3106 www.UniversalEngineering.com Sta 'te rt a Department of State I certify from the records of this office that UNIVERSAL ENGINEERING SCIENCES, INC. is a corporation organized under the laws of the State of Florida, filed on April 29, 1966. The document number of this corporation is 304669. I further certify that said corporation has paid all fees due this office through December 31, 2011, that its most recent annual report was filed on January 26, 2011, and its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Seal of Florida, at Tallahassee, the Capital, this the Twenty Seventh day of January, 2011 'x Y aro_triat—___ II fit 4 ` � Secretary of State (_ ' • 4 1-• , * Authentication ID: 500192573805- 012711- 304669 E WB , ' To authenticate this certificate, visit the following site enter this ID, and then follow the instructions displayed. https:// efile .sunbiz.org/certauthver.html Z • t 2 0 iitt ,v 're ° ...., E - 4 411 m o ` 3 V - C li z m f L al Noma a 'a N i 1 1:4 k �' # 4 y 7 1 . 0 dam I po a tik) 1v o0 est z z • a . a A2 WQ 0 tei 0 r eV r II i t rx t; 2s * iik ., r f *Pt / / .: : , s : ' - 1 ;(*; ' ' ' . j'4' ' ' I , g t it illit }. 0411 .4 ' '10' t',1 . 1 ; iir { C i 1 } vi . _; , it. „ S . .i: 4,,,,, 44 tl z * 40 ;:''' ii. 411- . , . .41 - - 4q" tf { t 0 lovoit, I iiin § 0 0 ' < gl sjek IN • i ilig fa oc b 5 Wo z a U c H. N W atill < CI cl. o O J f = W v. A,7 . • W a. . . Y U 4;"...tir ,,,,.A.7:7,,,,,,,, .m. f.... 1,-;:, • � t i� Ii tliii 4t rye P & y ' • j::1,1,' ,.,, 4PA 7 ,. :Lii 9 ,- W A.Alio ,A4 co z O 1/4 Sti ta 2 in N 1 M _ ]�J • 0 M `�C 0- N O 4 N a0 4 N O z N O O W < Z U ce 1 D N 6 4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 1- BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 , • 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 AUSTRIA, ALFREDO ANTIG JR 25385 PALISADE ROAD PUNTA GORDA FL 33983 Congratulations! With this license you become one of the nearly one million ; «fir - �� TMA 14Ci #- 5 A N Z04 Floridians licensed by the Department of Business and Professional Regulation. "o flPR PROFESSIONAL ltil4+ L *EGUI TS TON Nl?' • fi S IOit3U1:1lT Our professionals and businesses range from architects to yacht brokers, from • boxers to barbeque restaurants, and they keep Florida's economy strong. EN523 i)3J' Ll 110112514 Every day we work to improve the way we do business in order to serve you better.: For information about our services, please log onto www.myfloridalicense.com. S rAND.}1RD � There you can find more information about our divisions and the regulations that AUSTRIA, AZFNi R T : JR impact you, subscribe to department newsletters and learn more about the Department's initiatives..c Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to,serve you better so that you can serve your customers. ZS :QXRT2TIitt under eai ytors. }oo. oY ce. {6s rat Thank you for doing business in Florida, and congratulations on your new license! s�e•ae. dam.. 1fOY 3A:, 201/ : ` t si0 ' s aa2a • DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK "' PATENTED PAPER AC# 5769104 STATE OF FLORIDA • DEPAR pF Jgo sc� A�D pR 1tstsz ]�S TION 8 Im6 CODE ADMINISTRATORS it INSPECT SEC L11092202693 LICENSE NBR CATEGORY 89/22/7011:.110112514• • EN523 �. _ B G� EN; ',p ' ELEC. MECN, PLUM, RELEC 1 • T'he., STAND,#1RD• IssiEciron . Named b IS CBRTIFIED tinder the proviaione of Chapgter 468, FS, r Expiration date: NOV 30, 2013 Y ; j - - AUSTRIA, ALFREDO A JR , . 25385 PALISADE RD' PORT CHARLOTTE Ft 33983' • RICK' SCOTT KEN LAWSON GOVERNOR SECRETARY I _ _ DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 • 1940 NORTH MONROE STREET oftwow TALLAHASSEE FL 32399 AUSTRIA, ALFREDO ANTIG JR 25385 PALISADE ROAD PUNTA GORDA FL 33983 * r a n oF. amour • A C # 5 7 6 9 0 3 5 Congratulations! With this license you become one of the nearly one million p 8 OF • gZ ANA' Floridians licensed by the Department of Business and Professional Regulation. o , o pgOp gsyo *d, REotlt ATZON Our professionals and businesses range from architects to yacht brokers, from 1 L. boxers to barbeque restaurants, and they keep Florida's economy strong. px244 9 /Ze ll 1101125 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. 