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2092 VELA NORTE CIR RES19-0005 WINDOW PERMIT RESIDENTIAL PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RES19-0005 800 SEMINOLE ROAD ISSUED: 1/14/2019 ATLANTIC BEACH. FIL 32233 EXPIRES: 7/13/2019 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts, state agencies,or federal agencies. JOB ADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK: 2092 VELA NORTE CIR RESIDENTIAL ALTERATION 12 WINDOWS $23844.00 RESIDENTIAL TYPE OF REALESTATE BUILDING USE ZONING: SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 1695061036 SELVA NORTE U NIT 01 COMPANY: ADDRESS: CITY: STATE: ZIP: Renewal by Andersen of 5606 Cader Road Orlando FIL 32810 Central Florida OWNER: ADDRESS: CITY: STATE: ZIP: LINDORFF REVOCABLE 2092 VELA NORTE CIR ATLANTIC BEACH FL 32233-4532 LIVING TRUST AGREEMENT WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. LIST OF CONDITIONS 'Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 4SS-0000-322-1000 0 $170.00 BUILDING PLAN CHECK 4SS-0000-322-1001 0 $85,00, STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $3.83 STATE DCA SURCHARGE 455-0000-208-OE 0 $2.55 issued Date: 1/14/2019 1 of 2 RESIDENTIAL PERMIT PERMIT NUMBER -0005 CITY OF ATLANTIC BEACH RES19 ISSUED: 1/14/2019 800 SEMINOLE ROAD Uji 9 ATLANTIC BEACH. FL 32233 EXPIRES: 7/13/2019 TOTAL: $261.38 Issued Date: 1/14/2019 2 of 2 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assi ned b the Buildin De a ment.) 800 Seminole Road 9 y g p rt Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 L E-mail: building-dept@coab.us _�ate routed: Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 710az_ \&L-R 1\\)Oe-z- DeEallment review required Yes 0 Icauildinq _.� Applicant: 0/00&eZ(�Z1_a9ning &Zoning Tree Administrator Project: C)0 Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date — of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation — St.Johns River Water Management E—Strict Army Corps of Engineers — Division of Hotels and Restaurants — Division of Alcoholic Beverages and Too—bacco — Other: — APPLIgATION STATUS Reviewing Department First Review: MApproved. FIDenied. (Circle one.) Comments: =BUILDIN�) PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: ElApproved as revised. ODenie9!��=�� PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by.- Date: FIRE SERVICES Third Review: []Approved as revised. FIDenied. Comments: Reviewed by: Date: Revised 07/27/10 Call-rim for Pick UP 727-637'6400 >_ Building Permit Application Updated 12/8/17 CL 0 City of Atlantic Beach C) 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 UJ Job Address: 2092 VELA NORTE CIR Atlantic Beach FL 32233 Permit Number: 0 0 Legal Description 39-94 08-2S-29E SELVA NORTE UNIT ONE LOT 18 RE# /a 3 6 LJ__ Valuation of Work(Replacement Cost)$23,844.00 Heated/Cooled SIF—N9jL-_Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Moua—D4=0 Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial CRej�id�enfi) 0 No( N If an existing structure,is a fire sprinkler system installed?(Circle one): Yes UJI • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: < Z Replacing 12 Windows Size for Size 0. 0 Florida Product Approval# for multiple products use product aprgro�.jl�r Property Owner Information UJ < n Name: LINDORFF REVOCABLE LIVING TRUST AGREEMENT Address: 2092 VELA NORTE CIR A City Atlantic Beach State FL Zip 32233 Phone �LOI!4_!5;14—r? E-Mail Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) 0 0 Contractor Information �l >_ NameofCompany: Renewal by Andersen of Central Florida Qualifying Agent: Jared Mellick LLJ >_ EL CC M Address 5655 Cader Rd Citv Orlando State FL Zip 3?§1A �,u C3 W 4" Office Phone 407-803-4723 Job Site/Contact Number cc State Certification/Registration# CGC1524135 Perrnits@rbafla.com Eli > E-Mail W Architect Name&Phone# ILL; IM Engineer's Name&Phone# Workers Compensation 'FS S(Y)CSA'c)L'> I .7-ol q Exempt/Insurer/Lease Employees/Expiration DSte Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or instal lation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS, POOLS,FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF rVIMMENCEMENT. :2 ��17 Z' - (Sign;t-ure of Own or gent) (Signature of Contractor) ntr o (including co�v r) Signed and sworn to(or affirmed)before me this.ftclay of igne nd sworn to(or affirmed)before me this&I'lltday of A&W0rX', 'X�q by _'AQAex-% 9MONW Vt% by Pz�clk DI- L�v4u&&_ (UQRA�0'. �ulAd 0 A.r I gn Megan K.rTp(Jay (Jgnature of Notary) at *ta,NOTARY Pbtl-I Megan R.Monday P5er onally Known OR 01'STATE OF FLORITAPersonally Known OR �R_YA& NOTARY pUBLIC Comm#GG1 56224 ]Produced Identification S?