The URL can be used to link to this page

Home My WebLink About1000 WP Ball BlvdV RECEIVED L�2005 CITY OF SANFORD PERMIT APPLICATION OL I Permit # /� Date: G �O PjE/2 26 0 Z.OQ� Job Address: � 0C30 1rV i 691dl.`/c) Description of Work: L � -EIAA _ � 9-C A-LA-yZ-M cs�%%�M Historic District: Zoning: Value of Work: $ 0 Permit Type: Building Electrical Mechanical Plumbing Fiye Sprinkler/Alarm is Pool _ Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _ Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets. Replacement New (Duct Layout & Energy Calc. Required) # of Water & Sewer Lines # of Gas Lines Occupancy Type: Residential Commercial X_ 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 #: (Attach Proof of Ownership & Legal Description) Owners Name "& Address: 0 3Z Phone: Con actor me& Address: APT SE<-Lo—i�rj 31(00 9(-,j Jk g p f� State License Number: VE O QOO 1 -tq Phone & Fax: d — 12. - I tD Z-6 I g I.3 Contact Person: W 11(l W M S M 44d /J 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. 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 management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of loci Lien L S l3. IAA /O v6s— Signature of Owner/Agent Date Signature of ontractor/Agent Date S (EPf+c/,J cA LA i5g6. Print Owner/Agent's Name Print Contractor/ ent's N Signature of Notary -State of Florida Date SignatureofWtary-State—ofXlorida Date oar pub Nancy E Gibson My Commission DDI 04472 or f` Expires March 28, 2006 Owner/Agent is — Personally Known to Me or Contractor/Agent is X Personally Known to Me or Produced ID Produced ID APPLICATION APPROVED BY: Bldg:Zoning: (Initial & Date) Special Conditions: Utilities: FD: 1 ' (Initial & Date) (initial & Date) (Initial $ It M tyco Fire & Security ADT Security Services Inc 3160 Southgate Commerce Blvd Suite 38 Orlando, FL 32806 Tele: 407-712-1620 Fax: 407-712-1813 State License # 0000949 LIMITED POWER OF ATTORNEY I hereby name and appoint Nancy Gibson, William McMahon or Pablo Vera of ADT Security Services to be my lawful attorney in fact and apply To Sanford for a fire alarm permit for work to be performed at the following location: 1000 W P Ball Blvd Job address Smokey Bones Restaurant Project Name And to sign my name and do all thins necessary to this appointment. Stephen Calabro, certi ed contractor, License #EF0000949 Personally known to me and acknowledged: Sworn to and subscribed before me this Notary Public, t/of Florida. 076 A- day of dCr A.D. 200J— �e4 014k,Nancy E Gibson �; My Commission/)0104472 '' of nod Expires March 28, 2006 My Commission Expires: AC# 1460799 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L04062303053 .� - LICENSE NBR D6/23/-`20041030740.982 EF0000949 The ALARM SYSTEM CONTRACTOR I Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2006 CALABRO, STEPHEN GREGORY ADT SECURITY SERVICES, INC. 803 S. ORLANDO AVENUE SUITE J WINTER PARK FL 32789 DIANE CARR SECRETARY * E PIES 09 30 2006 CERTIFICATE NUMBER CERTIFICATE OF INSURANCE 224017 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. ADT Security Services, Inc. One Town Center Road COMPANY D: Insurance Company of the State of PA COMPANY E: National Union Fire Insurance Co. Boca Raton, FL 33486 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 (MM/DDIYY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS B GENERAL LIABILITY 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 R OCCUR PERSONAL & ADV INJURY $7,500,000.00 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) $1 Q QQQ.QQ 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 10/1/2006 BODILY INJURY (Per person) SCHEDULED AUTOS BODILY INJURY (Per accident) �( HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE PROPERTY EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM B WORKERS COMPENSATION AND SEE PAGE TWO SEE PAGE TWO SEE PAGE TWO s X uWCMnsTATUTORY OTHER E EMPLOYERS' LIABILITY — EL EACH ACCIDENT $2,000,000.00 D C THE PROPRIETOR! PARTNERS/EXECUTIVE INCL EL DISEASE-POLICY LIMIT $2,000,000.00 EL DISEASE-EACH EMPLOYEE $2,000,000,00 F OFFICERS ARE: EXCL OTHER DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/SPECIAL ITEMS Please see page 2 for additional insureds and any additional language. CERTIFICATE HOLDER,,,-,. 'CANCELL/kTION. City Of Sanford Bldg. Dept. 300 N. Park Ave. SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE ION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TOTTHE 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: LG Katherine O'Leary, Casualty Program amkIN- ..w j MM1(3/02) ' VALID AS'-OF: 10`/412005 . � 'k, ADDITIONAL INFORMATION CERTIFICATE NUMBER 224017 PRODUCER COMPANY I: White Mountain Insurance Co. Marsh, Inc. 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345-5000 INSURED ADT Security Services, Inc. One Town Center Road Boca Raton, FL 33486 United States TEXT WORKERS COMPENSATION POLICIES Carrier Policy Number Eff. Date Exp. Date State (B) American Home Assurance Co. RMWC6610498 10/1/2005 10/1/2006 CA (E) National Union 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 CERTIFICATE HOLDER IS HEREBY GRANTED STATUS AS AN ADDITIONAL INSURED WITH RESPECT TO THE GENERAL AND AUTOMOBILE POLICIES; PROVIDED, HOWEVER, THAT COVERAGE FOR CERTIFICATE HOLDER, AND ANY OBLIGATION TO DEFEND AND INDEMNIFY IT UNDER SUCH POLICIES, IS STRICTLY LIMITED TO DAMAGE, LIABILITY, AND EXPENSE RESULTING SOLELY FROM THE NEGLIGENCE OR WILLFUL MISCONDUCT OF THE INSURED'S AGENTS AND EMPLOYEES COMMITTED DURING AND WITHIN THE SCOPE OF EMPLOYMENT OF SUCH PERSONS WHILE THEY ARE PHYSICALLY PRESENT ON THE CERTIFICATE HOLDER'S PREMISES. NOTWITHSTANDING ANYTHING TO THE CONTRARY CONTAINED HEREIN, THIS ADDITIONAL INSURED STATUS SHALL NOT APPLY TO ANY LIABILITY, LOSS, COST OR EXPENSE DUE DIRECTLY OR INDIRECTLY TO OCCURRENCES AND/OR THE CONSEQUENCES THEREFROM THAT THE EQUIPMENT AND/OR SERVICES PROVIDED BY ADT SECURITY SERVICES, INC. OR ITS AFFILIATES ARE DESIGNED OR INTENDED TO AVERT, DETECT, OR PREVENT, IRRESPECTIVE OF CAUSE OR ORIGIN, AND/OR DUE DIRECTLY OR INDIRECTLY TO THE INSURED'S NEGLIGENCE OR GROSS NEGLIGENCE (ACTIVE, PASSIVE, OR OTHERWISE), STRICT LIABILITY, VIOLATION OF ANY APPLICABLE LAW, OR ANY OTHER ALLEGED FAULT ON THE PART OF THE INSURED, ITS AGENTS, AND/OR EMPLOYEES. Additional Insureds: City Of Sanford Bldg. Dept. Project: If there is a question regarding this certificate please contact William McMahon (Email: wmcmahon@adt.com Phone: 1-407-628-5050) CERTIFICATE HOLDER City Of Sanford Bldg. Dept. 300 N. Park Ave. Sanford, Fl, 32771