'STUD ) PLANE >9 AJ *RR There you can find more information about our divisions and the regulations that AUSTRIA, - ALtilEDO ANTIC 'JR impact you, subscribe to department newsletters and learn more about the Department's initiatives. ! ;- Our mission at the Department is: License Efficiently, Regulate Fairly. We '` -' • constantly strive to serve you better so that you can serve your customers. Y SIITIPTIS wider the y essoed oe cs.460 ys Thank you for doing business in Florida, and congratulations on your new license! cro sr.rao. dace 30; 1013 pllogts4tTas DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND • f.IICROPRINTING • LINEMARK PATENTED PAPER AC# 5 76903 5 gg �� S gg TATE OFF FLORIDA 'REGULATION • DEPARTMENT; S O YNt B S j A D P TR R A o?RS & INSPECTOR • $EQ# L11092202762 LICENSE ERR 09/2212033" 140112514 8X844 llBCS The, $ZCAND94tD 0../Aug *XAMINBR Named `belhar IS c Rririon Linder the . of Chapter 468 FS. Expiration date: NOV 30, 2013 AUSTRIA AjiFERVY ANTIG °JR • -. 225385' i�' B' ;Rb PORT CHARLOTTE F 33983' RICK SCOTT XEN LAWSON • GOVERNOR DISPLAAY AS REQUIRED BYLAW SECRETARY Licensing Portal - License Search Page 1 of 1 10:28:59 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard AUSTRIA, ALFREDO ANTIG Primary BN523 Current, Active Inspector )R Inspector 11/30/2013 License Location Address *: Private Main Address *: Private * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Centerildbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Comeriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterdsdbor.state.fl.us. https : / /www.myfloridalicense.com/w111. asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:29:21 AM 11t21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:28 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard Plans AUSTRIA, ALFREDO PX244 Current, Active Examiner ANTIG 7R Primary Plans Examiner 11/30/2013 License Location Address *: Private Main Address *: Private * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center(dtdbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterdodbor.state.fl.us. https : / /www.myfloridalicense.com/w111. asp?mode=2&search=LicNbr&SID=8thr&Sztyp... 11/21/2011 0 �L� STATE OF FLORIDA A‘ .,'",r44.„ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION i ,: 4;cr,�,t• '- BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 1940 NORTH TALLAHASSEE STR FL T 32399 PANCAKE, WILLIAM A III 9950 BOCA AVE NORTH NAPLES FL 34109 I . STATE OF FLORIDA AC# 5703938 Congratulations! With this license you become one of the nearly one million i #' a DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. 1 - 1.4 PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. BN2957 08/25/11 118025464 Every day we work to improve the way we do business in order to serve you better.! For information about our services, please log onto www.myfloridalicense.com. STANDARD INSPECTOR There you can find more information about our divisions and the regulations that PANCAKE, WILLIAM A III impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! Is CERTIFIED under the provisions or ct,.468 rs Expiration data: NOV 30, 2013 L11082502738 DETACH HERE AC# 5703938 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ# L11082502738 DATE BATCH NUMBER LICENSE NBR CATEGORY 08/25/2011 118025464 BN2957 BLDG, CELEC, 1 &2, MECH, PLUM, RELEC The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 PANCAKE, WILLIAM A III 9950 BOCA AVENUE NORTH NAPLES FL 34109 RICK SCOTT KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION "n BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 •' ='' • 1940 NORTH MONROE STREET a0 0% well"' TALLAHASSEE FL 32399 PANCAKE, WILLIAM A III 9950 BOCA AVE NORTH NAPLES FL 34109 • STATE OF FLORIDA AC# 5703943 Congratulations! With this license you become one of the nearly one million "!�`" DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. �` PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. PX1711 08/25/11 118025464 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myftoridalicense.com. STANDARD PLANS EXAMINER There you can find more information about our divisions and the regulations that PANCAKE, WILLIAM A III impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the Thank you for doing business in Florida, and congratulations on your new license! i provisions L1 of Ch. 108250227474 FS Expiration data: NOV 30, 2013 L13 t DETACH HERE AC# 57039 4 3 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ #L11082502743 DATE BATCH NUMBER LICENSE NBR CATEGORY 08/25/2011 118025464 PX1711 BLDG, ELEC, MECH, PLUM The STANDARD PLANS EXAMINER Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 PANCAKE, WILLIAM A III 9950 BOCA AVE N NAPLES FL 34109 -7302 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 0. STATE OF FLORIDA > . 4. , DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION y .. t - " 1- ' e — I V -. BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 -' 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 PANCAKE, WILLIAM A III 9950 BOCA AVE NORTH NAPLES FL 34109 ` �, AC# STATE OF FLORIDA g 7 L 3 9 L" 7 Congratulations! With this license you become one of the nearly one million a'- ,, DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. , j PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. BU1344 08/25/11 118025464 Every day we work to improve the way we do business in order to serve you better.! For information about our services, please log onto www.myfloridalicense.com. ; BUILDING CODE ADMINISTRATOR There you can find more information about our divisions and the regulations that PANCAKE, WILLIAM A III impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! Is CERTIFIED „Haar the provisions of cn.468 Fs . Expiration date: NOV 30, 2013 L11082502747 DETACH HERE ''C'' 5703947 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ # L11082502747 DATE BATCH NUMBER LICENSE NBR 08/25/2011 118025464 BU1344 The BUILDING CODE ADMINISTRATOR Named below IS CERTIFIED , Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 PANCAKE, WILLIAM A III 9950 BOCA AVE NORTH NAPLES FL 34109 RICK SCOTT KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY Licensing Portal - License Search Page 1 of 1 10:28:06 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard PANCAKE, WILLIAM A III Primary BN2957 Current, Active Inspector Inspector 11/30/2013 License Location Address *: Private Main Address *: 9950 BOCA AVE NORTH NAPLES, FL 34109 4 111=0 CT= * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Cail.Center(odbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterdidbor.state.fl.us. https : / /www.myfloridalicense.com/w111. asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:27:43 AM 11121/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard Plans PANCAKE, WILLIAM A primary PX1711 Current, Active Examiner III Plans Examiner 11/30/2013 License Location Address *: Private Main Address *: 9950 BOCA AVE NORTH NAPLES, FL 34109 Back New Search * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: CaII.CenterCadbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasteredbor.state.fl.us. • https:/ /www.myfloridalicense.coim /w111. asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:28:30 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Building Code PANCAKE, WILLIAM A primary BU1344 Current, Active Administrator III Building Code A 11/30/2013 Main Address *: 9950 BOCA AVE NORTH NAPLES, FL 34109 IICEMO Search * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Cail.Center@dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA /EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasteredbor.state.fLus. https : / /www.myfloridalicense.com/w111. asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 I AN" 1 ;-.. Q! o 0 �j /;Wz-iri o Q Z Z g � o . cu ecs . .44 4‹ g CU I:10 bo "4111111!N 14::: Z O ”N•I N o (1:1 cn 0 `.# 5 It cz .i..# A o a q b Z �o z E-NI CI) t r1114 ("I °■4 -,'.' 1--Z :E 44 i °A ft � '• w.' o ° rte' Nod o V ‘70 Cn e Q v . ra f t ., 14 a ,..1I9 ...* i :1b7tlnl•Iy17,r�: /_1731tN1J. 771. 1• YSLM:t H. lglat• nhlltlKSIJ'.11aMrla[tpAfal�fi /� n�v_�raarranf_r�ac AC# 5830381 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ# L11101701635 DATE BATCH NUMBER LICENSE NBR CATEGORY 10/17/2011 118076199 BN4564 BLDG, ELEC, 1 &2, MECH, PLUM The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 'FS Expiration date: NOV 30, 2013 RUTHERFORD, LESLIE S RICK SCOTT KEN LAWSON GOVERNOR DISPL AS REQUIRED BY LAW SECRETARY AY THIS 00rUME-NT !IA', A COLORED E3ACKGROLJND • MICROPRINI ING • LINEMARK PATENTED PAPER AC# 5830409 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ#L11101701663 DATE BATCH NUMBER LICENSE NBR 10/17/2011 118076172 2U1437 The BUILDING CODE ADMINISTRATOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 RUTHERFORD, LESLIE S RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW THIS DOCUMENT PAS A COLORED