HomeMy WebLinkAbout270 Towne Center Cir 06-2167 com int remodelPERMIT ADDRESJ I O�
CONTRACTOR
ADDRESS
PHONE NUMBER
l.. C . . s
ADDRESS
PHONE NUMBER
ELECTRICAL CONTRACTOR
MECHANICAL CONTRACTO
PLUMBING CONTRACTOR
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER FEE
ALQA*4m-Q%r C IIBDIVISION
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PERMIT # O DATE 0
PERMIT DESCRIPTION S
PERMIT VALUATION �� J
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CITY OF SANFORD PERMIT APPLICATION
Permit # : (0 Z�
/-
Date: to _0(0
Job Address:
0
Description of Work:
Historic District: Zoning:
�1 n
Value of Work: $ [�gl
Permit Type: Building Electrical
Fire Sprinkler/Alarm Pool
Mechanical Plumbing Fire
Electrical: New Service — # of AMPS
Addition/Alteration V Change of Service Temporary Pole
Mechanical: Residential Non -Residential
Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Phone: —
Contractor Name &Address: � �. t.+
SLtate en�N`umber: '' c� 26o ) J cAA _
Phone & Fax: Z�.-t— �� Contact Person: R
X Phone: _!A�J7:_7LL"�,��
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to, meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulaturig
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA Y ING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
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.
Acceptance of permit is verification that I will notify the owner of the property of the requirem is 1 gw, FSr.
MidLien
�a,0t,
Signature of Owner/Agent Date
� Date
Signature o�Contractor/r�'
.CUM �
Print Owner/Agent's Name
Print Contractor/Agent's Name
N' 1d�a.`ob
Signature of Notary -State of Florida Date
Signature of Notary -State of Florida Date
D,�PFiY Pv@� Deborah Oldson
Owner/Agent is _ Personally Known to Me or
Contractor/Agent is _ Personally mown e*orCOmmISSiOn # DD323235
Produced ID
_ Produced ID o� Expires June 6, 2008
. P. l3oMad Troy Fain • Inwrancq Inc. WO-38 r` T019
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Zoning:
(Initial & Date) (Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
i
/ CITY OF SANFORD PERMIT APPLICATION / t
Permit # : l �'� L 6 _ A Q Date: -
Job Address: F7 `• SemIA.,b�~ /ZL[,CA�'�,(.�'��
—Description of Work: Total Square Footage
Historic District: Zoning: ---Value of Work: $ / B B�•
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/AIteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement X New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial
Construction Type: # of Stories: of Dwelling Units: Flood Zone: (FEMA form required I
Owners Name & Address:
Phone:
F17v
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information inaccurate 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 COMMENCEMENT.
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.
Acceptance of permit is verification that I will notify the owner of the property of the raigna;t
f Florida Lie FS 71 .
Signature of Owner/Agent Date tr for/Agent Date
__2>40,4a A17-7-�sO J
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
Personally Known to Me or
UTIL.
Prifi 446t gent's Name
Signature of of ' to of Flon Date
DESE3
Mr OMMISSIO TON
f�.3•NO7AAYEXP11?ES;Febr ry��884.91
Contractor/Agent is F e or 1
Produced ID
FD: ENG: BLDG:
Sent By: EXPRESS PERMITS is Faster ; 3103280336; A.pr-17-06 3:50PM; P o 1
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permit mm be mmod far M,&-- P1CAL W09VK PLUMMJG, SWCW%; WELLS, FOOLS, FUR NACkS, DOi..i3lS. BEAT[%& TANKS, alxl
AM CONL►71; Dr)iMM lie.
QVWNE R'S APHO&Yff11 Lw* thel an of the forg9tog talfamaatiurl is widA lb WA titer cif welic will btl dose to ecoftgrtavaoe wo'All owieabie blws regulating
Limomw6m and amuiqj� WARNING TO OWNW YOUR FAILLWE TO i RMO A ML IVE OF COWENCTMOM MAY RESULT W YUUR PAYING
7W.If'I i?Ott t?wW»1 f$ TO YOi�it WtCSPSRTY. IF YO(11N %ND TOMTALN jlV4AA1[,'DiR CONW.T wrM v(xm i..gw)EX C* AN
ATft2 Y woRE REc(?RmG Youit Name OF cnwdENcEKENT.
