221 Pine St wdo permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEI(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-2700
Job Type: WINDOW AND/OR DOOR
Description: REPLACE DOORS AND WINDOWS
Estimated value: $11,000.00
Issue Date: 12/8/2016
Expiration Date: 6/6/2017
PROPERTY ADDRESS:
Address: 221 PINE ST
RE Number: 170564-0000
PROPERTY OWNER:
Name: Sprague, Judith
Address: 221 Pine ST
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $52.50
BUILDING PERMIT FEE $105.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $161.50
PERM]IT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE 11ORIDA
RUILDING CODES.
Li, City of Atlantic Beach APPLICATION NUMBER
1EBuilding Department (to be assigned by the Building Department.)
800 Seminole Road ' (2 N 0 z 7
Atlantic Beach,Florida 32233-5445 -W IN 0 -Z
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@wab.us Date routed: 17,_�/
City web�slte: http:#�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
�ent review required Y �No
a
142ul - 7—
Property Address: , pa-) C- 11sa 1 De p1d,
Applicant: _ nu-) to E-rz__ _Planning &Zoning
Tree Administrator
Project: 101000LAD Tublic Works
-Public Utilities
62\e_PLAQcfnr_- Qr Public Safety
-Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required 'v'rew or. eceP'y Date
of Pe rmt V rified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Divislon of�Al�holic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: DApproved. DIDenied.
(Circle one.) Comments:
E�D
PLANNING&ZONING Reviewed by:— Dt-- Date: 12--7-16
TREE ADMIN. Second Review; [JApproved as revised. E:]Den!eP
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: —Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied.
Comments;
Reviewed by: —Date,—
Reylsed 05/14109
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office;(904)247-5826 - Fax:(904)247-5845 G-W W D Z700
Job Address: A-P,4.�, /2
-A, Permit Number:
-20C
Legal Description RE# t ;&A -000e)
Valuation of Work(Replacement Cost)$ / 0.000-) Heated/Cooled SF Non-Heated/Cooled
_L
Class of Work(Circle one): Nm Addition Alteration R arr �M�e 0 Pool ��Wndow/Do,
in
Use of existing/proposed structure(s)(Circle one): Comno 'I sidential
If an existing structure,is a fire sprinkler system installed?(Circle one): e, N/A
Submit a Tree Removal Pertnit Application if my trees mr,to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:ge,-,*-Q C_Xj, �_d Zs b 45U
142�� WJ",�daui,
.42
Florid.Prodmi Approval# for multiple products use product approval form
Property Oytrier Information
Nmnc� e- Address: Ar� 5�-
city StateFL_ Zip ,��33 Phone JDj-
E-Mail r 0�
O��oryglit-Ilp(CItz��-�fAto�mAgmy�m
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 NOTIft OF COMMENCEMENT.
Contractor Information:
Name of Company: !�Elj F,4YaVI-5 FVK Qualifying Agent: (!�;j tW4 Z� &ggQC
Address: VC2 79 C;7 Ic 60677W CityW aa � _ Stafe Zip 224;75l
7
mfie Job Site/Contact Number L6� OW
g
state Certification/Registration -E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
Qi TVt In.. 1,ease Employees, Expintion Date
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I hereby certly,that I have read and examined this a tion and know the same to be true and corre Allprovisions aflaws,and
0 r i no
ordinances governing this type k will be complied with whether sp�yzedherein a'not granting of a pe�mht does not
wo
presume togive authority to vilae=r cancel the p visions ofanyotherffe eral,state, orlocal w regulating construction orthe
.g
perforvance ofcomtruction.
Rev.3/14/16
OFFICE COPY
NOTICE OF COMMENCEMENT
Stateof EL County of Tax Folio No.
To Whom It May Concern:
The undersigned limby informs you that improvements will be made to certain real property,and in accordance with Section 713 Of
the Florida Statutes,the following infisonation.is stated in this NOTICE OF CON2AFN NT.
t 'Ll.
