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Home My WebLink About262 Towne Center Cir (2)07 AIPermit #: Job Address: Description of Work: RECEIVED CITY OF SANFORD PERMIT APPLICATION lj c 0 5 ?006 41 Z_4i oGDate: Historic District: 'Coning: Value of Work: 3Z Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm _A Pool Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Poly_ Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures _ Plumbing/ New Residential: # of Water Closets of Water & Sewer Lines # of Gas Lines Occupancy Type: Residential Commercial )f_ Industrial Plumbing Repair — Residential or Commercial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel 0. Owners Name & Address: Contractor Name & Address: Phone & Fax: =tw Bonding Company: Address: Mortgage Lender: Address: Architect/ Engineer: Address: Contact Person: Attach Proof of Ownership & Legal Description) Phone: License Phone: Fax: 3Z1- 2(ox - .V;76 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. 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: 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 1 will notify the owner of the property of thereuire of Florida Lien Law, F5 713. y x. / 2 Signature of Owner/Agent Date Z4-17 o C tractor/Agent Date Print Owner/ Agent's Name Print Contractgr gc 's me Signature of Notary -State of Florida Date Signature of N tary- tale of Florida Date MISAEL ALICEA~ Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ ersonally Known `y''' COMMO DD=1100 S Produced ID Produced ID :' nae ti APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: efte Initial Date) ( Initial & Date) (Initial & Date) (I vial Date) Special Conditions: I Two 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 l 5, 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 2005n 2- "n NOTARY PUBLIC STATE OF .FLORlbA PAMELA A . MCELROY Notary Public, SWO o2Fl ride My Comm. exp. 4117, 2009 Comm. No - Do lu STATE OF FLORIDA DEPARTMENT,OF FINANCIAUSERVICES DIVISION OF STATE FIRE MARSHAL TALLAHASSEE, FLORIDA CERTIFICATE OF COMPETENCY w"°r THIS CERTIFIES THAT: GEORGE E MILLER 10255 FORTUNE PARKWAY BUILDING 500 SUITE 120 JACKSONVILLE, FL 32256- BUSINESS ORGANIZATION: SIMPLEX GRINNELL LP CONTRACTOR 11 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 [TyptiClassl County 60476500012001 License/Permit Number Chief Financial Officer,. 7626340001 1 150.00 10613012008 Application M I Taxes & Fees I Expire Date Earl K. Wood, Tax Collector Occupational License Orange County, Florid; Thisdicense is In addition to and not in lieu of any other license, recl6ired by law or mnninpai ordinance. It is subject to regulation of Xining, health and any other'lawt authority. it is valid from October 1 through September 30 gflicense ,year. Delinquent. penalty is added October 1, ORIGINAL*** 2006` EXPIRES 9/30/2007 3121 0.537842 3121 CERT ALARM/FIRE CONTR " $225,00 100-EMPLOYEES. c 4 t fd, 81Mp EX GRINNELL LF . TOTALTAX $225i00 y {t'ANLICENSINC i PREVIOUSLYPAID $ 0.00 a'r a i;+ 5 f OtE30X 3042 ?„ TOTALDUE $225,00 t tRy ON E L,,3 i4 S'i t43bCf j}; 46l 3701 N JOHN YOUNG PY #110 1'6•RA,'f,I CHAE'r QUALI,FIF..R A ORLANDO 32804 9/21/2006. 02:48 M Csh 00,15 Reg 0024 k } r6 011pf 0024006834 D&I: 9/21/2006 225 00 Uel No: 0024 005542 ii " Ad DI L 0 10 iF ThisformbecomesareceiptwhenvalidatedbytheTaxCollector. Earl K. Wood,.Tax Collector - This. hcensc Occupational License Orange County; Florid is in addition to and not,In lion of any other license required by law or munleipal ordinance, It issubiecf to rogulation of zoning, health end any other law authority. It is valid from Octubnr 1 through Septenibor 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! G f 1 TOTAL TAX $70.00 1 EX GRINNE!_L Lh WHO XPREVIOUSLY PAIL $ 0.00 C 13.ONFL 33431,-0942' CA hKATNTOTALDUE $70.00 S 3701 N JOHN YOUNG PY #110 i SRUCFIANAN MICAHEL PRESIDENT A - ORLANDO, 32804 M , tt " A, 19/2006 12:46 PN , rsh 0046 Reg 0024 g i/Rpf 0024006G56 0&I: 9/19/2006 w:.-i • w" M 00 Vol No: 0024-005329 This form becomes a receipt when validated by the Tax Collector. CERTIFICATE OF INSURANCE CERTIFICATE NUMBER 309622 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 _ SimplexGrinnell, LP 3701 N. JOHN YOUNG PARKWAY ORLANDO, FL 32804 COMPANY E: National Union Fire Insurance Co. 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 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 (MMIDD/YY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS B GENERALLIABILITY RMGL5759120 10/1/2006 10/1/2007 GENERAL AGGREGATE 15,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS -COMP/OPAGG 15,000,000.00 PERSONAL & ADV INJURY 7,500,000.00CLAIMSMADEFx_1 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 AUTOMOBILE LIABILITY RMCA 5836480 (TX) 10/1/2006 10/1/2007 COMBINED SINGLE LIMIT 7,500,000.00 B B B X ANY AUTO ALLOWED AUTOS RMCA 5836479 (VA) RMCA 5836481 (MA) RMCA 6836482 (AOS) 10/1/2006 10/1/2006 10/1/2006 10/1/2007 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 UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO X vncalAMonr oTB11B owns 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 2.000,000.00 IFOFFICERSARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/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 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION PATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TIEREIN, 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: 60v A y Q_ J(/ f KatharineO'Leary, Casualty Program h Y MM1( 3/02) VALID AS OF: 10/512006 r PRODUCER 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 ADDITIONAL INFORMATION ' CERTIFICATE NUMBER 309622 COMPANIES AFFORDING COVERAGE COMPANY I: White Mountain Insurance Co. WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date State B) American Home Assurance Co. RMWC 2920280 10/l/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/l/2007 FL B) American Home Assurance Co. RMWC 2920290 10/l/2006 10/l/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/l/2006 10/l/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/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 r! CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-2516 - FAX # 407-302-2526 DATE: Q1 Ql)—c' BUSINESS NAME / PROJECT: ADDRESS: 01-919 PHONE NO.: -a / (00 FAX NO.: 22 ! -- CONST. INSP. ( C / O INSP.:[ ] REINSPECTION [ ] . PLANS REVIEW [ ] F. A. [ ] F. HOOD [ ] PAINT BOOTH [ 1 BURN PERM[ TENT PERMI NK PERMIT (] OTHER _ T TOTAL FEES: S 'Da (PER UNIT SEE BELOW) s 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 # -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 J6)will comply with all applicable codes and ordinances of the City of Sanford, Florida. Sanford Fire Prevention Division Applicant's Signature