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Home My WebLink About219 Town Center Cir (3)II Permit # :y. Job Address: Description of Work: CITY OF SANFORD PERMIf APPLICATION RECEIVED JUN - 9 2006 Date: Historic District: Zoning: Value of Work-.$ 7 aoo r Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm O Pool Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole_ Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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 K Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name & Address: Contractor Name & Address: Phone & Fax: 'W97- Contact Person: _ Bonding Company: Address: Mortgage Lender: Address: (Attach Proof of Ownership & Legal Description) Phone: License Number: Architect/Engineer: Phone: Address: Fax: 9(b7- Z J —//Z & Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713. .,40 o -fr OCo Signature of Owner/Agent Date Signature of tractor/Agent Date Qlr► i� Print Owner/Agent's Name Print Co ctor/Agent' e L 6 Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date Elbe L. Hartis MY Commission p15217997 AuguM Owner/Agent is _ Personally Known to Me or Contractor/Agent is _I- e a nit orr 18.2007 Produced ID _ Produced ID APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: -- (Imtial & Date) (Initial & Date) Initial & D to (Initial BFDate)_/' Special Conditions: df 11, Tyco Fire & Security SimplexGrinnell 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 T MILLER 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 /�� a- C&I NOTARY PUBLIC STATE OF FLORI PAMELA MCELROY aryblic, State i F10"a My comm. exp. Mal. 2T, 2009 Comm. No. DD 411691 n Tyco Fire & Security SimplexGrinnell MAY 151p 2006 3701 North John Young Parkway Suite 1 l 0 Orlando, FL 32804 (407) 235-1100 Phone (407) 235-1150 Fax POWER OF ATTORNEY TO WHOM IT MAY CONCERN: PLEASE ALLOW THE FOLLOWING INDIVIDUALS TO PICK UP PERMITS FOR SIMPLEX GRINNELL TO INSTALL FIRE PROTECTION SYSTEMS IN FLORIDA. JEREMY COOK, CLAY SETLIFF, TOM SMITH, FRANKO RIVERIA, MIKE OLIVER, RYAN FUNK, JOSH GIBSON CONTRACTORS LICENSE NUMBER: 60476500012001 GEORGE STATE OF FLORIDA 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 THERE IN EXPRESSED. WITNESS MY HAND AND OFFICIAL SEAL, THIS 16 DAY OF MAY 2005. NOTARY PUBLIC STATE OF FLORIDA PAMELA A. MCELROY Notary Public, State of Florida My comm. exp. Mar. 27, 2009 Comm. No. DD 411691 1 `- :;"CERTIFICATE-:OF ..+a.f 1N;SURANCE' ''y �CERTIFICATE N - , 4 UMBER I C a ^2 , ry mot i236827 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: At South Insurance Co. Telephone (212) 345-5000 COMPANY B: American Home Assurance Co. INSURED COMPANY C: Illinois National Insurance Co. 3701 N. JOHNll, 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. United States COMPANY G: New York Marine & General Insurance Co. (Lead) COMPANY H: Noetic Specialty Insurance Company ,COVERAGES,x':' 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICYPERIODINDICATED. NOTWITHSTANDING ANY REOUIRMENTS, 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS B GENERAL LIABILITY RMGL5749708 10/1/2005 10/12006 GENERAL AGGREGATE $15,000,000.00 X COMMERCIAL GENERAL. LIABILITY PRODUCTS - COMP/OP AGG $15,000,000.00 CLAIMS MADE D OCCUR PERSONAL & ADV INJURY $7,500,000.00 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $7,500,000.00 FIRE DAMAGE (Any one fire) $1,000,000.00 MED EXP (Any one Persson) $10,000.00 B AUTOMOBILE LIABILITY RMCA3017798 (TX) 10/1/2005 10/1!2006 coMBlNeo SINGLE uM1T $7,500,000.00 