Legal Description Ofproparty being impiroved:-1� -/L P. a.-�- �I rqir, 9R�-3 UJO
2 V R Ck z4� L§+ -!���i-
Addrws oflimparty beingidprii-d: saa S+ A41 Kb - J).�1,
Citmeraldeacriptionofimprovements: pr-D)4� - zknp.—&—�e
C)�
Owner: 77V&A�MQVAAWL Address:
Owner'3 interest in site fle impQryovement:
- I Titich Id (ifoth than )
ISF,aeSmipe I o at a owner
Narne:
Contractor:
Addi—
Telephcmeblo.:�?,Q'/�R,92—�y 6 F-No':
Surety(if=y)
Address: Amount ofBand
Telephone No: Fax:No:— Doo#20162752".OR SK 1 T796 Page 1470,
Name and address of my person nisking a loan for the construction ofthe improvements Number Pages:I
Name: Recwded I ZMQOI 6 at 11:35 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING$10.00
Phone No: FaxNo:
Name Of Pasco within the State of Florida,other dian himself,designated by OWoff upon whom notices or other documents my be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: FmNo-
Expiration date ofNotice ofCommencement(the expiration date is one (1)year from the date oftecandirLi;unless a different date is
specified):
THIS SPACE FOR RECORDER'S ESE ONLY 0 NE
Sigued: Date: A 70
Beforeinee is theComtyofDuval, tate
W, TONI 0 1MILD'71%Z' 1.] OfTIorid has�M�naOyamppmciered I,w�-r]
My C'M ION#FF92 951 1
M COMISS
'In" � " 2oq
75EYX octoa,6.2019 Pecsonally Known: or
or
El a.I�X�F 5� q P, Produced Identification:
NotaryPublic:
My commission expires:
CITY OF ATLANTIC BEACH OFFICE COPY
OWNER/ BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION To THAT
LAW THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACrAs
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUS
SIT-ERYISE THE CONSTRUCTION YOURSELF, YOU MAY 13UILD OR U14PROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF S25,000.00 OR LESS. TEE
MUST 13E FOR YOUR USE AND OCCUPANCY IT MAY NOT BE BUILT FOR SALE ORLEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EMWTION. YOU MAY NOT
FURE AN alLCENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE 131B]LDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE B-NELOYED BY YOU HAVE
LICENSES REQUIRED 13Y SIM LAW AND BY COIaUY OR MUNICIPAL LICENS
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICEN�ED CONTRACTORS CANNOT BE EMPLOYED UNDER AN
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN -OCCUEATIONAL LICENSE' IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
AUVRESS �)JQ
I �E
RE
SIG
G nal
.fare..Mrs dayof 2d-�--unty of
Du.],�eof�Flod�da,hmpemonallyepwr ,mn by hImseffl hemeffand affims that
.11 statements and clenclamUcas are toaa and a=rate.
Notaryftlhdcatl-ar,,�Stateof Cwntyof--D—OVO—(
0 P—n,�. GIRDB� ER
0 Pmd�fden�on- 1p"FROZ
,.0
tho��ohtnann
Notary Signatum Pseill
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100-1 70 Series Impact Patio Doors 2 Panel-5802 1 M PACT $1z'7i7.96 1
95.625 x 80 $1,460.26 $1,460.26
Installation Zip Code=32233
U.S.ENERGY STAR-Climate Zone=Southern Save$257.70(15%)until 10/5/2016
ENERGY STAR Required=No S/0 SILVER LINE BLDG PRD-273309 Promotion
Standard Width=RO:96 1/8" 1 UNIT:95 5/8" 1120/5/2016
Standard Height=RO:80 1/2" 1 UNIT:80" OFFICE COPY
Frame Width=95 5/8
Frame Height-80
Unit Code=80x68
Venting/Handing=Stationary-Right
Eicterior Color=White
Interior Finish Color=White
Performance Grade(PGj Rating z PG50
Unit 1:Patio Door Assembly=Factory Assembled
