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HomeMy WebLinkAbout2400 French Ave (2)r CITY OF SANFORD PERMIT APPLICATION 1 Permit t; : a1 s a a �� Date: Ic4 Jofi Address: t�UMQYL 400 ie S Y, Z'ZC Description of Work: S Historic District: Zoning: Value of Work: $ Permit Type: Building t--" Electrical 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 Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: -"Owners Name & Address: Vy, %0%-,, ft Contractor Name & Address: Phone & Fax: Bonding Company: Address: Mortgage Lender: . Address: Architect/Engineer: Address: Contact Person: (Attach Proof of Ownership & Legal Description) Phone: State License Number: 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 ermi i4venica 'n t t I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. It 6t Si ature oentsn ,, Date Signature of Contractor/Agent Date �r(ene- S. (.lard P � t Owner/Agent's Name Print Contractor/Agent's Name /v Si ature of Notary -State of Florida Date Signature of Notary -State of Florida Date LDEB131E BLANTON '�Y-68t�tK>ti�3lt�i�Y�>mIDvtBa��te 25.2007 TARY FL Notary Discount Assoc CoAPPLICAVED -BY: (Initial & Date) Special Conditions: Contractor/Agent is. Produced ID _ Zoning: Utilities: (Initial & Date) Personally Known to Me or FD: (Initial & Date) (Initial & Date) RE: Sanford Church of God Fall Carnival Permit for Nov: 4-6, 2004 -Youth Pastor Dale Broom' Attached please find the proof of insurance for Spectacular Attractions, Inc. DBA Murphy Bros. Expositions. We have contracted with this company, to conduct a Fall Carnival on our property located at 801 W. 22nd St. Sanford, FL. 32771. We have submitted the paperwork requesting a permit for this event. All paper work was submitted to the City Permit Department on September 16,_2004. Please advise as soon as I if you are in need of anything additional to" release the permit. Sincerely; Darlene S. Clark r , Sanford Church of God _ Ladies Ministry •�xSemor Adu1t�;Pastor �F ' Music 1Vhmster �,; � �, '�� � ; �, ,,' John Holloway •Phil Turner . ` r'DL t soh - J � } '.; .c ,. j•. 0ctobe6, 2004 X RE: Sanford Church of God Fall Carnival Permit for Nov: 4-6, 2004 -Youth Pastor Dale Broom' Attached please find the proof of insurance for Spectacular Attractions, Inc. DBA Murphy Bros. Expositions. We have contracted with this company, to conduct a Fall Carnival on our property located at 801 W. 22nd St. Sanford, FL. 32771. We have submitted the paperwork requesting a permit for this event. All paper work was submitted to the City Permit Department on September 16,_2004. Please advise as soon as I if you are in need of anything additional to" release the permit. Sincerely; Darlene S. Clark r , Sanford Church of God _ Ladies Ministry To: City of Sanford Permit Department From: Sanford Church of God RE: Sanford Church of God Fall Carnival Permit for Nov. 4-6, 2004 Attached please find the proof of insurance for Spectacular Attractions, Inc. DBA Murphy Bros. Expositions. We have contracted with this company to conduct a Fall Carnival on our property located at 801 W. 22nd St. Sanford, FL. 