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Home My WebLink About290 Towne Center Cir (3)07-14-4G CITY OF `dANFORD PERMIT APPLICATION RECEIVED Permit #: V Date: – Z O 0 6 2007 Job Address: Z CID 10&_)r) cfn der Cif. l Description of Work: Historic District: Zoning: Value of Work: S-4 a 70 Permit Type: Building Electrical Electrical: New Service – # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets_ Occupancy Type: Residential Commercial Construction Type: # of Stories; Mechanical Plumbing ire Sprinkl Alarm Pool _ Addition/Altcration ___ Change of Service Temporary Pole. _ Replacement New (Duct Layout & Energy Calc. Required) _ # of Water & Sewer Lines # of Gas Lines Plumbing Repair – Residential or Commercial Industrial Total Square Footage: _ # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: _ (Attach Proof of Ownership & Legal Description) Owners Name & Address: Phone: Contractor Name & Address: ,l�State (cense Number: 64?!Y % (d r'o0o / zonj Phone &Fax: y�739–' ��ii IOD �p-j` J/Sa Contact /�t Person: ►Ke Off dfPhone: q07-23``//()(7 Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: Application is hereby made to obtain a pemiit 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 ofthis 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 r of Florida Lien Law, FS 713. Z- 28-0 � Signature of Owner/Agent Date Stg�narur f C tractoor/^Agent Date I`tIC�/rl Print Owner/Agent's Name Print ntractor/Agen 's Name Signature of Notary -State of Florida Date gnature ofN ary- to of Florida Date r Owner/Agent is — Personally Known to Me or Contractor/Agent is — Personally Known to Me or _Produced ID JR � _Produced ID APPLICATION APPROVED BY: Bldg: Zoning: Utilities: _ FD; (Initial & ate) (Initial & Date) (Initial & Date) (In Special Conditions: 4.� P� JOAN L. KWIATKOWSKI a 01F Notary Public' State of FloridaJMy Commission Expires May 13, 2009?Commission # DD 386096 Bonded By National Notary Assn. TYCO Fire & Security .3701 North John Young Parkway Suite 110 Orlando, FL 32804 Simplex Grinnell (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 �4 6 GEORGE 1 ILLER 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 200 C19,� NOTARY PUBLIC STATE OF FLORIDA PAMELA A . NICEOW' Votary Public, State o2FFlorida 2009 My comm° exp a f. Comm.° CD 41169 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY THIS CERTIFIES THAT: GEORGE E MILLER 10255 FORTUNE PARKWAY BUILDING 500 SUITE 120 JACKSONVILLE, FL 32256 - BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR Il IS LIMITED TO THE EXECUTION OF CONTRACTS REQUIRING THE ABILITY 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, ALL PIPING THAT IS AN INTEGRAL PART OF THE SYSTEM BEGINNING AT THE POINT OF SERVICE, SPRINKLER TANK HEATERS, AIR LINES, THERMAL SYSTEMS USED IN CONNECTION WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED THERETO, EXCLUDING PRE-ENGINEERED SYSTEMS. 07 10112006 1 07 1 16 1 Duval Issue Date iTypelClassl County 60476500012001 License/Permit Number Chief Financial Officer 7626340001 1 150.00 10613012008 Application N Taxes & Fees I Expire Date n __..�� Ftij., t a �.1Vl.�.l.tk _ � l+ .