Unit I Left Slab Left Glass,1 Right Slab Right Glass:Glass
Construction Type=Dual Pane
Unit 1 Left Slab Left Glass,I Right Slab Right Glass:Glass
Option=Lo.-E Argon
Unit I Left Slab Left Glass,I Right Slab Right Glass:High
Altitude Breather Tubes=No
Unit 1 Left Slab Left Glass,I Right Slab Right Glass:Glass
Strength=Tempered Impact Resistant
Unit I Left Slab Left Glass,I Right Slab Right Glass;Glass
Tint=No Tint
Unit I Left Slab Left Glass,1 Right Slab Right Glass:
Specialty Glass-None
Unit I Left Slab Left Glass,1 Right Slab Right Glass:Gas
Fill=Argon
None
Hardware=Stainless Steel
Insect Screen Type=Full Screen ell
Insect Screen Material=Fiberglass POZ
Re-Order Item=No
Room Location=Custom Location
Custom(Enter Room Name)=1
Unit U-Factor=0.28
Unit Solar Heat Gain Coefficient[SHGQ=0.29 C FAICTOY IFrFffwa";;y 1-46*
U.S.ENERGY STAR Certified=No
SKU=273308
Vendor Name=S/0 SILVER UNE BLDG PRO
Vendor Number=60660514
Customer Semice=(888)888-7020
Catalog Version Date=09/10/2016
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�.HomeDepotxorn Page 2 of 10 Printed By: GARRY Date Printed:9/23/2016 4:42 PM
200-� 70 Series Impact Patio Doors 2 Panel-5802 1 M PACT $1,444.3;
71.625 x 80 $1,119.76 $1,119.76
installation Zip Code=32233
U.S.ENERGY STAR*Climate Zone=Southern Saw$197.59(IS%)until 10/5/2016
ENERGY STAR Required=No *S/O SILVER U NE BLDG PRD-273308 Promotion
Standard Width=RO:72 1/8" 1 UNIT:715/8" until 10/5/2016
Standard Height=RO;80 1/2" 1 UNIT:80"
Frame Width=715/8
Frame Height=80
Unit Code=6Ox68
Venting/Handing=Left-Stationary
Exterior Color=White
Interior Finish Color=White
Performance Grade(PG)Rating=PG50
Unit 1:Patio Door Assembly=Factory Assembled
Unit I Left Slab Left Glass,I Right Slab Right Glass:Glass
Construction Type=Dual Pane
Unit I Left Slab Left Glass,1 Right Slab Right Glass:Glass
Option=Low-E Argon
Unit I Left Slab Left Glass,1 Right Slab Right Glass:High
Altitude Breather Tubes=No
c
Unit I Left Slab Left Glass,I Right Slab Right Glass:Glass
Strength=Tempered Impact Resistant
Unit I Left Slab Left Glass,1 Right Slab Right Glass:Glass
Tint=No Tint
Unit I Left Slab Left Glass,I Right Slab Right Glass:
Specialty Glass=None
Unit 1 Left Slab Left Glass,I Right Slab Right Glass:Gas
Fill=Argon
None
Hardware-Stainless Steel
Insect Screen Type-Full Screen 7X
Insect Screen Material=Fiberglass
Re-Order Item No
ROOM Location Custom Location
Custom(Enter Room Name)=2
Unit U-Factor=0.28 60
Unit Solar Heat Gain Coefficient(SHGC) 0.29 t 4�%eC- J�lr 0
U.S.ENERGY STAR Certified=No
SKU=273308
Vendor Name=S/O SILVER LINE BLDG PRD
Vendor Number=60660514
Customer Service z(888)888-7020
Catalog Version Date=09/10/2016
Ila A z
574(,vAF_,;_(_ 574:?-FL_ 5-C12FW '& ,F
www.HomeDepoLcorn Page 3 of 10 Printed By: GARRY Date Printed;9/23/2016 4:42 PP4
"ac,U."eGli",8700IMPACT
300 npact Double Glider $499.29
$679.40 $2,717.60
Installation Zip Code=32233
U.S.ENERGY STAR'Climate Zone=Southern Save$479.56(15%)until 10/5/2016
ENERGY STAR Required=No *5/0 SILVER LINE BLDG PRD-260803 Promotion
Frame Width=72 until 10/5/2016
Frame Height=48
Venting/Handing=Active-Passive
Exterior Color=White
Interior Finish Color=White
Performance Grade(PG)Rating=PG50
Glass Construction Type=Dual Pane
Glass Option=Low-E Argon
High Altitude Breather Tubes=No
