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Home My WebLink About119 Bellagio CirRECEIVED APR 14 2011 BY' CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: -7 Documented Construction Value: $ _ 006 e'v Job Address: ( q t G l l r Historic District: Yes No Parcel ID: zc6 - -`> " 6C)O() - (-)ZA Zoning: I c\ . 1 Description of Work: a J r Plan Review Contact Person: ' a Vv r hclac Title: u Phone: c4-co-7 iZ- 1-764 Fax: 7-' 1 d Ll E-mail: 1 ; Property Owner Information Name Gc A( n iiV 1. Phone: Street: 0/ cii U Resident of property? : (1 City, State Zip: jj Contractor Information Name A C)T-_'Stp U r 1' 1_k_I 6 M F! i /&Al-,tn 9,i i Phone: q6-Z- i I Street: Lin(na Fax: 4 CJ7- 7 l Z- City, State Zip: 8r 16 el(j rz, 3z2-6 c..e State License No.: Name: Street: City, St, Zip: Bonding Company: Address: Building Permit 06" Square Footage: _ Architect/ Engineer Information Phone: - Fax: E- mail: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: No. of Stories: No. of Dwelling Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical 0 (Duct layout required for new systems) Plumbing New Construction - No. of Fixtures: Fire Sprinkler/Alarm No. of heads: 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. 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. 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. The City of Sanford requires payment of a plan review fee. A copy of the executed contract is.required in order to calculate a plan' review charge. If the executed contract is riot submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges . exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the permit is released. Signature of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID APPROVALS: ZONING: ENGINEERING: COMMENTS: Rev 11.08 UTILITIES: FIRE: Ae' 14 1141 11 Signature o tractor/Agent Date n 5rin Contra6 /Agent's Name re of otary-State of Flo ' DaDat M; SAMANTHA t- FURDOTE , tidy COrliUISSi0N # i7D66,4" rXPIRES March 01, 2` 8-0188 F Contractor Agent is Personally Known to Me or Produced ID Type of ID WASTE WATER: BUILDING: Date: liq 1, I POWER OF ATTORNEY I hereby name and appoint of ADT Securitv Services to drop off and pick up permits at the 4 Building Department on my behalf for a LOW VOLTAGE SECURITY permit for work to be performed at a location described as: Parcel Ki- 19 —z-,C)"SZO - (i b - 45 6 Subdivision Address of job N Owner [>VI'lGi I (lS {J 1/ L George Manzinelli EF0001121 Type or Print Name of Certified Contractor 1(11)6-- signatur ified Contractor The foregoing instrument as acknowled ell before me this i day of 20 br y 'r _6CLj& l who is personalown to me/vAo produced as identification and who did not take oath. St to of Florkla, gMANTHA L FURBO Coutyof''•= MY COMMISSION'# D0885138 IEXPIRES March 01, 2013 t17 398 F NaryPublic, Seminole i,Florida = SMALL BUSINESS CONTRACT CONTRACT DATE: • I / TOWN N0: CUSTOMER NO: JOB NO: — LEAD SOURCE: ADT Security Services, Inc. ("ADT") :Business Name ("Customer") c;: _! l• !.'f' : +r !: <"f Office Address (Address City.