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Home My WebLink About241 Town Center Blvd (2)h�/} RecelvEn C v 1 O I r) t CITY OF SANFORD PCRMIT APPLICATION JUL 2 4 Permit # : `� IDate: / — z � oo 2-t Job Address: I T[CP �w,\ l f .14el - ,,-3 1 yd - Description of Work: AAA Neu,) (Ifs WP rP Mall a*s /Ylrl✓i? J- / bimm Historic District: Zoning: Value of Work: 2006 o afar 5 fie. Permit Type: Building Electrical Mechanical Plumbing S ri /Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration Change o ervice Temporary Pole Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures PIumbing/New Residential: # of Water Closets_ Occupancy Type: Residential Commercial Replacement New (Duct Layout & Energy Calc. Required) # of Water & Sewer Lines # of Gas Lines Plumbing Repair - Residential or Commercial 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: (Attach Proof of Ownership & Legal Description) Phone: State License Number;(00Y /(P.> GW/LDU / Phone & Fax: _ /V Z 3��(%(� 'Yd7 Z -AO' contact Person: y'l//1 �"Lrt I' Phone: 6,107- Z 3 -// Zi? Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: r 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: 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 I will notify the owner of the property of there Florida Lien Law, FS 713. Signature of Owner/Agent Date Signature o C tractor/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Owner/Agent is _ _ Produced ID Personally Known to Me or APPLICATION APPROVED BY Special Conditions: Print Con for/Ag Date Signature oTR6 ry Contractor/Agent is Produced ID_ Bldg: Zoning: (Irkm & ate) (Initial & Date) Known to _ Utilities: (Initial & Date) Oa110ad thn r+� FD:,vct �.)L72a,� (Initial & Date) Two 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 —4— �_ "�'_M 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 2005 a'� a, chi NOTARY PUBLIC STATE OF FLOR115A PAMELA A. MCELROY Notary Public, State e27l t'da My comm. exp. Comm. No. DO 411691 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY qw THIS CERTIFIES THAI': GEORGE E N L,ER 10255 FORTUNE PARKWAY BUILDING S00 SUITE 120 JACKSONVILLE, FL 32256- BUSI *M ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR n IS LIhBTED TO THE EXECUTION Of CONTRACTS REQUIRING THE ABILITY TO LAYOUT. FABRICATE, INSTALL INSPECT, ALTER Olt SERVICE WATER SPRINKLER SYSTEMS, WATER SPRAY SYSTEMS, FOAM -WATER SARDWIM SYSTEMS, FOAM WATER SPRAY SYSTEMS. STANDPIPES. COMBINATION STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT 1S AN INTEGRAL PART OF THE SYSTEM BEGINpIING AT THE POINT OF SERVICE, SPRINKLER TANK HEATERS, AIR IDES. THERMAL SYSTEMS USED IN CONNECTION WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED THERETO, EXCLUDING pRE4DrANEERED SYSTEMS. Flo, 12M 1 07 1 16 lvuvaI Ism Dope 1Twlaml Count' 60476500012001 Lic�it NtimW CYicf Fiaaoefal QlRker S 9AA4— 7626340001 150.00 10613012008 AWi a ion I Taxes B Fas I Expue Date 7 iv r. ,•.. "S. •Zl ``T' ?� `� 'T ''- 'x. .. yCERTFCAE F NSURANCE _ CERTIFICATE NUMBER ER 236827 PRODUCER THIS 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 Marsh, Inc. CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. 1166 Avenue of the Americas New York, NY 10036 COMPANIES AFFORDING COVERAGE Telephone (212) 345-5000 COMPANY A: At 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) COMPANY H: Noetic S cia Insurance Company CSE GES_ �• t., , - . _. _ _ _ .., ,.. :T: 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 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 POUCY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS B GENERAL UABILITY RMGL5749708 10/1/2005 10/1/2006 GENERAL AGGREGATE $15,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGG $15,000,000.00 CLAIMS MADE Q OCCUR PERSONAL d ADV INJURY $7,500,000.00 OWNERS b CONTRACTOR'S PROT EACH OCCURRENCE $7,500,000.00 FIRE DAMAGE (Any one ke) $1,000,000.00 MED EXP (Any one pawn) $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 BODILYINJURY (Per pason) 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/ PARTNERSIEXECUTNE INCL SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X L�.,,,8'yA7Of0RY OTHER1,= EL EACH ACCIDENT $2,000,000.00 EL DISEASE-POLICY LIMIT $2,000,000.00 F OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEI $2,000,000.00 OTHER DESCRIPTION OF OPERATONSILOCATIONSNEHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language. CERTIFICATE HOLDER`CANNCELLATION ail City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fl, 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:� A�-4� Katherine O'Leary, Casually Program J(/ �-,�� -�.r__ ,• .,,,: �., .:.,....-T,�r,..._r---..,....:.�.,:_.�..._....rr. ,:MMi(3/02)_.`—, — ---ltiVALIDASOF�10N0/Z005:_. L L t— ADDITIONAL4 FORMATION , "'� n Gh CERTIFICATENUMeER "i '236827 , ,w"C �A • Yk�..r:wa.,�M/.�4w..Ww.dl...�Y..ib �w-+� R- - � 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 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, FI, 32771 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 10/1/2006 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, FI, 32771 DATE: BUSINESS T ADDRESS:_ PHONE NO.: r CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-1091 * FAX #: 407-330-5677 CONST. INSP. [ ]/ O INSP.:[ ] REINSPECTION [ J PLANS REVIEW [ J F. A. [ ] F.S. [ HOOD [ ] PAINT BOOTH [ ] BURN PERMIT [ ] TENT PERMIT ] TANK PERMIT [ ] OTHER [ ] TOTAL FEES: S K (PER UNIT SEE BELOW) COMMEN Address / Bldg. # / Unit # Square Foot a¢ Fees per Bldg. / Unit 1. 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 rz� of the City of Sanford, Florida. Sanford Fire Applicant's Signature � Hy.%. vi.��! -. '. _� "�-- _ "'T•►'�1-• '�^,�,�yF�M1�1-�-^�+�7'1 Tf �•. ••.`� -�-HY�„ - , �-�w� �rM'IWTM�1I•'.-_'Tw vL-• i{f1f-��I CITY OF SANFO�tD FIRE DEPARTMENT FEES FOR SERVICES P ONE # 407-302-1091 * FAX #: 407-330-5677 DATE: PERMIT #: BUSINESS N ME / PR r) ��— ADDRESS: V4 PHONE NO.: L 1 �AX NO.: G4&-7) .5-- 45C CONST. INSP. [ J C / O INSP.:[ 1] REINSPECTION [ ] PLANS REVIEW [ ] F. A. [ ] F,S. [ HOOD [ ] PAINT BOOTH[ ], BURN PERMIT [ ] TENT PERMIT ] TANK PERMIT [ ] OTHER [ ] TOTAL FEES: $ (PER UNIT SEE BELOW) COMMENTS: Address / Bldg. # / Unit # Sauare Footae ,,,* Fees per Bldg. / Unit 1. 2. 3. 4. 5. 6. 7. 8- 10 i 4 Il. 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 1 will comply with all applicable codes and ordinances 1 of the City of Sanford, Florida. A Sanford Fire KI Applicant's Signature A_ �1 4,