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HomeMy WebLinkAbout220 Towne Center Cir (2)CITY OF SANFORD FEZ'MIT APPLICATION RECEIVE Permit # : Job Address: Description of Work: Historic District: Date: / 6 -0 CgEP 6 20 , Zoning: Value of Work: 5 CDC S y Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm L— 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 --A— 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) W Phone: State License Number: LDE,*'f Phone & Fax: VQ— 21- //0O cD7 —Z3 //$U Contact Person: EVh Phone: 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 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: 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 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. Signature of Owner/Agent Date Signature ontractor/Agent Date G)......................................... Print Owner/Agent's Name Print ontract r/Agenntt's Name 1r11SAEL ALICEA 1 1 *ram CommM DD029wce Signature of Notary -State of Florida Date Signature of Notary -State of Florida ! I t ttawe0 tlau (800jr32 2• Owner/Agent is _ Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg: Zoning: Initial Date) Special Conditions: Contractor/Agent is Personally Kno to Me or Produced ID -- Utilities: FD: Initial & Date) (Initial & Date) (Initial • Date L STATE OF FLORIDA DEPARTMENT OF FINANCUIL SERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY qw THIS CERTIFIES THAT: GEORGE E MILLER 10235 FORTUNE PARKWAY BUIIDfM 50D SUITE I20 JACKSONVILLE, FL 32256- BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR U IS LIMITED TO THE EXECU`IW i OF CONTRACTS REQUIRING THE ABILITY TO LAYOUT, FABRICATE. INSTALL, INSPECT, ALTER, OR SERVICE WATER SPRINKLER SYSTEMS, WATER SPRAY SYSTEMS, FOAM WATER SPR13WA.ER SYSTEMS, FOAM WATER SPRAY SYSTEMS. STANDPIPES, QOMBENAT ION STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT IS AN INTEGRAL PART OF THE SYSTEM BEG1Np M AT THE POINT OF SERVICE. SMDWJ 6R TANK HEATERS, AIR LINES. THERMAL SYSTEMS USED IN CONNECTION WITH SPRINKLERS, AND TANKS AND PUMPS CONNECTED TII MM. EXCLUDING MEaqGINEERM SYSTEMS. 101 12M 1 07 j 16 IDuval Issue Date Type class Coumy 60476500012001 LkMwAbomit Number Chief Finaoeid OlTieer 7626340001 150.00 10613012008 Application r Taxe; t Fees I Expire Date M 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 151,2006 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 T _ -Wl GEORGE & 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 FLORIDA PAMELA A. MCELROY Notary Public SMae.01 Fl 2 da My comm. exp. Comm. No. DD 01691 CERTIFICATE OF INSURANCE CERTIFICATE NUMBER 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 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 COMPANIES AFFORDING COVERAGE _ Telephone (212) 345-5000 COMPANY A: Al 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 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 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. COLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS B GENERALUABIUTY RMGL5749708 10/1/2005 10/1/2006 GENERAL AGGREGATE 15,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG 15,000,000.00 CLAIMS MADE OCCUR PERSONAL 6 ADV INJURY 7,500,000.00 EACH OCCURRENCE 7,500,000.00OWNER'S 6 CONTRACTOR'S PROT FIRE DAMAGE (Anyone fire) 1,000,000.00 MED EXP (Any one Person) 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 1 0/1 /2006 BODILY INJURY (Per person) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE PROPERTY ESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATEFBWORIKERSOTHERTHANUMBRELLAFORM COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO WC STATUTORY OTHER Lkl'SPLOYERS'LABILITY C PROPRIETOR/ PARTNERS/EXECUTIVE INCL EL EACH ACCIDENT 2,000,000.00 EL DISEASE -POLICY LIMIT 2,000,000.00 F OFFICERS ARE: EXCL EL DISEASE -EACH EMPLOYEE 2,000,000.00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/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. 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 Sanford, Fl, 32771 THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES. OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: y% Katherine O'Leary, Casualty Program IQ '`/ MM1(3/02) VALID AS OF: 10/1012005 ADDITIONAL INFORMATION PRODUCER 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 WORKERS COMPENSATION POLICIES CERTIFICATE NUMBER 236827 Carrier Policy Number Eff. Date Exp. Date State B) American Home Assurance Co. RMWC6610498 10/1/2005 10/1/2006 CA E) National Onion 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) CERTIFICATE HOLDER City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, FI, 32771 CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-2516 - FAX # 407-302-2526 DATE: PERMIT Co -3 BUSINESS NAME /PROJECT: ., r I 1 C", ADDRESS: © ` U J-e_ C%3 VL! C'V (-z, PHONE NO.: CONST. INSP. [ ] F. A. [ ] F.S. TENT PERMIT f 1 , TOTAL FEES: $ COMMENTS: 2. 3. 4. 5. 6. 7. 8. 9. 10. 12. 13. 14. 15. 16. 17. 18. 19. 20. C / O INSP.:[ j HOOD [ TANK PERMIT [ Q , mo Address / Blde. #t / Unit #! FAX NO.: REINSPECTION [ ] , PLANS REVIEW 1 PAINT BOOTH [ J Z MIT 1 OTHER [`] PER UNIT SEE BELOW) Square Footage Fees per Bldg. / Onit- Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone N -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. Sanford Fire Prevent vision Applicant's Signature