•._) f`,, Al ''. `. State/Zip i 2 771 Responsible Party Y Protected Premises' Telephone QTraditional Phone Other (Qualified) Other (Non -Qualified) /`) , 7- Tel: 1-800-ADT-ASAP} 1-800-238-2727 (Alternate Telephone 1 (Circle one) Home / Cell / Work w/ ext. IF FAMILIARIZATION PERIOD IS ;Alternate Telephone 2 (Circle one) Home / Cell / Work w/ ext. ACCEPTED INITIAL HERE (EMAIL Communications Authorization: You hereby authorize ADT to fumish information and/or updates regarding your security system and new ADT and/or third party produc ADT customers to the contact information provided by you. You may unsubscribe or o ut by ematling donotcontact®adt.com or bar calling 888:DNC4ADT (888.362- Confirmation of Appointments: You hereby expressly authorize ADT to call you using an automated calling device to deliver a prerecorded message to set/confit ap oipntmentatthetelephonenumber(g shown above. Initial here Ownership of System and Equipment: ' Customer -Owned !ADT-Owned Verticals Retail: Business Services: Personal Services: Automotivefiransportation: Alarm Monitoring and Notification Services Burglary (BA) Hold-up (HUA) _ 171 Duress - — - - - - - - - Two-way voice Critical Condition Monitoring (CCM) Flood.-- Tempe(ature -•-- _-•-- _-_ Parallel Protection and services available to 38). Initial here _ a servicefinstallation Initial Fee 6T to obtain construction permit - _---- -- - Municipal Construction Permit Fee - - - Customer to obtain and pay for initial/annual municipal alarm use permit. Your failure to obtain and provide ADT with your municipal alarm use permit registration number could result in no municipal fire/police response to an alarm from your premises and/or a fine. Annual UL Certificate Fee _- ---- I 0 Other: ADT Select® DataSource I In Price Open/Close Login Supervised Scheduled Open/Close ADT Select Entry_ Other Services - _ ---- - - QQuality Service Plan (QSP) If Quality Service Plan (QSP) is Declined Customer must Initial here Preventative Maintenance/inspections Per Year - 1 2 3 4 6 12 (Circle One) Training Direct Connection Services _ — Monthly Recurring Municipal Fee (Subject to change based on local law) Customer to obtain and pay for municipl alarm use permit On Site Services Taxable Amount (Leave blank if ADT-Owned) _ Non -Taxable Amount (Leave blank if ADT-O+nmed_) I Connection Fee Sales Tax on Installation` Tax Exempt No. - - ---- Tax Expiration Date Total Installation Charge* - -- Deposit Received: 100% deposit required < $500 Minimum 50% deposit required $500+ Money Order Check CreditlDebit Card Guard Response Interior Exterior - Other: { Balance Due* I ... IN ' Total Monthly Service Charge* ; 'If applicable sales tax is not shown, it will be added to the first invoice. Estimated Installation Start Date I Estimated Installation Completion Date YOU ACKNOWLEDGE AND ADMIT THAT BEFORE SIGNING YOU HAVE READ THE FRONT AND BACK OF THIS PAGE IN ADDITION TO THE ATTACHED PAGES WHICH CONTAIN IMPORTANT TERMS AND CONDITIONS FOR THIS CONTRACT. YOU STATE THAT YOU UNDERSTAND ALL THE TERMS AND CONDITIONS OF THIS CONTRACT. YOU ARE AWARE OF THE FOLLOWING: NO ALARM SYSTEM CAN GUARANTEE PREVENTION OF LOSS; HUMAN ERROR IS ALWAYS POSSIBLE; WE MAY NOT RECEIVE ALARM SIGNALS IF THE TELEPHONE LINE OR OTHER ALARM TRANSMISSION SYSTEM IS CUT, INTERFERED WITH, OR OTHERWISE DAMAGED OR IF TELEPHONE OR ELECTRICAL SERVICE IS UNAVAILABLE FOR ANY REASON. THIS CONTRACT REQUIRES FINAL APPROVAL OF AN ADT AUTHORIZED MANAGER BEFORE ANY EQUIPMENT/SERVICES MAY BE PROVIDED. IF APPROV- AL IS DENIED, THIS CONTRACT WILL BE TERMINATED AND ADT'S ONLY OBLIGATION TO YOU WILL BE TO NOTIFY YOU OF SUCH TERMINATION AND REFUND ANY AMOUNTS PAID IN ADVANCE_ SECOND AND THIRD PAGES ACCOMPANY THIS PAGE WITH ADDITIONAL TERMS AND CONDITIONS SET FORTH ON