Glass Strength=Impact Resistant
Glass Tint=No Tint
Specialty Glass=None
Gas Fill=Argon
None
Number of Sash Locks=Double
Lock Type=Standard
Insect Screen Type=Half Screen
Insect Screen Material=Fiberglass
Foam=Foam in Frame
Vinyl Sill Angle=Anchor Plate
Re-Order Item=No
Room Location=Custom Location
Custom(Enter Room Name)=3 and 6
Unit U-Factcur=0.31
Unit Solar Heat Gain Coefficient(SHGQ=0.27
U.S.ENERGY STAR Certified�No
Florida Product Approval Number(FL#)=14994
High Velocity Hurricane Zone(HVHZ)=Yes
Clear Opening Width=30.4375
Clear Opening Height-43.5
Clear Opening Area=9.194661
SKU=260803
Vendor Name=S/O SILVER LINE BLDG PRO
Vendor Number=60660514
Customer Service=(898)BW,7020
Catalog Version Date 09/10/2016
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�.HomeDepoLcorn Page 4 of 10 Printed By: GARRY Date Printed:9/23/2016 4:42 PM
400-1 70 Series Buck Impact Double GI ider-87001 M PACT 2
48 x 24 $332.27 $664.54
Installation Zip Code=32233
U.S.ENERGY STAR-Climate Zone=Southern Save$117.22(15%)until 10/5/2016
ENERGY STAR Required=No S/0 SILVER LINE BLDG PRD-260803 Promotion
Frame Width=48 until 20/5/2016
Frame Height=24
Venting/Handing=Active-Passive
EAerfor Color=White
Interior Finish Color=White
Performance Grade(PG)Rating=PG50
Glass Construction Type=Dual Pone
Glass Option-Low-E Argon
High Altitude Breather Tubes=No
Glass Strength=Impact Resistant
Glass Tint=No Tint
Specialty Glass=None
Gas Fill=Argon
None
Number of Sash Locks=Single
Lock Type=Standard El
Insect Screen Type=Half Screen .--v
Insect Screen Material=Fiberglass
Foam=Foam in Frame
Vinyl Sill Angle=Anchor Plate
Re-Order Item=No
Room Location=Custom Location
Custom(Enter Room Name)=4
Unit U-Factor=0.31
Unit Solar Heat Gain Coefficient(SHGC)=0.27
U.S.ENERGY STAR Certified=No
Florida Product Approval Number(FL#)=24994
High Velocity Hurricane Zone(HVHZ)x Yes
Clear Opening Width=19.4375
Clear Opening Height=19.5
Clear Opening Area=2.496745
SKU=260803
Vendor Name=S/O SILVER LINE BLDG PRO
Vendor Number=60660514
Customer Service=(888)898-7020
Catalog Version Date=09/10/2016
wvov.HomeDeport.cont Page 5 of 10 Printed By: GARRY Date Printed;9/23/2016 4:42 PM
500-1 70 Series Buck Impact Do ubleGlider-8700IMPACT 659&78 $598,48
48 x 48 $508.98 $508.98
Installation Zip Code�32233
U.S.ENERGY STAR'Climate Zone=Southern Saw$89.80(15%)until 10/5/2016
ENERGY STAR Required=No *S/O SILVER LINE BLDG PRD-260803 Promotion
Frame Width=48 until 10/5/2016
Frame Height=48
Venting/Handing=Active-Passive
E,tterior Color=White
Interior Finish Color=White
Performance Grade(PIG)Rating=PGS0
Glass Construction Type=Dual Pane
Glass Option=Low-E Argon
High Altitude Breather Tubes=No
Glass Strength=Impact Resistant
Glass Tint-No Tint
Specialty Glass=None
Gas Fill=Argon
None 0
Number of Sash Locks=Double
Lack Type=Standard
Insect Screen Type=Half Screen
Insect Screen Material=Fiberglass
Foam-Foam In Frame
Vinyl Sill Angle=Anchor Plate
Re,Order Item=No RO-40 114
ROOM Location=Custom Location
Custom(Enter Room Name)=5
Unit U-Factor=0.32
Unit Solar Heat Gain Coefficient(SHGC)=0.27
U.S.ENERGY STAR Certified z No
Florida Product Approval Number(FUI)=14994
High Velocity Hurricane Zone(HVHZ)=Yes
Clear Opening Width=28.4375
Clear Opening Height=43.5
Clear Opening Area=5.569662