BACKGROUND • MICROPRINTING • L.INEMARK " PATENTED PAPER AC# 5830339 DEPARTMENT B ING B 3TRATO TION SEQ# L11101701653 DATE BATCH NUMBER LICENSE NBR CATEGORY 10/17/2011 118076172 PX2845 BLDG The STANDARD PLANS EXAMINER Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 UTHERFORD L ESLIE S RT('TC SCOTT KEN_LAWSON Licensing Portal - License Search Page 1 of 1 10:30:38 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:28 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard RUTHERFORD, LESLIE S Primary BN4564 Current, Active Inspector Inspector 11/30/2013 Main Address *: Private 4111:20 =MD * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center @dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovrlaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasteredbor.state.fl.us. https : / /www.myfloridalicense.com/w111. asp ?mode =2 &search= LicNbr &SID &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:29:49 AM 11t21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:28 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Standard Plans RUTHERFORD, LESLIE S Primary PX2845 Current, Active Examiner Plans Examiner 11/30/2013 Main Address *: Private * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center @dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA /EEO employer. Coovrlaht 2007 - 2010 State of Florida. Privacy Statemen Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterfddbor.state.fl.us. https : / /www.myfloridalicense.com/w111. asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:30:12 AM 1121/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:28 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires Rank Building Code RUTHERFORD, LESLIE S Primary BU1437 Current, Active Administrator Building Code A 11/30/2013 Main Address *: Private MC= New Search * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center @dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA /EEO employer. Coovriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmastertedbor.state.fl.us. https://www.myfloridalicense.com/w11 Lasp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 w q STATE OF FLORID F w , ,''TRATOR &,NSP� $Ettip>3a�5 :k n „7 a ! • ♦r a .. £ { !* { e 3 T yr.Jn� kR” ► Og/ 1/ i 802 644 BN48 B , ELEC, &a, ?M8c8 PL Und. ` �p�rovisi mocha tee 468 PS.. w � �` l � 1 � .. [n 'tJ f k °Fn I VY �, faµ g � � J , ",. t , ns KEN LAWSON DISPLAY AS REQU D BY L -? "‘ * :$ 4 i.i); 1 4:; *- STATE OF FLORIDA DEP T� INE RoF838 0 BUS TON N ~e #� I COIIB � ST T/3RS I P$ T „� 3 BATCH �u - " * fC NSS��.NBR � TNG 8J3 0i 11802864 PX2*54 swat, ELBC, > c , PLUM Un Che pros i �. s of C ialpter X68 FS . p .$'k.. ..rn'v'+k.' ^$ i ° 8. • t 2907 f DISPLAY AS REQUIRED BY LAW Licensing Portal - License Search Page 1 of 1 10:27 :17 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Type Number/ Status /Expires yP Rank Standard BN4870 Current, Active Inspector BENOIT, DAVID RUSSELL Primary Inspector 11/30/2013 Main Address *: Private * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center@dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida, Privacy Statemen% Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmaster @ldbur.state.fl.us. https : / /www.myfloridalicense.com/wl 11. asp ?mode =2 &search = LicNbr &SID=&brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:26:47 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:26 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name Number/ Status /Expires Type Rank Standard Plans BENOIT, DAVID PX2544 Current, Active Examiner RUSSELL Primary Plans Examiner 11/30/2013 Main Address *: Private Mailing Address *: Private Back CEO * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Cail.Centertadbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasteredbor.state.fl.us. https:/ /www.myfloridalicense.com/w111asp ?mode 2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 STATE OF FLORIDA ,s` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 • • 1940 NORTH MONROE STREET 4 co o; ,e+ TALLAHASSEE FL 32399 SUTHERLAND, PHILIP W PO BOX 22092 LAKE BUENA VISTA FL 32830 `t . STATE OF FLORIDA AC# 588 9 0 6 : Congratulations! With this license you become one of the nearly one million'v:. �,� DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. d _ PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. PX311 11/17/11 