B X ANY AUTO RMCA3017799 (AOS) 10/1/2005 10/12006 B B ALLOWED AUTOS RMCA3017797 (MA) RMCA3017796 (VA) 10/12005 10/1/2005 10/12006 10/12006 BODILY INJURY (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) X NON-OWNED AUTOS F PROPERTY DAMAGE n PROPERTY EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM B E D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERSIEXECUTNE INCL SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO EL EACH ACCIDENT $2,000,000.00 EL DISEASE-POLICY LIMIT $2,000,000,00 F OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEI $2,QQQ,QQQ,QQ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language. CERTIFICATE HOLDER "''i L $ms�w4rAl.+S�Ans►o.r�i,.�iiaar 3ri•�rEK,LtplcAIO=-P.,r�i�'aiJ, ~," �s�_, City Of Sanford Bldg. Dept. 300 N. Part( Ave. Sanford, Fl, 32771 SHOULDANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAR 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN• BUT FAILURE TO MIUL SUCH NOTICE SMALL IMPOSE HO OBLIGATION OR LUIBILrTY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES. OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: KaBrsriM O'Leary, Cesuafiy Program �� -0� ;MILA7(3/02)' +5 ` { �VAUD'AS OF: 0/110200512- .I - � .;j''I'. ter' X- .7 .1 1 . .. " ".. DDITIONALANFORMATION' CERTIFICATE NUMBER 41 1236827 PRODUCER COMPANIES AFFORDING COVERAGE COMPANY 1: 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 EXT WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date State (B) American Home Assurance Co. RMWC6610498 10/1/2005 10/1/2006 CA (E) National Union Fire Insurance Co. RMWC6610504 10/1/2005 10/1/2006 NV, OR (D) Insurance Company of the State of PA RMWC6610503 10/1/2005 10/1/2006 AR, MA, TN, VA (C) Illinois National Insurance Co. RMWC6610501 10/1/2005 10/112006 IL, MI (F) New Hampshire Ins. Co. RMWC6610505 10/1/2005 10/1/2006 NY, WI (A) AI South.Insurance Co. RMWC6610499 10/1/2005 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 10/1/2006 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) City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fl, 32771 —'s , -1A — - x STATE OF,FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSIIAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY THIS CERTIFIES THAT: GEORGE E Mill" i 10133 FORTUNE PARK BUILDING 500 SUM 120 JACKSONVIIIA FL 32256= BUSINESS ORGANIZATION: SIMPLEXGRINNELL LP CONTRACTOR[[ IS LIMITED TO THE EXECUTION OF CONTRACTS REQUIRING THE ABILTTY TO LAYOUT, FABRICATE, INSTALL, INSPECT, ALTER, OR SERVICE WATER SPRINKLER SYSTEMS, WATER SPRAY SYSTEMS, FOAM -WATER SPRINKLER SYSTEMS, FOAM -WATER SPRAY SYSTEMS, STANDPIPES, COMBINATION STANDPIPES AND SPRINKLER RISERS, EXCLUDING PRE-ENGINEERED SYSTEMS. Chia Fumuchd otrwer 1101120" 107 1 16 lWval ON76500012001 3041980001 250.00 06 30 2006 Issue Dale jTAwjCU=j ca"y �rmit Number Application # Tam= k Fees I E.Vito Date CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-2516 - FAX # 407-302-2526 DATE: PERMIT BUSINESS NAME / PROJECT: L�1 �— ADDRESS: S"4- (-P PHONE NFAX NO. Qe3-7) CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [) PLANS REVIEW F. A. [) F.S. HOOD [) PAINT BOOTH [ J BURN M IT [ J TENT PERMIT ] T&NKPERMIT [ ] OTHER cd1V�� TOTAL FEES: S C� (PER UNIT SEE BELOW) COMMENTS: f A I 1 (-Ih,.7 ) •— Address / Bldg. # / Unit # Square Footage Fees ner Me. / Unit 2. 3. 4. 5. 6. 7. 8. 9. 10. 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 ),�R of the City of Sanford, Florida. I Sanford Fire Prey&o06n-Division"�4--� Applicant's Signature