SKU=260803
Vendor Name=S/O SILVER LINE BLDG PRO
Vendor Number=60660514
Customer Se"ice=(888)888-7020
Catalog Version Date=09/10/2016
�..HomeDepotxom Page 6 of 10 Printed By� GARRY Date Printed:9/23/2016 4:42 PM
600-1 70 Series BUCk Impact Double-Hung-9500IMPACT
36 x 36 $434.30 $434.30
Installation Zip Code=32233
U.S.ENERGY STAR-Climate Zone=Southern Save$76.64(15%)until 10/5/2016
ENERGY STAR Required=No -S/O SILVER LINE BLDG PRO-260803 Promotion
Frame Width=36 until 10/5/2016
Frame Height=36
Exterior Color=White
Interior Finish Color=White
Glass Construction Type=Dual Pane
Glass Option=Low-E Argon
High Altitude Breather Tubes z No
Glass Strength=Impact Resistant
Glass Tint=No Tint
Specialty Glass=Obscure
Gas Fill=Argon
None
Number of Sash Locks=Double
Lock Type=Standard X
Insect Screen Type=Full Screen
Insect Screen Material=Fiberglass
Foam=Foam in Frame
Re-Order Item No
Room Location Custom Location
Custom(Enter Room Name)=7 1 36
Unit LI-Factor=0.32 RO-36 114
Unit Solar Heat Gain Coefficient(SHGQ=0.27
U.S.ENERGY STAR Certified-No
Florida Product Approval Number(FL#)=14996
High Velocity H urrica ne Zone(HVHZ)=Yes
Clear Opening Width=31.302
Clear Opening Height=9.536
Clear Opening Area=2.072888
SKU=260803
Vendor Name=S/0 SILVER LINE BLDG PRO
Vendor Number=60660524
Customer Service=(888)898-7020
Catalog Version Date=09/10/2016
v,v,w.HomeDepot.wm Page 7 of 10 Printed By: GARRY Date Printed:9/23/2016 4.42 PM
700-1 70 Series Suck Impact Double-Hung-95001M PACT $49?.92 2 $999 64
24 x 36 $423.14 $846.28
Installation Zip Code=32233
U.S.ENERGY STAR-Climate Zone=Southern San$149.36(15%)until 10/5/2016
ENERGY STAR Required=No -S/O SILVER LINE SLOG PRO-260803 Promotion
Frame Width=24 until 10/5/2016
Frame Height=36
Exterior Color=White
Interior Finish Color-white
Glass Construction Type=Dual Pane
Glass Option=Low-E Argon
High Altitude Breather Tubes=No
Glass Strength=Impact Resistant
Glass Tint=No Tint- 1�
Specialty Glass=Obscure
Gas Fill=Argon
None
Number of Sash Locks=Single
Luck Type=Standard
Insect Screen Type=Full Screen
Insect Screen Material=Fiberglass
Foam=Foam in Frame
Re-Order Item No
Room Location Custom Location
Custom(Enter Room Name)=7
Unit U-Factor=0.32
Unit Solar Heat Gain Coefficient[SHGC)=0,27 1 24
U.S.ENERGY STAR Certified=No I RO-24 1/4
Florida Product Approval Number(FUI)=14996
High Velocity Hurricane Zone(HVHZ)=Yes
Clear Opening Width=19,302
Clear Opening Height=10.8145
Clear Opening Area=1.449594
SKU=260803
Vendor Name=S/O SILVER UNE BLDG PRO
Vendor Number=60660514
Customer Service=(8881988-7020
Catalog Version Date=09/10/2016
Pre-Tax Price: $9,119.99
Promotional Price: $7,751.72
A ,66 4oP,-' Y6 /00
--All prices are subject to change
'-Customer is responsible for verifying product selections.The Home Depot will not accept returns for the above products
**All graphics viewed from the exterior
www.HomeDepot.com Page 8 of 20 Printed By: GARRY Date Printed:9/23/2016 4:42 PM
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17
2016-2017 BUSINESS TAX RECEIPT
MICHAEL CORRIGAN,DUVAL COUNTY TAX COLLECTOR
231 E.FORSYTH STREET,SLITE130,JACKSOWILLE,FL 32202-3370
PhWa:(9D4)630-1916,oplim 3; Fax: (904)63D�14W
0 Website:�.cco.netft:Email:WxcNWctor@wj.w
Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place at business.