118045859 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. STANDARD PLANS EXAMINER There you can find more information about our divisions and the regulations that SUTHERLAND, PHILIP , <W impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! IS CERTIFIED under the provision of ch. Fs Expiration date: NOV 30, 2013 L11111701174 DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK"' PATENTED PAPER AC #5889063 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ# L11111701174 DATE BATCH NUMBER LICENSE NBR CATEGORY 11/17/2011 118045859 PX311 BLDG, ELECT,.MECH, PLUM The STANDARD PLANS EXAMINER Named below IS CERTIFIED Under the provisions of Chapter 468 FS, Expiration date: NOV 30,2013 SUTHERLAND, PHILIP W .. <] PO BOX 22092 LAKE BUENA VISTA FL 32830 RICK SCOTT KEN LAWSON GOVERNOR - -- - - - - -- - L:4I! ...,.- -oaav -' Y STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 6". BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 SUTHERLAND, PHILIP W PO BOX 22092 LAKE BUENA VISTA FL 32830 S_. STATE OF FLORIDA AC# 588907( Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL , REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. j BU968 11/17/11 118045859 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. BUILDING CODE ADMINISTRATOR There you can find more information about our divisions and the regulations that SUTHERLAND,,' PHILIP W impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the provisions of ch.468 Fs Thank you for doing business in Florida, and congratulations on your new license! Expiration dace: Nov 30, 2013 Liiiu7oxisi DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK ' PATENTED PAPER AC #5889070 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ# L11111701181 DATE BATCH NUMBER LICENSE NBR 11/17/2011 118045859 BU968 The BUILDING CODE ADMINISTRATOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 , SUTHERLAND, PHILIP W PO BOX 22092 LAKE BUENA VISTA FL 32830 ' RICK SCOTT KEN LAWSON GOVERNOR . - ., * .., wn 1,9111 ar+rr� nv s .tAr SECR.E . "fir STATE OF FLORIDA 47,1 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 'e`l BUILDING CODE ADMINISTRATORS & INSPECTOR (850) 487 -1395 1940 NORTH MONROE STREET Goo „ti TALLAHASSEE FL 32399 SUTHERLAND, PHILIP W PO BOX 22092 LAKE BUENA VISTA FL 32830 STATE OF FLORIDA AC# 588905 Congratulations! With this license you become one of the nearly one million ” DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. . PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. BN650 11/17/11 118045859 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. STANDARD INSPECTOR There you can find more information about our divisions and the regulations that SUTHERLAND, , PHILIP W impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Is CERTIFIED under 468 provisions rovisions of Ch. Fs Thank you for doing business in Florida, and congratulations on your new license! Expiration date. Nov 30, a pro L111117 DETACH HERE ° THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARKT" PATENTED PAPER AC #5889052 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR SEQ# L11111701163 DATE BATCH NUMBER LICENSE NBR CATEGORY 11/17/2011 118045859 BN650 BLDG, CELEC, 1 &2, MECH, PLUM, RELEC The STANDARD INSPECTOR Named below IS CERTIFIED Under the provisions of Chapter 468 FS. Expiration date: NOV 30, 2013 SUTHERLAND, PHILIP W PO BOX 22092 LAKE BUENA VISTA FL 32830 RICK SCOTT KEN LAWSON GOVERNOR I AY AS RFrn n RFn Rv t aw SECRETARY Licensing Portal - License Search Page 1 of 1 10:23:03 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:21 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. Name License License Type Name e Number/ Status /Expires Type Rank Standard BN650 Current, Active Inspector SUTHERLAND, PHILIP W Primary Inspector 11/30/2013 License location Address *: Private Main Address *: Private Back C= * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center@dbpr.