�Y4 �- r} \ }r �. .k ,: 4 -' ■■/^-� `i.fi � i -i�fY��s�,t"}fit," >CEf2TIFICATENUMBER PRODUCER .THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVtt� IN THE POLICY. TMS CERTIFICATE DOES NOT AMEND, EETTENp OR ALTER THE COVERAGE AFFORDED BY THE Marsh, InC. POLICIES DESCRIBED HEREIN. 1168 Avenue of the Americas New York, NY 10036 COMPANIES AFFORDING COVERAGE Telephone (212) 3455000 COMPANY A. Al South Insurance Co. COMPANY B: American Home Assurance Co. INSURED COMPANY C: Illinois National Insurance Co. COMPANY. D: Insurance Company of the State of PA SimpiexGrinnell, LP COMPANY E: National Union Fire Insurance Co. 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32804 COMPANY F; New Hampshire Ins. Co. United States COMPANY G: New York Marine & General Insurance Co. (Lead) COMPANY H: Noetic specift Insurance Com an i "f', IK .. S ''.iQ t 4y z+t.7 4"t+., 4, 4 :�by ,.r, :- W '2.QAGJZ A I+f�tT1 5f ti.r., iil!Y�fl,. tf�,s4 �'`7n `�v �; -� �'�'+('.� r�1'-p4Mh. 13� j, ��1 a'�. t"5;T1i1 Oi � 1 ��.iki.d .my;..i-ia`w,...e: '�',�firc�.sl'.i.:.s,—=x'?.....,vw'k,Yr';,k. `,Sr�.�a.....n . a .d..m.,a.nx�i „t�.Y�eS+.a - �'..n,lr-Nr. .�.1. r., .c .:,�t?,�'�,�.�.'� �,'�,M .:..,v>J��'7'4:,.Y74�Y. .r.3.`.:C::.2..^a-"ftkaX.f HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHi6i DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT l O ALL THE TERMS, CONDmONS AND F�(CLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MMIDDTYY) POLICY EXPIRATION DATE(MMIODNY) LIMITS B GENERAL LIABILITY RMGL 5759120 10/1/2006 10/112007 GENERAL AGGREGATE $15,000,000.00 PRODUCTS-COMP/OP AGO $15,000,000.00 �( COMMERCIAL GENERAL LIABILITY PERSONAL & ADV INJURY $7,500,000,00 CLAIMS MADE a OCCUR OWNER'S & CONTRACTORS PROT EACH OCCURRENCE $7,500,000.00 FIRE DAMAGE (Arty one fire) $1,000,000.00 MED EXP (Any one person) $10,000.00 B B B B AUTOMOBILE X LIABILITY ANY AUTO ALLOWED AUTOS RMCA 5836480 (TX) RMCA 5B36479 (VA) RMCA 5836481 (MA) RMCA 5836482 (AOS) 10/1/2006 10/1/2006 10/1/2006 10/1/2006 10/1/2007 10/1/2007 10/1/2007 10/1/2007 COMBINED SINGLE LIMIT $7,500,000.00 BODILY INJURY (Per person) SCHEDULED AUTOS BODILY INJURY (Per aeddeM) �( HIRED AUTOS X NON•OWNEDAUTOS PROPERTY DAMAGE PROPERTY EXCESS UA131UTY EACH OCCURRENCE AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO YIOe7AMORY GfKER )( C EMPLOYERS' LIABILITY EI EACH ACCIDENT $2,000,000.00 E THE PROPRIETOPJ TIVE INCL PARTNERS/EXECUTIVE EL DISEASE -POLICY LIMIT $$,000,000.00 EL DISEASE -EACH EMPLOYEE $2,000,000.00 F OFFICERS ARE: I EXCL OTHER DESCRIPTION OF OPERAMONSAACA-nONSNEHICLES/SPECIAL ITEMS Please see page 2 for additional Insureds and any additional language. (� I r } I ".` - _ "� � s �.. 1� k ✓ yr : - is g / y� - z �+,.- i -u�x2 c tF tetA ! 1 ' "�iy�'?k'o � 'arb t�q� n�1f l �') k4 City Of Sanford Bld Dept. SHOULD ANY aF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION PATE THEREOF, THE g• P ,.. I ` INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TG THE CERTIFICATE HOLDER 300 N. Park Ave. NAMED HEREIN, BUT FAIUM TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON Sanford, Fl, 32771 TME INSURER INC. B :. COVER —, ITS AGENTS OR REPRESENTATIVES. OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: ^ �I //y.Q Katherine O'Loary, Cawatty Program LGNY4 �i(/ GYp� J �i }� i S �,1}i''w.bk.740y. T }'F `y�i�. � , ., ��,(IIIM1 tNO!N ?r; A:.s.9 -.: �=, ..