{ in wftcm tp tho MM&tpft* of this pbl* theta my bo,dtffno wa3 tlione ate¢ to am imty thaw posy he fouind as W'public i �POrda of
this ommy, ad ftm may be addaWW. permits roy®at bum other pvsrnmawW arAetim mh m vm*z mEAROfturt distsis s, axim &# o, rust aq wcs.
Aaecgaeloe dpamet at vmfwdioe IW I sill ea16 do twwear of dw prcomy of 1bt=wo
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APMOYALS: ZONWO; _��i vm.,: LC1? S
I" a./moa
r3
sc of Florida
DEBBIE BLANT(3ff
MY COMMISSION # DD 188491
EVIRFS: February 25, 2007
2 v..,.., n—nnnt Assoc. Co.
®E JAGER CONSTRUCTION INC.
75 60TH STREET, S.W. WYOMING, MICHIGAN 49548-5761
(616) 530-0060 • FAX (616) 530-9888
PROJECT NAME: wet Seal
Seminole Town Center
Sanford, FL
Please accept this letter as my authorization for my supervisor, Cecil Carter
to act in my behalf and in my absence as signatory for the building
permit for the above referenced project.
Enclosed please find a copy of my State License for your use.
Robert Menkveld, Vice President
DeJager Construction, Inc
STATE: Michigan
COUNTY: Kent
BEFORE ME, the undersigned, a Notary Public in and for the said County and
State, on this day personally appeared ROBERT MENKVELD, known to me to
be the person whose name is subscribed to the foregoing instrument, and
acknowledged to me that the same as the act of such Corporation for the purposes
and consideration therein expressed, and in the capacity therein stated.
GIVEN UNDER MY HAND AND SEAL, THIS 1st Day of June, 2006
tii da DeKfdyter, Notar,.-Pnblic
L1:JDA Al. • DEKR UYTER
Notary�Public-,�>`Oilowa County, MI
Acting iii,%en1 County, .till
A1y Conine lion Fipires 10-26-2007
CITY OF SANFORD FIRE DEPARTMENT
FEES FOR SERVICES
PHONE # 407-302-2516 • FAX # 407-302-2526
DATE: PERMIT #: ®��
BUSINE S NAME / PROJECT: �
ADDRESS: o �70
PHONE N .: _ /lU FAX N �j6� 3 `'C)
CONST. INSP.,[ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEW
F. A. [ ] F.S. J HOOD [ ] PAINT BQOTH [) BURN PE IT ]
TENT PERMIT ] TANK PERMIT (] OTHER p(1�1,J
TOTAL FEES: $ (PER UNIT SEE BELOW)
COMMENTS:
Address / Bldg. # / Unit # Square Footage Fees Qer.Bldg. / Unit
ka
1.
2.--_
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13. -
14.
15
16.
17.
18.
19.
20:
Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone # -407-
330-5656. Proof of Payment must be made to Fire Prevention division before any further services can take
place. I certify that the above is true and correct and that
will comply with all applicable codes and ordinances
of the City of Sanford, Florida.
Sanford Fire P ention Divisi Applicant's Signature
M ARYMW RM[9%0", li-I t W CIMMIT ULURT
SE"1140.1: (ION"
tif1/g U",,
NOTICE OF COMMENCEMENTCLEIRK' S 0 20OL050 B
RECIIEtI�i� t>M;.dtS�k'� t1+'.:�'t7:'t3 �
State of Florida t�FtDINLi �8 1�.t�tl
fdK004i)i_D BY t holdea
County of Seminole
The undersigned hereby gives notice that improvement will be made to certain real property, and
in accordance with Chapter 713, Florida Statutes, the following information is provided in this
Notice of Commencement.
