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Home My WebLink About273 Town Center Cir (2)` • to agar m. Job Address: Description of Work: Historic District: Zoning: RECFEIVEO JUL 1 8 2006 CITY OF SANFORD HERMIT APPLICATION Date: G' r. Value of Work: 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 _X— 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: -1i07 Z3 �l�V , 907-27&-//P Contact Person: Bonding Company: Address: Mortgage Lender: (Attach Proof of Ownership & Legal Description) Phone: License NdIbber: Address: Architect/Engineer: Phone: Address: Fax: M `/07— Z 3S- Ile Co 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. 1 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 M 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 re�tueatent Florida Lien Law, FS 713. Signature of Owner/Agent Date S a,ure Co iractor/Asent Date `7 6 �' LL))r\ L Print Owner/Agent's Name PrintCo tract gent's a t c Q Signature of Notary -State of Florida Date Signature of Nota - tat o Florida ate Owner/Agent is _ Personally Known to Me or _ Produced ID Contractor/Agent isXPersonally Known _ Produced ID C0WdW ppOQiU06 E4*0112M&2 OB Bonded rent POWN1411 APPLICATION APPROVED BY: Bldg:c:51ffi k "Zoning: Utilities: FDM� (Int nal & Dat (Initial & Date) (Initial & Date)(I�ittal &Date) Special Conditions: Q) 0I .00 7 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY i THIS CERTIFIES THAI': GEORGE E MILLER 10233 FORTUNE PARKWAY BUILD1JJSi 500 SURE 120 JACKSONVILLE, FL 32256. BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR A IS LIMITED TO THE ED;CU TK)" OF CONTRACTS REQUIRING THE ABILITY TO LAYOUT FABRICATE, INSTALL, INSPECT, ALTER. OR SERVICE WATER SPRINKIER SYSTEMS, WATER SPRAY SYSTEMS, FOAM -WATER SPRINKLER SYSTEMS, FOAM -WATER SPRAY SYSTEMS, STANDPIPES. COM M77ON STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT IS AN INTEGRAL PART OF THE ' SYSTEM BEGINIONG AT THE POINT OF SERVICE, SPRINKLER TANK HEATERS, AIR LINES, THERMAL SYM M$ USED IN CONNECTION WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED THER Ip, EXCLUDINGME4NODIEEREDSYSTEM. 01 12M 1 07 1 16 Issue Date Type Cas 60476500012001 C-ody I LwmdPdmil Numw Cl+isf iioaoeial 9113ser � ;;.,q��,�/� 7626340001 150.00 10613012008 Applkmioa / Taxes B Fees I Expbe Date .. -.. ... �, t✓.... C } "r?�F�T •Yi-'} �� t �y�,.1 '- 'r "CERtIFICATE=;OFINSUR4NCEr �' �'F� ` `'r r r�CERTIFI ATE NUMBER, �i ...' 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. COMPANY G: New York Marine & General Insurance Co. (Lead) United States COMPANY H: Noetic S ecial Insurance Company COVERAGES ,.r .. w• as i 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 LTR TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MNOD/YY) POUCY EXPIRATION DATE (MMIDD/YY) LIMITS B GENERAL LIABILITY RMGL5749708 10/112005 10/1/2006 GENERAL AGGREGATE $15,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $15,000,000.00 7 CLAIMS MADE FX] OCCUR PERSONAL d ADV INJURY $7,500,000.00 OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE $7,500,000.00 FIRE DAMAGE (Any ons fire) $1,000,000.00 MED EXP (Any one pemorn) $10,000.00 g AUTOMOBILE LIABILITY RMCA3017798 (TX) 10/1/2005 10/112006 COMBINED SINGLE LIMIT $7,500,000.00 B X ANY AUTO RMCA3017799(ADS) 10/1/2005 10/1/2006 B B ALLOWED