«� ,,.;., �.;+n r,.d, £�si„�<� ,..x3,�a t•c.-+.3...,3, �k'F�:,i7.,� ��' s. Ib PRODUCER COMPANY I: White Mountain Insurance Co. Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 INSURED SlmplexGrinnell, LP 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32604 United States WORKERS COMPENSATION POLICIES CERTIFICATE NUMBER 309622 State CA MI FL NJ GA NV IL PA DE NY, WI OR AR,MA,TN,VA LIABILITY PROGRAM Certificate holder is added as an additional insured for General Liability, but only to the extent of the Named Insured's negligence. Additional Insureds: City Of Sanford Bldg. Dept. Project: All Projects If there is a question regarding this certificate please contact Ellen Harris (Email: eharris@tycoint.com Phone: 407-235-1100) City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fi, 32771 Carrier Policy Number Eff. Date Exp. Date (B) American Home Assurance Co. RMWC 2920280 10/1/2006 10/1/2007 (B) American Home Assurance Co. RMWC 2920292 10/1/2006 10/1/2007 AK,AL,AZ,CO,CT,DC,HI,IA,ID,IN,KS,KY,LA,MD,ME,MN,MO,MS,MT,NC,NE,NH,NM,OK,RI,SC,SD,TX,OT,VT (C) Illinois National Insurance Co. RMWC 2920289 10/1/2006 10/1/2007 (B) American Home Assurance Co. RMWC 2920287 10/1/2006 10/1/2007 (B) American Home Assurance Co. RMWC 2920290 10/1/2006 10/1/2007 (A) Al South Insurance Co. RMWC 2920281 10/1/2006 10/1/2007 (E) National Onion Fire Insurance Co. RMWC 2920283 10/1/2006 10/1/2007 (C) Illinois National Insurance Co. RMWC 2920286 10/1/2006 10/1/2007 (B) American Rome Assurance Co. RMWC 2920291 10/1/2006 10/1/2007 (B) American Home Assurance Co. RMWC 2920285 10/1/2006 10/1/2007 (F) New Hampshire Ins. Co. RMWC 2920282 10/1/2006 10/1/2007 (E) National Onion Fire Insurance Co. RMWC 2920284 10/1/2006 10/1/2007 (D) insurance Company of the State of PA RMWC 2920288 10/1/2006 10/1/2007 CERTIFICATE NUMBER 309622 State CA MI FL NJ GA NV IL PA DE NY, WI OR AR,MA,TN,VA LIABILITY PROGRAM Certificate holder is added as an additional insured for General Liability, but only to the extent of the Named Insured's negligence. Additional Insureds: City Of Sanford Bldg. Dept. Project: All Projects If there is a question regarding this certificate please contact Ellen Harris (Email: eharris@tycoint.com Phone: 407-235-1100) City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fi, 32771 CITY OF SANFORD FIRE DEPARTMENT FEES` FOR SERVICES li:HONE # 407-302-1091 * FAX #: 407-330-5677 DATE:PERMIT BUSINESS NAME/PROJECT: ADDRESS: a 3� ► PHONE NO.: o o FAX NO.: C CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEW ?.1 F. A. [ ] F. S. [ ] HOOD [ ] PAINT BOOS -I [ ;.— BUR RM[T TENT PERMIT ] TANK PERMIT [ ] OTHER f4 Xa— rI TOTAL FEES: $ 0 �® (PER UNIT SEE BELOW) Address / Bldg. # / Unit # Square Footage Fees per Bldg. / Unit 1. 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 4 -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. -7::�I)�4L Sanford Fire Prevention Di sion Applicant's Signature 0