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida, Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterfadbor.state.fl.uf. https: / /www.myfloridali cense. com/w111. asp ?mode= 2&search= LicNlrr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:25:54 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:23 AM. Search Results Please see our blossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Name Number/ Status /Expires License Type Name Type Rank Standard Plans PX311 Current, Active Examiner SUTHERLAND, PHILIP W Primary plans Examiner 11/30/2013 License Location Address *: Private Main Address *: Private * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee FL 32399 :: Call.Center @db0r.state.fl.us :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Coovriaht 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmasterCedbor.state.fl.us. https:// www .myfloridalicense.com/w111.asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 Licensing Portal - License Search Page 1 of 1 10:26:18 AM 11/21/2011 Data Contained In Search Results Is Current As Of 11/21/2011 10:23 AM. Search Results Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Name Number/ Status /Expires License Type Name Type Rank Building Code BU968 Current, Active Administrator SUTHERLAND, PHILIP W Primary Building Code A 11/30/2013 License Location Address *: Private Main Address *: Private den, C=IfiD * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Contact Us :: 1940 North Monroe Street, Tallahassee 850.487.1395 all .Center @dbpr.state.fl.us :: Customer Contact Center: The State of Florida is an AA/EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions regarding DBPR's ADA web accessibility, please contact our Web Master at webmaster(adbor.state.fl.us. https:// www .myfloridalicense.com/w111.asp? mode =2 &search= LicNbr &SID= &brd= &typ... 11/21/2011 , j r\J� Jo CITY OF ATLANTIC BEACH Vi 800 SEMINOLE ROAD +.� z ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002929 Date 12/08/11 Property Address 961 ATLANTIC BLVD Tenant nbr, name NAVY FEDERAL CREDIT UNION Application type description COMMERCIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 69877 Application desc TELLER LINE REMODEL Owner Contractor EQUITY ONE ATLANTIC VILLAGE ROLLINS -PCI CONSTRUCTION OF FL 1600 NE MIAMI GARDENS DR 4913 VAN DYKE RD MIAMI BEACH FL 33179 TAMPA FL 33606 (813) 676 -1822 Permit ELECTRICAL PERMIT Additional desc . REWIRE TELLER LINE /OUTLETS Sub Contractor . GLOBE ELECTRICAL CONTRACTORS Permit Fee . . . 90.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 6/05/12 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS FLORIDA FIRE PREVENTION CODE NATIONAL ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 90.00 90.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 94.00 94.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: 961 Atlantic Blvd. — PERMIT# 11 00002929 JEA INFORMATION R'EQUII2ED ON ALL PERMITS 400 AMPS 208 VOLTS 3 PHASE VALUE OF WORK $ 4,000.00 NEW SERVICE ❑ Overhead ❑ Underground D Underground up Pole ❑Residential (Main) Service ❑O.100 amps 0 101- 150amps 0151- 200amps 0 amps # of Meters ❑Commercial (Main) Service 00 -100 amps 0101- 150amps 0151- 200amps 0 amps OCT Service amps Conductor Type Size ❑Multi - Family (Main) Service 00-100 amps 0101- 150amps 0151- 200amps ❑ amps #of Unit Meters ______ _ OTcmporary Pole 0 amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER ( ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps ❑ 150amps ❑200amps ❑ amps OCT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets/Switches: 12 0 - 30atnps 31.100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0.60amps 61.100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: 8 OTHER ELECTRICAL PROJECTS OSwimming Pool ❑ Sign OSmoke Detectors Qty ❑Transformers KVA ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts/amps VALUE OF WORx $ REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can ❑Safety Inspection :Panel Change DOH to UG ❑other: Rewire teller line Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not, The permit dots not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name Equity One Atlantic Village Phone Number Electrical Company Globe electrical Contractors Office Phone 810 -0900 Fax 810 -0907 Co. Address: 1745 Lakeside Ave. City St. Augustine State _Fj.,_ Zip 32084 License Holder (Print): Charles Wayne Jones State Certification/Registration # E00001384 1 , . . ....... r 01\i CES M. SUNSTROM k , t, imission DD 820356 Sworn and subscribed before . e this day of /. _ 20� i =N „ � 4 . r:xps December 3, 20 k✓'1, '�A:d' -d I'' itY PIM IM441""" 5'�U19 Signature of Nota Public •a I �_�AL it Y1�a`, _ i �- t `�� 1 zw.ipewersormeanklmaalto L/L d 4 i56109Z;i06 « M5 LtZ • 4dap 6u ipl ire 11:51, 10-FL- L LOZ