1. Description of Property: Seminole Towne Center i
200 Towne Center Circle
MAl' AN M'-
Sanford, FL 32771 CIER M' C� LT URT
iSEMIN
2. General description of improvement: tenant build out i
3. Owner information: p
a. Name and address: Wet Seal r,
26972 Burbank
Foothill Ranch, CA 92610 ' JUN -:' 20
b. Interest in property: Lessee
c. Name and address of fee simple titleholder (if other than Owner:)
Simon Property Group
115 W Washington St
Indianapolis, IN 46204
4. a. Contractor's name and address:
DeJager Construction, Inc
75 — 60 St SW Wyoming MI 49548
b. Contractor's phone number: 616.530.0060
5. Surety
a. Name and address: N/A
b. Phone number:
c. Amount of Bond:
6. a. Lender's name and address:
N/A
b. Phone number:
7 a. Persons within the State of Florida designated by Owner upon whom notices or other
documents may be served as provided by Section 713.13 (1)(a)7., Florida Statutes
Michael Kelch_
b. Phone, numbers of designated persons: 714.699.3957
8 a. In addition to himself or herself, Owner designates Dan DeJager of DeJager
Construction, Inc to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner: 616.493.9333
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of
recording unless a different date is specified)
Michael Kelch— C nstruction Manager
Sworn to (or affirmed) and subscribed before me this 25th Day of May, 2006 `' •
by Michael Kelch.
(name of person making statement)
(S gnature of NotarV PulTlic —tS e cyMt) J ,,
LI)VDA Al DEKRUYTER
Notary Public, Ottmna 0`oziza7y;
Actinq in Kent Ccirntht Air" N
(Print, t3Nz�`iIFPtllrt4io :Na `
Notary Public)
Personally Known _X_ OR Produced Identification
Type of Identification Produced
:r
L
Permit Number
Lighting Compliance Certificate Checked By/Date
2001 IECC
COMcheck-EZSoftware Version 3.0 Release 1
Data filename: WSSEMI—I.CCK
Section 1: Project Information
Project Name:
Designer/Contractor:
Telephone:
Document Author:
Section 2: General Information
Wet Seal
Seminole Towne Center
200 Towne Center Circle
Sanford, FL 32771
Robert Quintana Architects
14900 Landmark Blvd #640
Dallas, TX 75254
Building Use Description by: Whole Building Type
Project Type:. New Construction
Building Tyne Floor Area
Retail Sales, Wholesale Showroom 3579
Section 3: Requirements Checklist
Bldg.
Dept.
Use
[ ] Interior Lighting
1. Total actual watts must be less than or equal to total allowed watts
Allowed Watts Actual Watts Complies(Y/N)
17480 13990 YES
Exterior Lighting
[ ] 2. Efficacy greater than 45 lumens/W
Exceptions:
Specialized lighting highlighting features of historic buildings; signage; safety or security lighting;
low -voltage landscape lighting.
Controls, Switching, and Wiring
[ ] 3. Independent controls for each space (switch/occupancy sensor).
Exception;: Areas that must be continuously illuminated.
[ ] 4. Master switch at entry to hotel/motel guest room.
[ ] 5. Two switches or dimmer in each space to provide uniform light reduction capability.
s
Lighting Application Worksheet
2O01 IECC
COMcheck-ET. Software Version 3.0 release I
Section 1: Allowed Lighting Power Calculation
A B
C
D
Total
Floor
Allowed
Allowed
Area
Watts
Watts
Du l •m Tvne ����ttc_/n
_)
dLt x C}
Retail Sales, Wholesale Showroom 3579
1.9
6800
Allowance: Fine Merchandise Display / Fix. ID: M 2800(a)
3..9
9900(b)
Allowance: Fine Merchandise Display / Fix. ID: L 200(a)
3.9
780(b)
(a) Area claimed must not exceed the illuminated area permitted for this allowance type
(b) Allowance is (B x Q or the actual wattage of the fixtures given in Section 2, whichever is less.
'rota! Allowed Watts =
17480
Section 2: Actual Fighting Power Calculation
A B C
D
E F
Fixture Fixture Description / Lamps/
# of
Fixture
M L=p L&agtiptisal / WattaBg gMp 11allast_ Eixture
f a=.
