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Home My WebLink About222 Towne Center Cir (3)I I RECEIVED 09~ 30-) CITY OFSANFORDPERMIT APPLICATION OCT 2 0 2006 Permit #: O Date: /v — / l Q(P Job Address: 2Z7 —TP)cxwtrfl ( rO.n4-e Description of Work: Historic District: Coning: Value of Work: S) Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarrn'ZiL Pool Electrical: New Service — # of AMPS AdditiordAlteration _eK_ 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: State License Number: CoPIICU Y 1CO-01zc70/ N Phone & Fax: 7— 23.S -1--co Contact Person: /r!1 wn L Phone: 07- 23s 1pyo Bonding Company: Address: Mortgage Lender: Address: Architect/ Engineer; Phone: Address: 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 I will notify the owner of the property of the regyittmentsAf Florida Lien La r. 713. Signature of Owner/Agent Date Si nature o ontr for/Agent Date CP Print Owner/ Agent's Name Print Co A s in _ Signature of Notary -State of Florida Date Signature of No -Slat of Florida Date Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Pe ovally Known to a or Produced ID ` 01 1 _ Produced ID Eli APPLICATION APPROVED BY: Bldg: Zoning: Initial & ate) Special Conditions: Utilities: Initial & Date) ( Initial & Date) R ")0. E Tyco Fire & Security Simplex Grinnell MAY 15, 2006 3701 North John Young Parkway Suite 110 Orlando, FL 32804 407) 235-1100 Phone 407) 235-1150 Fax POWER OF ATTORNEY 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 GEOR~G-- aEr\. 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. WZ NOTARY PUBLIC STATE OF FLORI PAMELA A . MCELROY Notary Public, SMae°2il ride MY comm. exp. . Comm. No. DD 411691 0 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES Aft DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY THIS CETt7MES THAT: GORGE E MILLER I M55 FORTUNE PARKWAY BUIIDING 500 SUITE 120 JACKSONVILLE, FL 32256• BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP COHNTRACTOR n 15 L"TED TO THE EXECU`M N OF CONTRACTS REQUIRING THE ABILITY TO LAYOUT. FABRICATE, INSTALL, INSPECT, AI;TER, OR SERVICE WATER SPRD KM SYSTEMS, WATER SPRAY SYSTEMS. FOAM -WATER SPRINKLER SYSTEMS, FOAM - WATER SPRAY SYSTEMS, STANDPIPES. OOi INA710N STANDPIPES AND SPRINKLER RISERS, ALL PIPING THAT IS AN INTEGRAL PART OF THE SYSTEM REG WMNG AT THE POINT OF SERVICE, SPRINKLER TANK HEATERS, AIR 124M TIONAL SYMW USED IN CONNECTIONWITHSPRINKLER$ AND TANKS AND PUMPS CONNECTED 7MRETO. EXCLUDING SYSTEMS. i 01 12M 1 07 1 16 IDuval Issue Date jTypcjClmjCoumy 60476500012001 LkwwJPeamit Number Cbicf ETeaoelal 011icer 7626340001 150.00 10613012008 Appikoi. 0 Taney t Fees I Eapbe Dale 7 CERTIFICATE NUMBERCERTIFICATEOFINSURANCEVG309622 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. COMPANY D: Insurance Company of the State of PA COMPANY E: National Union Fire Insurance Co. COMPANY F: New Hampshire Ins. Co. SimplexGrinnell, LP 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32804 United States 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 LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS B GENERAL LIABILITY RMGL5759120 10/1/2006 10/1/2007 GENERAL AGGREGATE 15,000,000.00 X COMMERCIALGENERALLIABILITY PRODUCTS -COMP/OPAGG 15,000,000.00 PERSONAL & ADV INJURY 7,500,000.00CLAIMSMADE OCCUR 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 AUTOMOBILE LIABILITY X ANY AUTO RMCA 5836480 (TX) RMCA 5836479 (VA) 10/1/2006 10/1/2006 10/1/2007 10/1/2007 COMBINED SINGLE LIMIT 7,500,000.00 B B ALLOWED AUTOS RMCA 5836481 (MA) RMCA 5836482 (AOS) 10/1/2006 10/1/2006 10/1/2007 10/1/2007 BODILY INJURY (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE PROPERTY EXCESS LIABILITY EACH OCCURRENCE AGGREGATE UMBRELLA FORM OTHER THAN UMBRELLA FORM g C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X YRSAMO Y OTRER EL EACH ACCIDENT 2,000,000.00 A THE PROPRIETOR/ INCLPARTNERS/EXECUTIVE EL DISEASE -POLICY LIMIT 2,000,000.00E 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 CityOf Sanford Bldg. Dept. 9• P 300 N. Pall( Ave. Sanford, A, 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 I IEREIN, 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: Katherine O'Leary, Casualty Program ea1Q1Y4 . /" a,_ MM1( 3/Q2) VALID AS OF: 10/5/2006 r ADDITIONAL INFORMATION CERTIFICATE NUMBER 309622 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 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/l/2006 10/l/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/l/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/l/2006 10/1/2007 NJ A) Al 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/l/2007 IL B) American Home Assurance Co. RMWC 2920291 10/1/2006 10/1/2007 PA B) American Home Assurance Co. RMWC 2920285 10/l/2006 10/1/2007 DE F) New Hampshire Ins. Co. RMWC 2920282 10/l/2006 10/l/2007 NY,WI E) National Union Fire Insurance Co. RMWC 2920284 10/l/2006 10/1/2007 OR D) Insurance Company of the State of PA RMWC 29202B8 10/l/2006 10/1/2007 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) CERTIFICATE HOLDER City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, FI, 32771 CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES r PHONE # 407-302-2516 - FAX # 407-302-2526 DATE: d o 3 ` a PERMIT #:U BUSINESS NAME / PROJECT: '\ V *J •A ADDRESS: U t„r-= Ca Ci*/ PHONENO.:h*2 0 3{-%O FAXN(L) -03S —/000 CONST. INSP. [ ] C / O INSP.:[ ] F. A. [ ] F.S. [ 1 HOOD TENT PERMIT J TANK PERMIT TOTAL FEES: S 0 •0t> COMMENTS: 2. 3. 4. 5. 6. 7. 8. 9. 10. REINSPECTION [ 1 , PLANS REVIEWPAINTBOOTH [ BURN PE MI ] OTHERA PER UNIT SEE BELOW) Address / B1dQ. # / Unit # Square Footat?e Fees uer Bld¢. / Unit 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. Z 4 )-Av Sanfor ire Prevention Division Applicant's Signature