This business tax receipt is furnished pursuant to Municipal Ordinance Code, Chaptera 770-772,for the period
October 1, 2016 through September 30,2017.
NICHOLS, EDWARD R
NICHOLS, EDWARD R
905 IN 11 TH ST
JACKSONVILLE BEACH, FL 32250
ACCOUNT NUMBER: 109811
LOCATION ADDRESS: 905 N 11TH ST
JACKSONVILLE BEACH, FIL 32250
DESCRIPTION: CONTRACTOR-ALL TYPES STATE LICENSE NO.:
COUNTY RECEIPT DESC: CONTRACTOR-ALL TYPES COUNTYTAX: 11.25
MUNICIPAL RECEIPT DESC: MC 772.309 MUNICIPALTAX: 0.00
TOTAL TAX PAID- 11.25
VALID UNTIL September 30, 2017
***ATTENTION***
THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY.
CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING.
This is a business tax reoelpt only. It does not permit the receipt holder to violate any exisfing regulatory or zoning laws of
the County or City. It does not exempt the receipt holder from any other license or permit required by law. This is not a
certification of the receipt holder's qualifications.
TAX COLLECTOR
THIS BECOMES A RECEIPT AFTER VALIDATION.
PAID-4098383.0001-0001 Y02 08/23/2016 11 .25
EDWA-10 OP ID:AF
I WE IN I
CERTIFICATE OF LIABILITY INSURANCE 71717
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 MEND, EXTEND OR ALTER TFIE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFI
IMPORTANT: If the cartificate holder I.an ADDITIONAL INSURED,the policy(ift) must W endomed. If SUBROGATION IS WAIVED,subject to
tha terms and conditf.ris of the pollcy,ceftIln Policies may require an andomememL A statement on this certficate does not confer dghts to the
certificate holder in lieu of such ndomement(s).
PRODUCER Phone:904-249-2345 mmNTecY Allison Folds
FletcherStein Fax:904-246-7986 =,d,90"94-03211
P,0.Box 50069
Jacloom,ille Beach,FL 32240,0069 afticisiftfletcherertelln.com
FletcherlSmin MU�S)MFORMO�
NSU�A:Southem Owners Insurance,Co. 10190
INSURED Edward R.Nichols,Inc. afflueffte�
Edward Nichols
905 11 th Street N.
Jacksonville Beach,FL 32250 INSURER 0
mu.E�
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF NSURJkNCE LISTED BELOW MVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI-fE POUCY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OITiER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAUN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEMN IS SUWECT TO AU-THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY MVE BUN REDUCED BY PAID CI-AIMS.
09
�C"OCCURFE)ICIE a 11,000,00(
COMMERCI�.EIIER�LVISILITY 97106 07HEM6 07115117 a
A X _300,OOC
C�I�m 1K OCCUR ED EXP(MY S 10,00(
PERSONN=&�INJURW a i'000'
GENER�AGGREGNTE 3 2,000,001
GEK,NGGREGAnUxm"PUESPER- PRODUCTS COMPRAPAGG 6 2,000,00q
POLICY F�D.— F-1,oc COMBINED SINGLE LIMIT
E.Iu=kU;.
BODILY IMURY(PW pvNNN) 3
ALL�D q SCHEDULED BOIULY MURY(P�RIck*SIQ 3
AUTOS AUTOS —
NONLONNAIED P... a
RRED ALITOS �Gx
Hu�Las "OCCUR EACH NCE a
mm� AGGREGATE
I—19--UMDE
I I DED I I RETENTION$
SKARKERS�mm�
AND EMPLOYERS LNUINUDY YIN E MHACC
N
IA
EL $
If
.m..
ELDO�-P�yMff S
FULPTION OF OPERATORS W.
CERTIFICATE HOLDER CANCELLATION
FORIN-1 SHOULD ANY OF THE ASIGIRE DUCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN
FOR INFORMATIONAL ACCORDANCE WITH THE POLICY PROVISIONS.
PURPOSES ONLY
AUTHORWED IUEPIUESISITA�
Aphita v jW41
C 1988-2010 ACORD CORPORATION- All rights Reserved.
ACORD 25(2010105) The ACORD Game and logo am registered marks OfACORD