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HomeMy WebLinkAbout2841 Central DrPermit # : 0-7- 2,04 - Job 04 - Job Address: e29 1-k k Lal Description of Work: Historic District: CITY OF SANFORD PERMIT APPLICATION Date: -X-LA-TAA-,C- +0 ik. k! U. Total ,,iS1quare Footage Zoning: Value of Work: $ Lm• cio Permit Type: Building Electrical J Mechanical Plumbing Fire Sprinkler/Alarm 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 Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) Owners Name & Address: � a $ y X QSL,,�-ICa-9, �WLi Je-AW-ok Contractor Name & Address: LX -.,Z J 3 N CO d -A-. lA'7 C Phone & Fax: Bonding Company: Address: Mortgage Lender: _ Address: Architect/Engineer: Address: Phone: 14 al 1 _ 3 al - "1"l ot-0 " State License Number.C Contact Person: e.Q �.�� o �+u hone: Phone: Fax: 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, 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 managem�-S713 agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Flo to Signature of Owner/Agent Date Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPROVALS: ZONING: Special Conditions: Rev 03/2006 UTIL: FD: ggnature of C or/?kgeint q Date ,tag • s Name iso j I ion Vry-State of Florida Date Contractor/Agent is ✓Personally Known to Me or Produced ID ENG: BLDG: MICHELLE S000SK1 Notary Public -State of Florida . •_My Commission Expires Jan 8, 2010 "o` Commission # DD 504640 Bonded By National Notary Assn. �L� ELECTRICAL SERVICES, INC. 109 COMMERCE ST, LAKE MARY, FL 32746-6206 POWER OF ATTORNEY May 7, 200'I Dear Sir/Madam: This letter is written to give authorization for /�- r ��� to pull an electrical permit for Del Air Electrical Services for Daniel Puglisi Electrical Contractor EC 0001663 Del Air Electrical Services, Inc ICU NVOness A c'#'1--?.A�.P�� itness THIS INSTRUMENT WAS ACKNOWLEDGED BEFORE ME T ''1 DAYC' BY a WHO IS PERSONALLY KNOWN TO ME. SIGNAT07W OF NOTARY PUBLIC " MICHELLE SODOSKI Notary Public - State of Florida • =My Commission Expires Jan 8, 2010 :N� 4 S -Ty 1 Jam` Commission # DD 504640 Bonded By National Notary Assn. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID P DATE (MM/DDIYYYY) DELAELE 05/26/06 -oDucEh THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EFFECTIVE DATE MMIDD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE olfe Davis Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND -OR- P -0. Box 945255 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Maitland FL 32794-5255 Phone : 407-691-9600 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA Amerisure Mutual Ins. Co. 23396 INSURER B: Great American Insurance Co. Del -Air Electrical Services, INSURER C: Inc P 0 BOX 520522 MED EXP (Any one person) $ 10000 Longwood FL 32752-0522 INSURERD: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBERICY EFFECTIVE DATE MMIDD POLICY EXPIRATIONLIMITS DATE (MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR GL2037417 06/01/06 06/01/07 PREMISES(Eaoocurence) $ 300000 MED EXP (Any one person) $ 10000 X Contractual Liab PERSONAL BADV INJURY $ 1000000 X Per Project Aggre GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $2000000 POLICY PRO- JECT LOC A AUTOMOBILE X LIABILITY ANY AUTO CA2037415 06/01/06 06/01/07 COMBINED SINGLE LIMIT $ 1000000 (Ea accident) X X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ B EXCESSIUMBRELLALIABIL.IIY X, OCCUR FICLAIMSMADE SBU595778 06/01/06 06/01/07 EACH OCCURRENCE $ 5000000 AGGREGATE $ 5000000 $ DEDUCTIBLE $ X RETENTION $ 10000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC2037419 06/01/06 06/01/07 X I TORY LIMITS ER E.L. EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYE $500000 E.L. DISEASE -POLICY LIMIT I $500000 SPECIALPROVISIONSbelow OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The General Liability policy includes a blanket additional insured endorsement for the Certificate Holder if required by written contract. Liability is limited to loss or damage arising out of negligent acts of the insured. *Except as required by Florida Statute. CERTIFICATE HOLDER CANCELLATION CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Sanford IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 300 N Park Avenue REPRESENTATIVES. Sanford FL 32771 ¢ REPRESENTATIVE AGUKU Zb (ZUUIIUt$) © ACORD CORPORATION 1988