AUTOS RMCA3017797 (MA) RMCA3017796 (VA) 10/1/2005 10/1/2005 10/112006 10/1/2006 BODILY INJURY (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) T NON -OWNED AUTOS PROPERTY DAMAGE PROPERTY EXCESS UABIUTY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X I "tiR$8'A"01" , :} E D C EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERSIEXECUTIVE INCL EL EACH ACCIDENT $2,000,000.00 EL DISEASE -POLICY LIMIT $2,000,000.00 F OFFICERS ARE: EXCL$2,000,000.00 EL DISEASE -EACH EMPLOYEI OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language.CER - xTtI�FICsai O�1NII't'..+i__S:_ �;i'.u�.�ivtR~ �„ -�� + .a• ' gib' City Of Sanford Bldg.Dept. p 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 MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABLITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES. OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY:� n KaUrerine O'Leary, Casually Program �� ' r " " . ' :" i1;} �. • "' '"';'"" �'-N a : MIN7(3/ 2).--- "f -r --';- l ALID-AS OF:'10/1012005 "",- }. �` ;i� W a- ..i - + :� " ` .': : _ �: 4 'rpm Y;�•� CERTIFICATE NUMBER J ADDITIONAL1INFORMATION '�j ��..► ... ti` . r .� • 1 ; 236827 .w w� !b�P.A�d n �wt.� Ria � �i �lY+ �} w — _ ��u.• ., 2 . a- .r . a9Z. a. Y . �, ' 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 TEXT �`'s. a f, �rr F_ •_..` • ,� r; . k _ x,'tl WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date (B) American Home Assurance Co. RMWC6610498 10/1/2005 10/1/2006 (E) National Union Fire Insurance Co. RMWC6610504 10/1/2005 10/1/2006 (D) Insurance Company of the State of PA RMWC6610503 10/1/2005 10/1/2006 (C) Illinois National Insurance Co. RMWC6610501 10/1/2005 10/1/2006 (F) New Hampshire Ins. Co. RMWC6610505 10/1/2005 10/1/2006 (A) AI South Insurance Co. RMWC6610499 10/1/2005 10/1/2006 (B) American Home Assurance Co. RMWC6610502 10/1/2005 10/1/2006 (B) American Home Assurance Co. RMWC6610500 10/1/2005 10/1/2006 LIABILITY PROGRAM Project: Permit If there is a question regarding this certificate please contact Courtney Yocum (Email: Cyocum@tycoint.com Phone: 907-235-1100) CERTIFICATE HO, LDER .� ,, City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, FI, 32771 y State CA NV, OR AR, MA, TN, VA IL, MI NY, WI GA FL All Other States e Tyco Fire & Security 3701 North John Young Parkway Suite I 10 Orlando, FL 32804 SimplexGrinnell (407) 235-1100 Phone (407) 235-1150 Fax POWER OF ATTORNEY MAY 15, 2006 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 . \��' dA GEORGE Tc 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 2005. NOTARY PUBLIC STATE OF FLO PAMELA A . MCELROY Notary Public, State 01l. Fl vide MY comm. exp. Comm. No. DO 411691 0 CITY OF'SANFORD FIRE DEPARTMENT FEES FOR SERVICES 7/ PHONE # 407-302-2516 •FAX # 407-302-252l6� Q DATE: PERMIT BUSINESS NAME / PROJECT: 19 --Is ADDRESS: PHONE NO.: FAX NO.: CONST. / O INSP.:[ j REINSPECTION [ 1 PLANS REVIENvzs F. A. [ ] INS F.S. HOOD [ ] PAINT BOOTH [ ] BURN PTENT PERMIT ANK PERMIT [ J OTHERTOTAL FEES: S (PER UNIT SEE BELOW) COMMENTS: Address / Blde. # / Unit # Square Foota¢e Fees ver $1da. / 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 I will comply with all applicable codes and ordinances of the City of Sanford, Florida. San ord entionivisi Applicant's Signature C