�_,a.LL
A Quad 2-pin 26W / Electronic 1
9
95 855
B Metal Halide 100W / Electronic 1
11
125 1375
C Quad 2-pin 26W / Electronic 1
2
30 60
L Metal Halide 70W / Electronic 1
16
75 1200
M Incandescent 75W 1
132
75 9900
Q Incandescent 40W 1
15
40 600
X EIT SIGN / Other 1
3
10 Exempt
Exemption: Exemption:E.mergency Lighting (Automatic Control)
EM EMERG LT / Other t
6
10 Exempt
Exemption: Exetnption:Emergency Lighting (Automatic Control)
---- Total Actual Watts - 13990
Section 3: Compliance Calculation
If the Total Allowed (Watts minus the Total Actual Watts is greater than or equal to zero, the building complies.
Total Allowed Watts = 17480
Total Actual Watts = 13990
Project Compliance = 3490
Lighting PASSES: Design 20% better than code
L __
Permit Number
Mechanical Compliance Certificate Checked By/Date
2001 IECC
COMcheck-EZSoftware Version 3.0 Release 1
Data filename: WSSEMI—I.CCK
Section 1: Project Information
Project Name:
Designer/Contractor:
Telephone:
Document Author:
Wet Seal
Seminole Towne Center
200 Towne Center Circle
Sanford, FL 32771
Robert Quintana Architects
14900 Landmark Blvd #640
Dallas, TX 75254
Section 2: General Information
Building Location (for weather data):
Climate Zone:
Heating Degree Days (base 65 degrees F):
Cooling Degree Days (base 65 degrees F):
Project Type:
Section 3: Mechanical Systems List
Quantity System Type & Description
Section 4: Requirements Checklist
Seminole (Pinellas), Florida
2a
603
3626
New Construction
Bldg.
Dept.
Use Invalid data. Select the HVAC System, Plant, and/or Water Heating buttons on the Mechanical screen.
The proposed mechanical design represented in this document is consistent with the building plans, specifications and
other calculations submitted with this permit application. The proposed mechanical systems have been designed to meet
the 2001 IECC, Chapter 8, requirements in COM check-EZ Version 3.0 Release 1 and to comply with the mandatory
requirements in the Requirements Checklist.
Exceptions:
Only one luminaire in space; An occupant -sensing device controls the area;
The area is a corridor, storeroom, restroom, or lobby; Areas that must be continuously illuminated;
Areas greater than 250 sq.ft.
[ ] 6. Photocell/astronomical time switch on exterior lights.
Exceptions: Areas requiring lighting during daylight hours
[ ] 7. Tandem wired one -lamp and three -lamp ballasted luminaires.
Exceptions:
Electronic high -frequency ballasts; Luminaires not on same switch
Section 4: Compliance Statement
The proposed lighting design represented in this document is consistent with the building plans, specifications and other
calculations submitted with this permit application. The proposed lighting system has been designed to meet the 2001
IECC, Chapter 8, requirements in COM check-EZ Version 3.0 Release 1 and to comply with the mandatory requirements
in the Requirements Checklist.
bL� &HwAdlga� 90&4 &WdQ4/W _qlahp
Principal Lighting Designer -Name Signature Date
4
SANFORD FIRE DEPARTMENT
FIRE PREVENTION DIVISION
300 N. Park Ave., Sanford, Fl. 32771 / P. O. Box 1788, Sanford, Fl. 32772
(407) 302-2516 / FAX (407) 302-2526
Plans Review Sheet
Date: May 8, 2006 Business Address: 270 Towne Center Circle
Occ. Ch. 34 New Mercantile
Business Name: Wet Seal (at Towne Center Mall) Ph.
FAX
Architect: Robert Quintana
P H (972 ) 233-2718
FAX (310) 328-0336
Contractor: Unknown not on application
Ph. ( )
1.lApplication —New Interior Build out = Type IV, Fully fire sprinkled building (3,550 s.q. ft.)