32771. We have submitted the paper work requesting a permit for this event. All paper work was submitted to the City Permit Department on September 16, 2004. Please advise as soon as possible if you are in need of anything additional to release the permit., Sincerely, 0- Q Darlene S. Clark Sanford Church of God Ladies Ministry OUR MISSION: To Know Christ And Make Him Known To Others 801 W. 22nd Street Sanford, FL 32771 (407)322-3942 J I OUR MISSION: To Know Christ And Make Him Known To Others 801 W. 22nd Street Sanford, FL 32771 (407)322-3942 71 —77 SIN4,josy, NIC EST,, 77 I 'R CE*,,AC All' NSIJ .., AN , CONSULTANTS) Sl "k� Pairk. •Illinois- 6 `11 X11; vhidagd 1,1 �Q -AVehud 0a, Q302 r -'11 P, CERTIFICATE OF L]Xakift-�. SUPPLEME DATED 10122/2004, SPECTACULAR ATTRACTIONS, INC: DBA MURPHY 5ROS. EXPOSITIONS UNDERWRITERS, LLQYDS, OF LONDON POLICY #D2000CN0000.93,0, EFFECT NE 04111/2064 Ta,'04/ft/2005 RIDE LIST #_ YEAR MANUFACTURER' DESCRIPTION. SERIAL -4 ' 1 1994 OWENS MARDI GRAS GLASS HOUSE '1302S46XR1139270 2 1999 SARTORI . GAS STATION SRTRS327TN200002 3 1995. MAJESTIC SCOOTERS 2219 4 1996 A. R.M:, ALI BABA SA9STS034SE030009 5: 1989 CHANCE ZIPPER j 6, 1991 JTVOLV"" ORBITOR 4846230 7 1989 VENTURE JELEPHANT .25005 B. 1994- WISDOM ,,,.DRAGON WAGON L IF9GEW256 PLM063594 9 2002. MIDWAY.,", J'SLIDE �-'i�gSF4002121.42901 % j Is Td. j 708.383.9000 FAX: 708.383.9098 wvvw.forestzg6ncy.corn 10/22/2004 15:58 d CERTIFICATE s PRODUCER •(708)383-9000 FAX (jog) Forest Agency Inc. 1111 Chicago Ave. Oak Hark, IL 60302 Florida License #AO33034 mvReD SPECTACULAR ATTRACTIONS, INC. DBA MURPHY BROS. EXPOSITIONS 4707 E. 21ST STREET TULSA, OK 74159 flnUCOA/LCC YLIA�ILITYn'INSLl.RANC� ,�, t_ 10/22/N04 -9098 =THIS CERTIFICATE IS ISSUEQ AS A`•MATTER OF INFORNU4T1ON ONLxYYANDtONFERSvNO,RI'GHTS UP.,ON TME'CERTI,FICATE HOLpER THIS'CERTIFICATErDOES.LNOT AMEND; 'EXTEND OR ALTER THE COVERAGE AFBOROEDBY THE POLICIES BELOW. INSURERS AFFORDINGCOVERr4GErMI., �" , INSURERAt Underwriters, Lloyds''of}L'ondon, INSURER B; INSURER C; INSURER 0; 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. (HSR Q%LTR NS TYPE OF INSURANCE POLICY NUMBER PO Y EFFECTIV E POLICY EXPIRATION LIMITS GENERAL LIABILITY D2000CN0000930 04/11/2004 04/11/2005 EACH OCCURRENCE s 1 1 000, 000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED = S 1 00 CLAIMS MADE ff] OCCUR MED EXP (Arty one peram) $ A X PERSONAL 4 ADV INJURY $ 1,000.00 GENERAL AGGREGATE $ 5.000,000 GEN'L AGGREGATE LIMIT APPLIES PER.- PRODUCTS • COMPIOP AGG S 1, 0001 0O X POLICY p LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ee accident) ALL OWNED AUTOS BODILY INJURY S SCHEDt1LEDAUTOS (Per mw) BODILY INJURY HIRED AUTOS NON•OWNEO AUTOS (Per acPdont) S PROPERTY DAMAGE S (Par accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO AUTO ONLY' AGG S EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE S OCCUR a CLAIMS MADE AGGREGATE $ s _ DEDUCTIBLE S RETENTION' S WORKS COMPENSATION AND EREMPLOYERS' WC STATU• OTH- LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT S El.DISEASE- EAEMPLOYE S OFF(CERIMEMBEREXCLUDED? If