�/ ')A [srProduced Identification If W'P-STATE OF FLORIL Type of Identification: F1, /2(4$e of Identification: Comm#uu I 5022t Expires 10/30/2021 OFFICE COPY PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA Project Name:s��V � DLA,\Ox�e- L� nAnr--C4�,, Permit # ptsl __ZC)qZ V4&�C& NQf+C C�,\ Project Address: k As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72,please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product approval may be obtained at: www.floridabuildin2. rg. Category/Subcategory Ma=urer Product Description Limitation of Use State# Local# A. EXTERIOR DOORS 1. Swinging 2. Sliding 3. Sectional 4. Roll up 5. Automatic 6. Other B. WINDOWS 1. Single hung 2. Horizontal slider 3. Casement 4. Double hung Ptnafxsen 9, "rLAS tog.t 5. Fixed 6. Awning 7. Pass-through 8. Projected 9. Mullion 10. Wind breaker 11. Dual action OFFICE COPY 2. Other Category/Subcategory Manufacturer Product Description Limitation of Use State Local 9 H.NEW EXTERIOR ENVELOPE I. 2. in addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation instructions along with this Product Approval Sheet. I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones listed in this document must be approved by the Building Official. (Contractor Name) (Print Name) (Signature C)r- CompanyName: Ren"O'wn lorl, MailingAddress: �ptos- ��- C'C,�—c�ev— Rc� 'I State: Zip Code: city: 04:2 -2 Telephone Number: (�o 1 Fax Number: Cell Phone Number: ( E-mail Address: 'Renewal Order Summary OFFICE COpy byAndersen. dba.RENEWAL BY ANDERSEN OF CENTRAL FLORIDA STEVEN&DIANNE LINDORFF '0 Legal Name:Universal Roofing Group,inc.I License#CGC 1524135 2092 Vela Norte Cir 997 West Kennedy blvd I Orlando,FL 32810 WINDO.M.11.11.1 Phone:407-803-4723 1 Fax:407-386-8262 1 customerservice@rbafla.com Atlantic Beach,FL 32233 Measure Tech:Darren Fennessey,(904)414-4117 H:(904)241-4275 1 C:(904)545-6130 IDtf ROOM SIZE DETAILS 12 Lof t 72 44 Window: Gliding, Double, 1:1, Passive/Active, Base Frame, Exterior Canvas, Interior Canvas Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: Canvas Screen: Aluminum, Full Screen Grille Style: No Grilles Misc: Exterior window wood trim, 2nd floor install, Blinds- detach and reset Construction: None Material: None PRODUCTS: 13 WINDOWS: 12 PATIO DOORS: 0 SPECIALTY: 0 MISC: 1 Updated 11115118 JOB NOTES Estimated Duration: 31/2 days FLOORPLAN-IIST FLOOR BACK UNIT NOTES 6 7 8 9 SIDE 10 SIDE 4 2 FRONT 3 -7 11/15/18 Page 4 24 OFFICE COPY' CERTIFICATE OF LIABILITY INSURANCE IDDfYYYY) P�11172018 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 INSURERtS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certif irate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SLIBROGATION 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). CONTACT PRODUCER NAME: Bouchard Insurance PHONE FAX 101 N Starcrest DR F-MAIL O.EXII,727-447-6481 (AJC.Nol:727-4491-1267 Clearwater FL 33765 ADDRESS: cerlificates0bouchardinsurance.com INSURER(S)AFFORDING COVERAGE KAIC 0 INSURER A:Ohio Security Insurance Co 24082 INSURED LINIVERSA5 INSURER B:Bridgefield Employers Ins Co 10701 Universal Roofing Group, Inc INSURER C:United Specialty Insurance Co 12537— dba Renewal by Andersen of Central Florida INSURER D:Lloyds of London 5655 Carder Rd. INSURER E;Endurance Assurance Corporation Orlando FIL 32810 I INSURER F: COVERAGES CERTIFICATE NUMBER:356386528 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLjSU8R1 POLICY EFF POLICYEXP INSR TYPE OF INSURANCE I... POLICY NUMBER I Its LIMITS LTR IM IYYYY MIDDfYYYYI * I X COMMERCIAL GENERAL LIABILITY Y Y ATNATL 1821708 11/30/2018 11/l/20ig EACH OCCURRENCE $1,000.000 771 -DAITAUETOMENTED CLAJMS-MADE I OCCUR PREMISES(Ea occurrence) $50.000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 i PRO- X POLICY JECT F1 LOC PRODUCTS-COMP/OPAGG S2,000,000 OTHER� $ * AUTOMOBILIELLABLITY Y Y BAS58301028 111/11/20118 