1.2 Mixed — N/A
1.3 Special Definitions — Class `B " Mercantile Store
1.4Classification of Occupancy — Mercantile Store Class "B "inside mall
1.5Classification of Hazard of Contents — Ordinary;
1.6Minimum Construction — No special requirements
2.2 Means of Egress Components — one person per 30 sq, ft.
2.3 Capacity of Egress — O.K., clear width 3-0' door opening in rear.
2.4 Number of Exits — Ox, two
2.5 Arrangement of Egress O.K. -
2.6 Travel Distance — Up to 200' inside mercantile store.
2.7 Discharge from Exits — O.K., will field verify; within the 100' ft threshold per 7.5
1
ti
0
SANFORD FIRE DEPARTMENT � D
FIRE PREVENTION DIVISION.
300 N. Park Ave., Sanford, FL 32771 / P. O. Box 1788, Sanford, FI. 32772
(407) 302-2516 / FAX (407) 302-2526
2.8 Illumination of Means of Egress - O.K.; will field verify
2.9 Emergency Lighting - (])foot candle (10 lx & a minimum at any point of 0.1 foot-candle (ILX)
measured along the path of egress at floor level.
2.10 Marking of Means of Egress - O.K; will field verify
2.11 Special Features -Reserved
3.1 Protection of Vertical Openings — one hour tenant separation required
3.2 Protection from Hazards - Shall comply with sec 8.4 (ffp.c.) class A &B
3.3 Interior. Finish -Class A " and (or) " B "
3.4 Detection, Alarm and Communications System: N/A
3.5 Extinguishing Requirements -too 2) 3ct 1 b c ftre extzngu skier egWr&
3.6 Corridors —NIA
- 4 Special Provisions
- 5 Building Services
5.1 Utilities - as per LSC 9-1
5.2 HVAC - as per LSC 9-2
5.3 Elevators, Escalators, Conveyors (4A-47) - N/A
r-- -------- - ---- -- ---- —�---- --' -- -- ' — --' --�
Fromm: RU8ENMY/T7'
To: BUILDING DEPARTMENT
Date: 7/25/20068:54an1
Subject: Re: 2707ovvne Center Cir
oassed07-25-O
> > > BUILDING DEPARTMENT O7/Z4/OO1:44PM > > >
DG'Z167
Interior comm. Remodel
Rodney321-3O2-4133
"Wet Seal"
BUILDING DEPARTMENT Re 270 Towne Center Cir
From: CATHY LOTEMPIO
To: DEPARTMENT, BUILDING
Date: 7/24/2006 2:31 pm
Subject: Re: 270 Towne Center Cir
This is n/a for Public Works 7.24.06
Cathy J. LoTempio
Customer Service Rep
Public, Works Department
407-330-5681
fax# 407-330-5601
>>> BUILDING DEPARTMENT 7/24/2006 1:44 pm >>>
06-2167
Interior comm Remodel
Rodney 321-302-4133
"Wet Seal"
BUILDING DEPARTMENT - Re Fwd. 270 Towne Center Cir 1
From: RICHARD BLAKE
To: BUILDING DEPARTMENT
Date: 7/25/2006 4:53 pm
Subject: Re: Fwd: 270 Towne Center Cir
passed 7/25/06
Richard Blake
City of Sanford
Utility Engineer
407-330-5609
>>> JOHN CHANIOT 9:14 am Tuesday, July 25, 2006 >>>
Rick this is in the mall ,we do not do them if just a remodel .
Thank You: John
>>> RICHARD BLAKE 7/25/2006 8:45 am >>>
Richard Blake
City of Sanford
Utility Engineer
407-330-5609
>>> BUILDING DEPARTMENT 1:44 pm Monday, July 24, 2006 >>>
06-2167
Interior comm Remodel
Rodney 321-302-4133
"Wet Seal"
Page 1 of 1
BUILDING DEPARTMENT - Re: 270 Towne Center Cir
From: TERRY JAMES
To: DEPARTMENT, BUILDING
Date: 7/25/2006 9:24 AM
Subject: Re: 270 Towne Center Cir
completed 7-24-06
>>> BUILDING DEPARTMENT 7/24/2006 1:44 pm >>>
06-2167
Interior comm Remodel
Rodney 321-302-4133
"Wet Seal"
file://C:\Documents and Settings\BLANTOND\Local Settings\Temp\XPGrpWise\44C5E3... 7/26/2006
RECEIVED ;
Permit # : 0(o —:?_ '
Job Address: F_%0 7_a, D V'\ Ce,
ADescription of Work: LV ��QIO(
N
J U N x I Z006
�C-[-T.Y_O.F_SAN.FORD-RER_M[.T_AP„P, ,L��
Date:
C.t V� .
