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Home My WebLink About226 Town Center Cir (2)CITY OF SANFORD PERMIT APFt6ICATION Permit # : _ Date: Job Address: —?—?—b ✓own Ceakr C�/��t r r Jq Hoct ep RECEIVE[ ; MAY 3 0 2006- Description 006- Description of Work: �C�c7ea�e ✓lryl�lnK[erS �iQ(� �(��/—() Historic District: Zoning: Value of Work: $ 7,`7 Z Z Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm /` 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 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 iName & Address: p Cl/rnPIPXCr�nn�ll 4�7oJ N .)y['►n UyNU CKt1�/� 0 QO L 26v 1�/ State Lice lle Number: NOy�t'Qj ��D(��ZDD I Phone & Fax: Contact ✓�OC� 7�7� Z�S %fS� Contact Person: QV1 f v' i'I lC Phone: 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 l will notify the owner of the property of the requirements of Florida Lien Law, FS 713. ..l� ori Signature of Owner/Agent Date SKgnatt1!1o`ntactr1Agn1oeDate Print Owner/Agent's Name Print ntractor/Agent' s Na to Signature of Notary -State of Florida Date Signature 4 No a State f Flori a i5ate Owner/Agent is _ _ Produced ID Personally Known to Me or APPLICATION APPROVED BY: Bldg:Qnp� — Zoning: ( nidal Date) Special Conditions: oar Ellen L. Harris Contractor/Agent is Personally Knowre' My commission DD217997 Produced ID ` or � Expire August 16, 2007 Utilities: FD: r (initial & Date) (Initial & Date) (Initia & D'ite) • r. STATE OF FLORIDA e DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLOLRIDA CERTIFICATE OF COMPETENCY THIS CERTIFIES THAT: GEORGE E MILLER 10255 FORTUNE PARK BUILDING 500 SUITE 120 JACKSONVILLE, FL 32256 BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR It IS LIMITED TO THE EXECUTION OF CONTRACTS REQUIRING THE ABILITY TO LAYOUT, FABRICATE, INSTALLINSPECT, ALT ` ER, 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. Chief Financial Officer j &-, 07 01 2004 1 07 1 t6 Duval 1 60476500012001 5041980001 250.00 06 30 2006 Issue Date Type Class County License(Pemut Number Application # Taxes & Fees Expire Date Nki CERTIFICATE OF INSIln2ANCE CERTIFICATENUMBER X,� �s :236827 PRODUCER - 'rHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS • UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Marsh, Inc. POLICIES DESCRIBED HEREIN. 1166 Avenue of the Americas New York, NY 10036 COMPANIES AFFORDING COVERAGE Telephone (212) 345-5000 COMPANY A: Al South Insurance Co. 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. United States COMPANY G: New York Marine & General Insurance Co. (Lead) om an COMPANY H: Noetic Specialty Insurance Company bViEkk m OVERAGES a :, _ g 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 (MM/DD/YY) DATE (MMIDD/YY) 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 OCCUR »v PERSONAL & ADV INJURY $7,500,000.00 EACH OCCURRENCE $7,500,000.00 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one fire) $1,000,000.00 MED EXP (Any one person) $10,000.00 B AUTOMOBILE LIABILITY RMCA3017798 (TX) 10/1/2005 10/1/2006 COMBINED SINGLE LIMIT $7,500,000.00 B X ANY AUTO RMCA3017799 (AOS) 10/1/2005 10/1/2006 B B ALLOWED AUTOS RMCA3017797 (MA) RMCA3017796 (VA) 10/1/2005 10/1/2005 10/1/2006 10/1/2006 BODILY INJURY (Per person) SCHEDULED AUTOS �( HIRED AUTOS BODILY INJURY (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE PROPERTY EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM B E D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO Xj L- sc, Toev on BR y `- L° ns EL EACH ACCIDENT $2,000,000,00 EL DISEASE-POLICY LIMIT $2,000,000.00 F OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $2,000,000.00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language. . CERTIFICATE HOLDERS - MMI ., ..R, CANCELLATION _ City Of Sanford Bldg. Dept. 300 N. Park Ave. 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 Sanford, FI, 32771 THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Katherine O'Leary, Casually Program J� ,;rx' MM1(3/02)��w �: VALIDAS�dF 10110(2005 PRODUCER 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 COMPANIES AFFORDING COVERAGE COMPANY I: White Mountain Insurance Co. CERTIFICATE NUMBER'( 236827 (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 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 10/1/2006 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 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 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 1�� 4�2_ W1 NOTARY PUBLIC STATE OF FLORIDA PAMELA A. MCELROY Notary Public, State of Florida My comm. exp. Mar- 27, 2009 Comm. No. DD 411691 Tyco Fire & Security 3701 North John Young Parkway Suite 110 Orlando, FL 32804 SimplexGrinnell (407) 235-1100 Phone (407) 235-1150 Fax POWER OF ATTORNEY MAY 15, 2006 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 LORIDA: JEREMY COOK, CLAY SETLIFF, TOM SMITH, FRANKO RIVERIA, MIKE OLIVER, RYAN FUNK, JOSH GIBSON CONTRACTORS LICENSE NUMBER: 60476500012001 1 GEORGE 15MILLER 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. painy" a - �a NOTARY PUBLIC STATE OF FLORIDA PAMELA A. MCELROY Notary Public, State of Florida My comm. exp. Mar. 27, 2009 Comm. No. DD 411691 CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-2516 e FAX # 407-302-2526 DATE: PERMIT #: BUSINESS NAME / PROJECT: ADDRESS: 0 -7 f c rr.1 Ce43 �•Qr—'" C.� PHONE NO. FAX NO.: CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] . PLANS REVIEWKlx- F. A. [ ] F.S. J HOOD O PAINT BOOTH [ ] BURN PE IT [ ] TENT PERMIT ] TANK PERMIT [ ] OTHER]. TOTAL FEES: $ �� Q (PER UNIT SEE BELOV®') r� ��re 1 Address / B1dQ. # / Unit # Square Footage Fees per Bldg. / Unity' I 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 Prevention Divisi Applicant's Signature