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Home My WebLink About165 Towne Center Cir (2)01-aaa Permit # Job Address: Description of Work: Historic District: CITY OF SANFORCt,'ERMIT APPLICATION Date:-9— Zoning: Value of Work: S_.S Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm X 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 #: Owners Name & Address: Contractor Name & Address: Attach Proof of Ownership & Legal Description) Phone: _ c ?/c Li State License Number: POy7(o 7J00/ Zoo / 0L 2 3s -// 6Phone &Fax: OU /1b7- 23 '/ 5-U Contact Person: 2 Ladt /Z 1 Phone: .32 (- ZCe,3-zj Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: Phone: Fax: 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 theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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 the requi is of Florida Li w,FS 713. Signature ofOwner/Agent Dateature of ont ctor/Agent Date r-- Print Owner/Agent's Name Pri Contractor/Agent's Name r Signature of Notary -State of Florida Date Signature of Owner/Agent is _ Personally Known to Me or Produced ID zl s APPLICATION APPROVED BY: Bldg: Zoning: Initi I & Date) Special Conditions: Contractor/Agent is. Produced ID _ Utilities: Initial & Date) d(r:1L`____ Florida Comma OD0291406 Eroiraa 2M8r1008 Bonftd on (80014U a FD: I 11 t 1ate) Initial & Date) (Initial & 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 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 V GEORGE 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 2005. NOTARY PUBLIC STATE OF FLORIDA PAMELA A . MCELROY Notary Public, State 2Ti 2009 My Comm. exp. • 411T, Comm. No. DD STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY THIS CERTIFIES THAT: GEORGE E MILLER 1023S FORTUNE PARKWAY BVI.DINQ "D SUITE 120 IACKSONVILLE, FL 322%, BUSDMU ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR 11 IS LIMITED TO THE E?IEcunoN Of CONTRACTS REQUIRING THE ABILITY TO LAYOUT, FABRICATE, D BTALI., INSPECT, ALTER, OR SERVICE WATER SPRDWJXR SYSTEMS, WATER SPRAY SYSTEMS, FOAM -WATER SPRINKLER SYSTEMS, FOAM -WATERSPRAYSYSTEMS, STANDPIPES, COMBINATION STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT IS AN EMS,FOAM PART E THESYSTEMBEGINNINGATTHEPOINTOFSERVICE, SPRINKLER TANK HEATERS, AIR LINES. THERMAL SY$TFAN INTEGRALUSEIN CONNECTION T WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED THER,I;TQ, EXCLUDING PRE4ENGINEERED SYSTEMS. Cmd Fwascial poky gk 07 01 2006 1 07 1 14 Duval 6M76500012001 7626340001 1S0.00 106130120091 1issueDateITypeaWSJCoumyLkmse/Permit Number Application 0 Taxes & Fos I Expiry Data CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-2516 - FAX # 407-302-2526 DATE: BUSINESS NAME / PROJECT: ADDRESS: PHONE Nd CONST. INSP. [ ] C / O INSP.:[ ) REINSPECTION [ ] , PLANS REVI f F. A. [ ] F.S. [ .) HOOD [ ] PAINT BOOTH [ ] BURIq PERMIT[ J TENT PERMIT f ] TANK PERMIT [ J OTHER 1 TOTAL FEES: S .O (PER UNIT SEE BELOW) PERMIT #: Address / t31de. # / Unit # Square Footage Fees Der Blde. / Uni 2. 3.- 4. 5. 6. 8. 9. 10. 1- 11. 12. 13. 14. 15. 16. 17, 18. 19. 120. 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. r San ord Fire PrefKtion Division Applicant's Signature CERTIFICATE OF INSURANCE CERTIFICATE NUMBER 1 309622 PRODUCER k THIS CEK nFICATE 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 Telephone (212) 345-5000 COMPANIES AFFORDING COVERAGE _- 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 SimplexGrinnell, LP COMPANY E: National Union Fire Insurance Co. 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32804 United States COMPANY F; New Hampshire Ins. Co. COMPANY G: New York Marine & General Insurance Co. (Lead) COMPANY H: Noetic Specialty Insurance Company COVERAGES 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/DDNY) DATE (MMIDD/YY) B GENERAL LIABILITY RMGL5759120 10/1/2006 10/1/2007 GENERAL AGGREGATE 15,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG 15,000,000.00 PERSONAL & ADV INJURY 7,500,000.00CLAIMSMADEClOCCURJ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 7,500,000.00 FIRE DAMAGE (Any one fire) 1.000,000.00 MED EXP (Any one Person) 10,000.00 B B g B AUTOMOBILE LIABILITY ANY AUTO