Si0cIV1k1,0es "10 0'e&
Historic District: Zoning: Value of Work: $ 3 ( UU
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm 1_� Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Food Zone: (FEMA form required for other than X)
Parcel #: IIIIn (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Phone:
Contractor Name&Address: `y(w�(�IC>?C�i✓tnrl�(I 'Z%dl N- 1C)hvI�7(CW" oilCehe�(Jf��-
-
StateLicensse/eNumber: (ODY7i0���/ Ova
Phone & Fax: Contact Person: Phone: V0 7Z 2 -(/e G,
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of 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 COMMENCEMENT.
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.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Siature o o tr for/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _
_ Produced ID
Personally Known to Me or
Print do
141
Date Signature of
of Florida
Contractor/Agent is I— Personally Known
Produced ID
APPLICATION APPROVED BY: Bldg: OA7Zoning:
(initial & Date) (Initial & Date)
Special Conditions:
Utilities: FD: _
(Initial & Date)
A
Comm# DD0291408
Expires 2/16/2008
Bonded 1h a (8W)432425
^^wl1ili�uu —tu ryiNNAssn.,
ii ��ui
Date)
e
CERTIFICATE
QF INSURANCE: CERTIFICATE NUMBER
236827
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
PRODUCER
'
UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS
Marsh, Inc.
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES DESCRIBED HEREIN.
1166 Avenue of the Americas
COMPANIES AFFORDING COVERAGE
New York, NY 10036
COMPANY A: AI South Insurance Co.
Telephone (212) 345-5000
COMPANY B: American Home Assurance Co.
INSURED
COMPANY C: Illinois National Insurance Co.
SimplexGrinnell, LP
3701 N. JOHN YOUNG PARKWAY
COMPANY D: Insurance Company of the State of PA
COMPANY E: National Union Fire Insurance Co.
ORLANDO, FL 32804
COMPANY F: New Hampshire Ins. Co.
COMPANY G: New York Marine & General Insurance Co. (Lead)
United States
COMPANY H: Noetic Specialty Insurance Company
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN. MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MMIDDIYY) DATE (MMIDDIYY)
B GENERAL LIABILITY RMGL5749708 10/1/2005 10/1/2006 GENERAL AGGREGATE $15,000,000.00
X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $15,000;000.00
CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $7,500,000.00
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $7.,500,000.00
B
AUTOMOBILE LIABILITY
B
X
ANY AUTO
B
B
ALLOWED AUTOS
SCHEDULED AUTOS
X
HIRED AUTOS
X
NON -OWNED AUTOS
PROPERTY
FIRE DAMAGE (Anyone fire)
- $1,000',OX0.00
MED EXP (Any one person)
$10,000.00
RMCA3017798 (TX)
RMCA3017799 (AOS)
RMCA3017797 (MA)
RMCA3017796 (VA)
"
10/1/2005
10/1/2005
10/1/2005
10/1/2005
10/1/2006
10/1/2006
10/1/2006
10/1/2006
COMBINED SINGLE LIMIT
$7,500,000.00
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
B
E
D
C
F
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERS/EXECUTIVE INCL
OFFICERS ARE: EXCL
SEE PAGE TWO
SEE PAGE TWO
SEE PAGE TWO
X WcSTATUTORY OTHER
LWITS
'
EL EACH ACCIDENT
$2,000,000.00
EL DISEASE -POLICY LIMIT
$2,000,000.00
EL DISEASE -EACH EMPLOYEE
$2,000,000.00
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
Please see page 2 for additional insureds,and any additional language. .
City Of Sanford Bldg. Dept.
300 N. Park Ave.
Sanford, FI, 32771
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE
INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE.
MARSH USA INC. BY: - ea 0— �" -4� I.