11/1/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) IANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY AUTOS ONLY (Per sociderin I E 11 1 $ C UMBRELLA LIAR N OCCUR STNI82UM2 111/30120118 11/1/2019 EACH OCCURRENCE $5.000,000 T EXCESS UA13 CLAIMS-MADE AGGREGATE $5,000,000 - - I I DED 1 RETENTION$ $ WORKERS COMPENSATION Y 83056033 111112111 1111112019 X I STATUTE I I OTH- AND EMPLOYERSLIABILnY YIN E.L.EACH ACCIDENT ER $1,000.000 ANYPROPRIETORIPARTNER/EXECUTIVE —N NIA OFFICERIMEMBEREXCLUE F (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 1 If yes,describe under 1 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 D Leased/Rented Equip 567452R1 11/1/2018 111/1/2019 $100.ODO E Excess Auto EXC3DO00871300 11/30/2018 11 1/2019 $5.0130.0DO $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Rernarks Sct*dule,may be attached If more space is required) Certificate Holder and others as required in the contract documents are an additional insured on a primary and noncontributory basis With respect to General Liability and Auto policies including ongoing and completed operations,where required by written contract and subject to the terms,conditions and exclusions of the policy. See Attached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Atlantic beach 800 Seminole Rd AUTHORIZED REPRESENTATIVE Atlantic beach FL 32233 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: UNIVERSA5 LOC#: ACCIMF? ADDITIONAL REMARKS SCHEDULE Page 1 of 1 lllk� AGENCY NAMED INSURED Bouchard Insurance Universal Roofing Group,Inc dba Renewal by Andersen of POLICY NUMBER Central Florida 5655 Carder Rd. Orlando FIL 32810 CARRIER NAIC CODE I EFFEC-nVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Waiver of subrogation applies in favor of certificate holder as respects General Liability,Auto and Workers Compensation only if required by written contract,and subject to the terms,conditions and exclusions as specified in the policy. ACORD 101 (2008101) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Doc # 2018286454 , OR BK 18620 Page 1923, Number Pages : 1, Recorded 12/06/2018 01 :30 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10 . 00 FFIC E COPY NOTICE OF COMMENCEMENT 1PREPA111 IN 0111ICAIE, 169506-1036 Permit No. Tax Folio No. State of Flonda County of (Duval To whom It may concern: The undersigned hereby informs you that Improvements will be made to certain real property,and In accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF COMMENCEMENT, Legal description of property being Improved: 39-94 08-2S-29E SELVA NORTE UNIT ONE LOT 18 2092 VELA NORTE CIR Atlantic Beach FL 32233 Address of property being Improved: General description of improvements. Replacing 12 Windows Size for Size owner UNDORFF REVOCABLE LIVING TRUST AGREEMENT Address 2092 VELA NORTE CIR Atlantic Beach FL 32233 Owner's interest in site of the improvement owner Fee Simple Titleholder(if other than owner) Name Address Contractor Ren�waf by Andersen of Central FL/Jared Mellick Address 5655 Carder Rd Orlando,FL 32810 Phone No.407-003-4723 Fax No. Surety(ifany) Address Amount of bond Phone No. Fax No. Name and address of any person maRing a loan for the construction of the improvements. Name Address Phone No. Fax No. Name of person vithin the State of Florida.other than himself.designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to nimself,owner designates the following person to receive a copy of trie Lienor"s Notice as provided in Section 713.06(2)(bi.Florida Statutes.(Fill in at Owner's option). Name Address Phone No. Fax No- < Expiration date of Notice of Commencement(the expiration date is One(1)year from the date of recording unless a C�; E _J ED different date is specified): r- THIS SPACE FOR RECORDER'S USE 0 LY o ft ER/ Ile < E SianeCC -I/-- �ITF in 1 0-8 < B;fo,e me is 3f V xC- 0 X y e, rt ailly appearec U) Z U LLJ vi I'La Y Cau7,of D �.WIee Flo da.has POC C, hereint)i himself.1 herself and affirms that,0 statements ancl amarailons herein are I C rate My commission expires:_- PerscnaIly Kna.-in PrOd�ced dentl0callonFt; gqE OC FLOflIDA rrLWqj ccunty Courts,olpjal I ci IN)ri TIN'be cr.R., '0 rorret CIPY Of�618 onginall wmi�&n U, ovm is 9 tMoln, Ci cuit ,,fj,�IeClerkof' If en r"'Jrd and fiti,in,� fis tZ I 'ea. f qu,"al C.Ouniv.f! ot C coun harid and se e 12W N3 Ir gouty C