yes. describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S OTH NT OCATION: SANFORD, FL DATES: 11/04/04 HRU 11/06/04 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED 8 ENOORSEMENTI SPECIAL PROVISIONS DITIONAL INSURED IN REGARD TO THE OPERATIONSI'OF THE MANED INSURED: ANFORD CHURCH OF COD SANFORD CHURCH OF GOD ATTN: DARLENE CLARK 801 W. 22ND STREET SANDORD, FL 32771 ACOR13 25 (2001108) FAX: (407)322-7027 CANCELI-ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISGUINO INSURER WILL RNPEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THC LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY'.' ' OF ANY KIND UPON THE INSURER; ITS AGENT$ OR REPRESENTATIVES. _ AUTHORIZED REPRESENTATIVE // y William Brotivne DAVID ©AC ORD CORPORATION ,mss i"WAOWR im 22004 N�90 Deice. M IMPORTANT ,g • If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this Certificate does not confer rights to the certlflcate holder in lieu of such endorsement(s). X" If SUBROGATION IS WAIVED, subject to the terms and conddions of the policy, certain policles may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s), • DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the Issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it aft;,^,natively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. i I I 1 _ I i a y y I ACORD 25 (2001/08) f October 29, 2004 To Whom It May Concern: Hungry Howies Pizza is granting Sanford Church of God permission to place a sign on our private property for the Fall Carnival for the week of Nov 4 — 6. We will not be responsible for the sign. Hungry Howies PTizza TEAM SERC Meeting Date :Wednesday S E'V NT APPLICATION PERMIT REQUEST -ttp- 0 APPLICATION & $50.00 PROCESSING FEE Z (' l7 �lA S) O PERMIT APPLICATION NUMBER ASSIGNED /CJ Time: 9:00 am Place: City ManaQer's Conference Room We thank you in advance for the opportunity to receive and review this application for your proposed Special Event here in the Friendly City. Please complete and return at least sixty (60) days prior to the event date to the City of Sanford Recreation Department -City Hall 300 North Park Avenue Sanford FL 32771. In order for the application to be forwarded to the City's Special Event Review Committee (SERC), we must receive the original copy of the Special Event Application .notarized with the $50.00 non- refundable Application Processing Fee with an event layout. Should you have any questions or comments, please call us at 407-330-5697 or E-mail SERC ,ci.sanford.fl.us. Thank you for choosing the Beautiful Historic City of Sanford as your host site. Name of Event: Facility/Location R Event Date(s): J l ` AJI (� Event Hours: From: Setup Datc(s): 01 AMV?M tup Hours: From: AM/PM N V. Breakdown Date(s): Breakdown Hours: From: Estimated: Participants Spectators,500' I bbb Vehicles Type of Organization (Check one): Not for Profit td For Profit 0 Federal I.D. # 5%-c �3c-)aL) l a Tax Exempt #: A10 To: 1 ` AJI (� AM/PM To: eUtmM AMV?M To: AM/PM Vessels (for Boating events only) Individual (11 SS #: Do you anticipate this event being held next year? 2rYes Cl No Ifso, Date: 1 