Katherine O'Leary, Casualty Program
CERTIFICATE NUMBER
236827
PRODUCER COMPANIES AFFORDING COVERAGE
COMPANY I: White Mountain Insurance Co.
Marsh, Inc.
1166 Avenue of the Americas
New York, NY 10036
Telephone (212) 345-5000
INSURED
SimplexGrinnell, LP
3701 N. JOHN YOUNG PARKWAY
ORLANDO, FL 32804
United States
WORKERS COMPENSATION POLICIES
Carrier
Policy Number
Eff. Date
Exp. Date
State
(B) American Home Assurance Co.
RMWC6610498
10/1/2005
10/l/2006
CA
(E) National Union Fire Insurance Co.
RMWC6610504
10/l/2005
10/1/2006
NV,
OR
(D) Insurance Company of the State of PA
RMWC6610503
10/1/2005
10/l/2006
AR,
MA, TN, VA
(C) Illinois National Insurance Co.
RMWC6610501
10/l/2005
10/l/2006
IL,
MI
(F) New Hampshire Ins. Co.
RMWC6610505
10/1/2005
10/l/2006
NY,
WI
(A) Al South.Insurance Co.
RMWC6610499
10/l/2005
10/1/2006
GA
(B) American Home Assurance Co.
RMWC6610502
10/1/2005
10/1/2006
FL
(B) American Home Assurance Co.
RMWC6610500
10/1/2005
10/l/2006
All
Other States
LIABILITY PROGRAM'
Project: Permit
If there is a question regarding this certificate
please contact Courtney Yocum
(Email: Cyocum@tycoint.com Phone: 407-235-1100)
CERT�FICATE_HOLDER� '� �� �
�
0'
City Of Sanford Bldg. Dept.
300 N. Park Ave.
Sanford, FI, 32771
TKO
Fire & Security
Simplex0 innell
MAY 15, 2006
3701 North John Young Parkway
Suite 110
Orlando, FL 32804
(407) 235-1100 Phone
(407) 235-1150 Fax
POWER OF ATTORNEY
I HEREBY AUTHORIZE JOSEPH J. NEMCEK & RYAN FUNK OF
SIMPLEX GRINNELL TO SIGN FOR, APPLY FOR AND PICK-UP FIRE
SUPPRESSION PERMITS IN THE STATE OF FLORIDA
GEORGE
C� d,-a �,
LLER
BEFORE ME APPEARED GEORGE E MILLER TO ME WELL KNOWN
TO ME TO BE THE PERSON DESCRIBED IN AND WHO EXECUTED
THAT GEORGE E MILLER EXECUTED SAID INSTRUMENT FOR
THE PURPOSES THEREIN EXPRESSED.
WITNESS MY HAND AND OFFICIAL SEAL, THIS 16 DAY OF MAY
2005n
/JayAx� 1-2 '
NOTARY PUBLIC STATE OF FLO
PAMELA A. MCELROY
Notary Public, State of Florida
my comm. exp.
Comm. No. 00 411691
• STATE OF FLORA
DF,PARTMENT OF FINANCIAL SERVICES
DIVISION OF STATE F-ME MARSHAL,
TALLAHASSFX FLORI DA
CERTIFICATE OF COMPETENCY
THIS CERTIFIES THAT; GEORGE E MILLER
10255 FMTUNE PARK BUILDING 500 SU M l20
' rACKSONVU14 FL 32236
BUSDMSORGANVATM: SBeLEXGRINNELLLP
CONTRACf'OK U IS L[MrMD TO THE MECUTION OF CONTRACTS REQUIRING THE ABHM Y TO LAYOUT, FABRICATE. INSTALL, INSPECT,
ALTER,ORSERVICEWATERSPRINKLERSYS'fE1 ,WATERSPRAYSYSTEMS,FOAM-WATERSPRINKLERSYSTEMS;FOAM-WATER SPRAY
SYW—E- S, STANDPIPES, COMBINATION STANDPIPES AND SPRINKLER RISER$ EXCLUDING PREENGMERED SYSTEMS.
01 12W4 1 07 1 16
L.. Duce Type C s"
60476500012001
C--tY I Lioe—Pamk Nw ber
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504193Ml I
250.00 �twir.
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