ALLOWED AUTOS RMCA 5836480 (TX) RMCA 5836479 (VA) RMCA5836481 (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 X BODILY INJURY (Per penson) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) NON -OWNED AUTOSX PROPERTY DAMAGE PROPERTY EXCESS LIABILITY EACH OCCURRENCE AGGREGATEUMBRELLAFORM OTHER THAN UMBRELLA FORM B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X we srnruroxr OTHER uNrrs EL EACH ACCIDENT 2,000,000.00 A E THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL EL DISEASE -POLICY LIMIT 2,000,000.00 EL DISEASE -EACH EMPLOYEE 2,000,000.00FOFFICERSARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language. CERTIFICATE HOLDER CANCELLATION City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fl, 32771 NSGURER AFFORDING COVERAGE WILL D ANY OF THE POLICIES I ENDBED EAVOR TO MAIL 30 DAYS WRITTEN NOTICE ION OEREINBECANCELLEDBEFORETHETTHEDCERTFCATATETHEREEHODER 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- Katherine O'Leary, Casualty Program ea"1101 [/ J ' r- MM7(3/02) VALID AS OF: 10/5/2006 ADDITIONAL INFORMATION PRODUCER CERTIFICATE NUMBER 309622 COMPANY I: White Mountain Insurance Co. Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 IINSURED SimplexGrinnell, LP 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32804 United States WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date State B) American Home Assurance Co. RMWC 2920280 10/1/2006 10/1/2007 CA 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,UT,VT C) Illinois National Insurance Co. RMWC 2920289 10/1/2006 10/1/2007 MI B) American Home Assurance Co. RMWC 2920287 10/1/2006 10/1/2007 FL B) American Home Assurance Co. RMWC 2920290 10/1/2006 10/1/2007 NJ A) AI South Insurance Co. RMWC 2920281 10/1/2006 10/1/2007 GA E) National Union Fire Insurance Co. RMWC 2920283 10/1/2006 10/1/2007 NV C) Illinois National Insurance Co. RMWC 2920286 10/1/2006 10/1/2007 IL B) American Home Assurance Co. RMWC 2920291 10/1/2006 10/1/2007 PA B) American Home Assurance Co. RMWC 2920285 10/1/2006 10/1/2007 DE F) New Hampshire Ins. Co. RMWC 2920282 10/1/2006 10/1/2007 NY,WI E) National Union Fire Insurance Co. RMWC 2920284 10/1/2006 10/1/2007 OR D) Insurance Company of the State of PA RMWC 2920288 10/1/2006 10/1/2007 AR,MA,TN,VA ILIABILITY 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 11 Earl'K. Wood, Tax Collector Occupational License` Orange County,'Flori This, license is In addition to and not In lieu of any other license required by law i)r municipal ordinance. It is subject to regulation of zoning, health and any other lawf authority. It is valid from October I through September30 of license year. Delinquent penalty is added October1. ORIGINAL*** 2006 EXPIRES 9/30/2007 3121-0,537842 3121 CERT ALARM/FIRE CONTR $225.00 100-EMPLOYEES; u 3 a TOTAL TAX $225;00 sI e { 51JjPl EX GRINNELL L * y8.;or f A;I'N LICENSING PREVIOUSLY PAID $0.00 € eta "t"e d TOTAL DUE $225,00 ;4' kF 'r QtDX 3042 i •ON FLj33437 t I lA T`lrh 1+'fdy rr'1''f,Y 3.701 N ,JOHN YOUNG PY #110 l',BRANT-JIfC HAECQUALIFIER A ORLANDO; 32804 9/2t/2006. 02.40 PN Csh 0045 Reg 0024 r +, f "1 ` '' „ Tifief, 0029006034 DitT:, 9/211`1006 225.00 Vel No: 0024-005542 This form becomes a receipt when validated by the Tax Collector. Earl K. Wood, Tax Collector " Occupational Lice hse'"Orange County;Flori'd This license Is in addition to and not In lieu of any other license required by law or municipal ordinance. It is subject Ip regulation of zoning, Health and any other law authority. It is valid from October.1 tbrou0h Septernber 30 of license year. Delinquent penalty is added October 1, - ORIGINAL*'* 2006 EXPIRES 9/30/2007 3502-0524870 3502 WHOLESALE -ELECTRONIC SYSTEMS70.00 40 EMPLOYEES! x3! TOTAL TAX $70.00 4,.. SI)'v I. F:X GRINNELL Ly PREVIOUSLY PAID $0.00: t O ROX 304 TOTAL DUE $70 00 _. r QOCA BATON FLr3343 0942 k f r 7i n • i r' 9 + ,x '4,,. ; I s lhY .. it t t 7:f41E '{ ' 1. 3 ' 3701 N JOHN YOUNG PY #110 ""IBUCHANAN MICAHEL PRESIDENT 9/19 200f 2;46 P 1 Csh 0046 Bee 0024AORLANDO, 32804 `` t ° i/Ref 0024006fi56 D&I: 9/19/2006fE? °'` F $ 70,00 41 No: 0024-005329 J la r ol; L This form becomes a receipt when validated by the Tax Collector.