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Home My WebLink About1500 W 12 StJUN 1 2012 CITY OF SANFORD WILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 1,�2--' q3 Documented Construction Value: $ `7 i 0 -0 Job Address: 15-60 [, % 44 om J Historic District: Yes 0 No 0 Parcel [D: Zoning: / Description of Work: nn�v �. ¢-� l ��r' 4-'%.? oci Plan Review Contact Person: Title: Phone: Fax; x-E-mail:C1oI'o r�•e'l r'iCez p fory,cq Name Street City, State Zip: Property Owner Information Phone: Resident of property? : Contractor Information Name roT4 n Phone: 7o 7:9 o - � Street:�3� G —Y1PFax:.3sa City, State Zip: ��p�L + ?�77 State License No.: 46" 30 a 7a7.-2 Name: Street: City, St, Zip: Bonding Company: Address: Building Permit 0 Square Footage: _ Architect/Engineer Information Phone: Fax: E-mail: Mortgage Lender: Address: PERMIT INFORMATION Construction Type: No. of Dwellin Units: Flood Zone: Electrical New Service - No. of AMPS: Mechanical it (Duct layout required for new systems) No. of Stories: Plumbing 0 New Construction - No. of Fixtures: Fire Sprinkler/Alarm 0 No. of heads: 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, beaters, 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, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. 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. The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the plan review fee based on past permit activity levels. Should calculated charges exceed the documented construction value when the executed contract is submitted, credit will be applied to your permit fees when the Signature orNotary-State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID APPROVALS. ZONING: ENGINEERING: COMMENTS: Rev 11.08 UTILITIES: za Contractor/Agent v Date P int Co ra for/Agent's Name Signature orNotary-S ate of Ft rida Date FIRE: Contractor/ Produced it ""e or BUILDING: CITY OF SANFORD Fa<, " Contractor Registration Application I JUN 10 2012 300 N. Park Avenue, P. O. Box 1788, Sanford, FL 32772-1788 Phone: 407.688.5150 Fax 407.688.5152 ITYk?. Date: 6 Business Name: Business Mailing Address: —130) �V a, - �� 2 City: JC rr e& o, State: L Zip: _�a 7 2(2 Business Phone: Email: avrbr'el a�c�_7Ti� (%t Name of Qualifier on State License: State License Classification: State License Number: yppncani s oignawm All contractors will pay an annual $10.00 registration fee State Certified Contractors: State license from Department of Business and Professional Regulation. Certificate of Workers Compensation - The City of Sanford listed as the Certificate Holder. This can be faxed to 407.688.5152, but MUST come from the insurance agent/company. Certificates from contractor's offices are not accepted. State Registered Contractors: State license from Department of Business and Professional Regulation. • $2,000 surety bond — the City of Sanford shall be listed as the bond holder. Copies, faxes or binders will be not be accepted. • Letter of Reciprocity — must be mailed — it cannot be faxed or hand -carried from the municipality where the exam was taken. Competency Card Initial $75.00 Renewal $60.00 (every two years) • Certificate of Workers Compensation - The City of Sanford listed as the Certificate Holder. This can be faxed to 407.688.5152, but MUST come from the insurance agent/company. Certificates from contractor's offices are not accepted. Specialty Contractors • All specialty contractors that are not licensed by the State of Florida will be assessed a $10.00 registration fee. • $2,000 Surety Bond — the City of Sanford shall be listed as the bond holder. Copies, faxes or binders will not be accepted. • Certificate of Workers Compensation with the City of Sanford listed as the Certificate Holder can be faxed to 407.688.5152, but MUST come from the insurance agent/company. Certificates from contractor's offices are not accepted. // Control # � �� City Registration # i 310 � 7 1 Jun.15. 