rjj.)LE.KCr3DcX_ Location: N ^r/� oV. Sponsoring Organization Name: t�A j�1�O(� �i CA V jZ_C_ 1 i7� l� (7 (� Office Phone: -4c) 2-3 � 3 a -`1 �_ Contact Person Responsible for Event/Cbarges: YO I—�p A I F} Lt=�� Email rA�ddress: YEA tJKS Lt Y QCX •� 0 Phone: Work #: gc5_7- 3 -),a "3�'{ oZ i Home #: `/' ` ICI I p Fax #:-IJ /-J - /(`o CelVPaga PH# q6-7- 3 1 L -2 / 0'2 Address: $ I - lJ- a 5 I - City S,4--NrOP—✓), State ��- Zip Code Additional Contact Person: w W TA_r/ KS I -E Work #: Address: v-�SP N D Yy �}UL • �. C�- t'� *Please Provide Below a BriefDescriptionof Event to be Forwarded to Media* s A -Evg- D C, N ��c kl (- c� U W O rn r) `S r Yl 1 i ST 1 r S �EPrTv,IZ I /J Opf Dai 0TC9-STr4 TC- A-rn�SCr��NT r'i �-N iyA L_ �I f) F_S SV �oc�Q ELXtJ A-0 .D �', A rnr.S �0� 1 a E r� Y1 +(� E Tot �11 YVt 1 Ly, l V �� • t i' — J2 N\ Tr, 7 . J� C) y� I a- - I l o nti T t Ll« -r F_ 0 D �S (a o tnti . Application Pg 1 Of 3 "h,.T+gr`,t - +'Ak,x^"ynnPt i J iiiY ., 4; rt11.c�� r# ."�'kT y 47 �i.T a c^• y#��g,Y_ s# 9 f 1( '� Y Z .., ark,; �*'tN #. rr � � i^i "}. •,r nES1"tt "v. _ "'i x ,a'��. , � x .� r� `gid' &�, .c yy „i•��'K+�T t /✓ � rx+`�Y 3,s� y,^d � . ` i t�-r�..t#d¢+�q'ra'�7 �,�, ,.i *`k,5 •c #'� ,'� � V s ' _ . � '� r + i.. t r y+t i'�•w.{uScM,; x .yrti"" .�wr ..s. �r�� r (ease. specifyfielow� �. rer{ciestfo�Alcohoiic geyeraq;WO tdoors„Str+eet°.t�osure, Carni 4Wr; ir'CUS Parades, `technics �' �, x..,kwx�� v x Ceto"O lT ,PYA ,°�nfires or � �.,�� ..� �z ���� �,4..�- . � x,YPe�F res, and�arryfrequest� Watve Special Event Policies and/or Fees WN ,'i� ..�t.<p"'-,r hit••{.. x `_ a 1_. r � �:: '. ,7`. ,Z � u -3 t nu C, rz y ' P1eax Note: CC.t ilii!' Appbcant, O Other orNA Non A Pu All That APPcable to Apply For Your Event t ;sr<t1 "'h t � a .. m .t.•�.� �,.�.�� � � •.,X tY � P (rhe Foilowtrig Activihea/(Jses'May Regntre Permdi, Fees and/or Additional Documentation) TYPE OR EVEIVTDETAIISrra�as p UIPMENT�AEYENT it NEEDS- I: � , '.- 11 Admission Chatge%Ttdcd Sale " 23 AiidtN Egaipnieat c: IHovily Rites per Person 2: Ek1u'bd z ASYx W 1 V _ 12Ncohoi'Bevetage Sesles �f 24 In8atabk`Devtces • 35MffS-(S21) T i, 13.Conassion Stands , �J� 25 Poitable Restrooms 36.Off-Duty O (S21) 5,Geaaai Ivied -Ls 14Fuld Pcepatatwns, �1 26RegistcationTable 37.Eveat Management(S2S) 6 Parade �� 15 Fireworics/Pyrotecttnies 1I N 27.Sports Equipment 38.Fim(S21) 16Food/Be 1=9 . Ca, . 01c 28.StagdProp&Troduction 39.Police(S21) 7-Pic kftt} 17Machandise sales N-?%- 29 Tables & Chairs 40.Publie Works(S20) 9.VS/�en�ompetition � 18.Open to Public j N 30.Tcnts Ba---_Signage 41.Recrcatian 8� Patics(S I S) i IO.Othcr, g Reception —� 19.Special Set-ups - 31 Trash Cans/ Dumpster(s) VL ( 42-Code Enforcement (S 18) Explain _{N 20•St� lane, Sidewalk Closure �� 32.Vidco Equipment 21.Vcndors Number of tLA 33Mobflc Stage Times: Sct up Take Doom: �J �r 22.Watcr/Electric1� 34.Othe , Explain *** If you checked any of the. items�above, provide a complete description by number of the event/request. Additionally, please note all City services you are reg uestin .***(Add additional sheet, if needed) 1 Application Page 2 of 3