PAGES 4 THROUGH 6, INCLUSIVE, OF THIS AGREEMENT AND YOU UNDERSTAND AND AGREE TO ALL SUCH T)_RMSAND CONDITIONS. ADT Rep.:- ..: Rep. ID No. -- ----•---•-------- ----- Rep. License No.: I CUSTOMER'S APPROVAL: DATE: r Original Signature Required -- - Office Conv 02011 ADTSecurity Services_ Inc- (01/111 A " CERTIFICATE OF LIABILITY INSURANCE DAT1191DDlYYY1f) 11/9/2010 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 endorsements . PRODUCER Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 CONTACT NAME: E 1FAXAH/CNNo, Ext): 12 4 ADDRESS: PRODUCER CUSTOMER D INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: AGCS Marine Insurance Company (Allianz) ADT Security Services, Inc. INSURER B: CHARTIS CASUALTY COMPANY 3160 Southgate Commerce Blvd INSURER C: Commerce & Industry Ins Co. Ste 38 INSURER D: Illinois National Insurance Co. Orlando, FL 32806 INSURER E: Nat'l Union Fire Ins Co. of Pittsburgh, PA United States INSURER F: New Hampshire Ins. Co. COVERAGES CERTIFICATE NUMBER: 827805 -A 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. INSR LTRTYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF rPMWfDD E(P LIMITS F GENERAL LIABILITY GENERAL LIABILITY GL 4360884 (Primary GL) 10/1/2010 10/1/2011 EACH OCCURRENCE 1,0D0,000.00 PRREMISES Ea occurrence)$1,OOD,000.00 MED EXP (Any one person) 10,ODO.00 NCOMMERCIALCLAIMS -MADE a OCCUR PERSONAL & ADV INJURY 1.000.000.00 OWNER'S & CONTRACTOR'S GENERAL AGGREGATE 2,000,000.00 GEN' L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,ODD•000.00 X POLICY JPECT LOC E E E F AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS CA 3976576 (VA) CA 3976575 (ADS) CA 3976577 (MA) CA 3976624 (NH) (Primary AL) 10/ 1/2010 10/ 1/2010 10/ 1/2010 10/ 1/2010 10/ 1/2011 10/ 1/2011 10/ 1/2011 10/ 1/2011 COMBINED SINGLE LIMIT Each accident 1, OD0,000.00 X BODILY INJURY (Per person) BODILY INJURY (Per accident PROPERTY DAMAGE SCHEDULEDAUTOSX HIRED AUTOS Per accident) X NEW HAMPSHIRE (CSL) 250.000 NON -OWNED AUTOS UMBRELLA LAB OCCUR EACH OCCURRENCE AGGREGATE EXCESSLIABCLAIMS -MADE DEDUCTIBLE PRODUCTS - COMP/OP AGG NEW HAMPSHIRE (CSL) RETENTION $ B C D E F WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE OFRCEE / MEMSER ry n NH) EXCLUDED? If s, describe under DESCRIPTION OF OPERATIONS below NIA AWC 026149514 (FL) WC 026149516 (MI) WC 026149513 (CA) WC 026149518 (MA, ND, NY, OR WA, WI WY) 10/ 1/2010 10/ 1/2010 10/ 1/2010 10/ 1/2010 10/ 1/2010 10/ l/2011 10/ 1/2011 10/ 1/2011 10/ 1/2011(Manda 10/1/2011 X WC STATU-R ' I I E. L. EACH ACCIDENT Z000,000.00 E. L. DISEASE - EA EMPLOYEE 2,000,000.00 E. L. DISEASE - POLICY LIMIT SZOD0,000.00 A Builder's Riskfinstaliation/Contract Works OC & OCW 91128600 5/1/2010 5/1/2011 USD $1,000,000.00 per Jobsite A Rental EquipmentlContractoes Equipment OC & OCW 91128600 5/1/2010 5/1/2011 USD $1,000,000.00 per Jobsite Blanket Transit 11511120101conveygnce DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Please refer to attached ACORD 101 for further remarks. CFRTIFICATF Hni_nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sanford THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 N Park Ave ACCORDANCE WITH THE POLICY PROVISIONS. Sanford, FL 32771 AUTHORIZED REPRESENTATIVE UnitedStatesMARSH USA INC, BY: Fmnldm Halbdc, Global Marine David Kon Casual mm 1988- 2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Generated by EXIGIS LLC. For more information visit www.exigis.com.