2012 3:31PM No. 1985 P. 1 ACOffO®CERTIFICATE OF LIABILITY INSURANCE D IDD/Y 6/15//15/ 20122 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF. INSURANCE DOES NOT CONSTITUTE A CONTRACT' BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LRA Insurance 498 3 Lake Destiny Rd Orlando FL 32810 CONTACT NAME; DAidre Padgett PHoNF No (d07) 838-3445 FAQ Ne: (107)0]5-3660 E ,AIE .,dpadgett@Irainsurance.com INSURER(B) AFFORDING COVERAGE NAIL q INSURERA:Zenith Insurance Company 13269 INSURED T North Enterprises LLC DBA: Aurora Electric 33244 CR 437 Sorrento FL 32776 INSURER B : INSURER C: INSURER D: INSURERE. INSURER F: COVERAGES CFRTIOCATF NUMRFR:CL1231917239 RFVIRION NlrMBFR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Sanford POLICY NUMBER POLICY EFF IMMIDDNYY1A POLICY EXP (1111MIDDIVYYY UM)T8 Sanford, FL 32771 OEN6RAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR John Cox/DEB EACH OCCURRENCE • S E Ea ocn xe $ MED EXP (Any one person) $ PERSONAL 6 ADV INJURY S GENERAL AGGREGATE S GEWL AGGREGATE LIMIT APPLIES PER: POLICY M PRO- LOC PRODUCTS - COMPIOP AGG $ S AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS ' HIRED AUTOS NON COMBINW SINULt047— IMANY BODILY INJURY (Per person) E BODILY INJURY (Por aocideno & PRPERTY DAMAUt r amwen1lS E 4 UMBRELLA LIAR EXCESS LUIS OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE 3 OED RETENTION& S A WORKERS COMPENSATION AND EMPLOYERV LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUrIVE OFFICERIMEMBER EXCLUDED? (Mandatory is) NH) d Yes. deecdbe under DESCRIPTION OF OPERATIONS below NIA 071321902 /18/2012 /18/2013 X WC STATU I JOTH E.L EACH ACCIDEWT 100,000 1E.LDISEASE -EAEMPLOYE 5 100,000 E.L. DISEASE - POLICY LIMIT & 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addition Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION (407) 688-5152 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Sanford ACCORDANCE WITH THE POLICY PROVISIONS. 300 N Park Ave AUTHORIZED REPRESENTATIVE Sanford, FL 32771 John Cox/DEB ACORD 25 (2010106) INS025 (Yoioo6).oi ®1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r% o% m wA;,4 Ci wo FACILITI ,j-'.mAC-HINES'!',l4- 1_,,'R0O,MS--!:w %c -S IYPE;-" OF' .,,2CONTRACTING", -BUSINESS -BUSINESS-,-iAU :ELEC 7. -'105904'Z ,ACCT NO C -COUNTY -BUSINESS TAX, RECEIPT, _'.- -ATE"O F. FLORIDA EXPIRES,:, SEPTEMBER 30-2012 IPLOYEES ., -i, .:. . Ok6INAL TAX:0 tit. Vr er, we -.r. WN 'FEE.,v; 0*00. 01!4 7 ''AMOUNT W 30.0 .,ToTA'00. L o" w'DUE $0. W. LP Cr 7- 51, Recei6i'.'i20.*11;.6007732.'t 7- 4C x .46id. 09/26/"20r,,l,.%-,)30.00 WIC Electrical Outfitters, Inc. PO Box 449 Astor Fl. 32102 Date: June 11.2012 Job Name: New Salem Baptist Church 1500 W. 12" St. Sanford, Fl. 32771 PROPOSAL Electrical Outfitters Inc. is pleased to submit the following quotation for labor, materials, equipment, and supervision to perform the following scope of work. Description: Electrical wiring for modifications to interior walls and ceiling Work Involves: • Provide labor and material to install wiring for 10 ceiling fluorescent light fixtures and 3 wall outlets • Provide labor and material to install fixtures and outlets Total Amount: $1970.00 All material as specified and all work to be performed in a workmanlike manner per the above dated plans and specifications. All alterations or deviations will be by written order and subject to additional charges. All job duration re uirements contingent upon strikes, accidents, acts of God and delays beyond our control. Submitted by: Troy Signature: Accepted By: Signature: y ,}mss 3'�Cv Date: `rj crj G� �/C/G�s,Date -//- Er -)l &— // - ZO /Z