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Home My WebLink About2623 Elcapitan DrCITY OF SANFORD f. r BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: 16 - Documented Construction Value: $ 47-Q610 ' o Job Address: c 21 .,23 Historic District: Yes No 0 Parcel ID: O —S'O _'2.4'00 — e //,a Residential ®-tommercial Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of Work: `j _ , L S—. n `ec lezw Plan Review Contact Person: Phone: Fax: Email: Title: Property Owner Information Name Z U nC' c, Phone: 7U 7 Street: _ ?/; _ j ,,, Resident of property? City, State Zip: S ! c/ l 3' 7 7 3 Contractor Information Name Phone: Stree • _? ! r p -5-- el) Z' z"F' vGYFax: City, State Zip: Y -f V State License No.: Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Mortgage Lender: Address: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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. FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5'h Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 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 Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in com iance with all plicable laws regulating construction and ning. Sig ture Owner/Agent Date Signator fContractor/Agent Date Print Owner/Agent's Name Print C ntractor/Agent's Name l Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID Type of ID Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: Flood Zone: of Stories: Plumbing - # of Fixtures of Heads Fire Alarm Permit: Yes No UTILITIES: WASTE WATER: FIRE: BUILDING: Revised: June 30, 2015 Permit Application Mistic Air & Heat HVACP.O. Box 391054 Deltona, FL 32739 SERVICE ORDER Ph: (407] 322-5559 INVOICEPh: (386] 775-7751 .- Fax: 386-775-7753 3317StateLicense # CAC 1814608 THISWORKISTOBE BILL To C.O.D. CHARGE NO CHARGE Nbr , r'990 MAKE S I.T., 19,9(1 MODE . c MODEL Tl)3 NAME SERIAL NUMBER3 n SER L NU; fX 1\- C LI r 0 s , 4 5Y,`Ki;•' 'i+T'•t•:2.ATs is 04:t1 A.i,.t.-t lp• ti u`(! P e..J i. IK re1St Lc++r' + P3C { 2 f ONMENTAL^CFiEC LIST j`"' fit`` xa .s, 2 tcs.lENcVS iR : c v :..sci : alxrrs)'L.ili2 i' WORK PERORM ED n'{ CN PR MISED - r' '"'•" r FWORK•PEHFORN_ED; OTY.'!jYpE/5P y CONDENSING UNR COND'SATE DRAINS P O ' • RECOVERED LEVELED CLEANED _ El AM MAIN DRAIN CLBEFORE RM, RECYCLED CLEANED COIL REPAIRED TECHNICIAN AUTHORIZED BY MAIN DRAIN CHECKED CLEANED30e\ jl (•^ RECLAIMED CHARGE PAN DRAIN WORK TO BE PERFORMED RETURNED LEAK INECOIL PREPAIRED AN DRAIN I Cl DISPOSAL REPAIRED FURN. OR FAN COILLEAKINCOPPER 13 DISMANTLED i REF. REPLACED BELTCHANGEDOUT/REPLACED TOTAL $ N1 .'.•'i'L7`.ir'_•::SiE:`'ia i=t.x tl•S,Ys '' r'_IL' ti:'.}?ift::" r. J CiI,!#:' =;'J.•Yi-''"i' 1Ci; 1z\`r•4r_'' i:,,'.cu.,.ln;;; ' ti - r•,-''!c.'+e•'i.nr;C'i'"'4i:FJ'•' '•',) ri:; MCHECKED ADJUSTED BELT LORK' PEFFORMEDIC4irMATE.ALbECIO"OP,: UYMOTOR REPLACED ,,V-44 to'•+?'`zKxiUCHGED PULLEY REFRIGERANT R- LBS. y1BELT PULLEY Qh!1D,.r ADJUSTED ADJUSTED CLEANED BELT BLOWER J CONTACTOR REPLACED i'f}'(1RF R BEAflINGSj RFIEPL ELAY OILED MOTORs- _- f, lalr r }{ i l J._j REPL START CAPACITOR OILED BEARINGS REPLA ED EDCAPACITORNHEAATEXCH. ADJ. NED ORCONTACTOR REPLACEDCED REPAIRED CLEANED OR goo 60 a IRINO ADJ. PILOT Vim/ / p j PLACED FUSE REPLACEDG, 5'JR 1 THERMOCOUPLE REPAIRED REPLACED REPLACED r MPRESSOR VALVE REPLACED OIL CLEANED EVAPORATOR PVALVE BURNERS ADJUSTED EXP. VALVE DUCT REPLACED FILTERS x x "I-" // j'' L - ---"----- CAP,TUBE REPAIRED J C I ,-f "/ b-{- / y" f 0 .. CLEARED A .TUBE ADJUSTED FILTERS x x REPAIRED COIL LEAK THERMOSTAT J----' -----'- RE PAIRED REPLACEDBELTSl'Sir+:+'-'S%n:CLS•'r"H,':vfi.;;;'{i>:r't^.' 3 TF ram;•.•, COPPER CONN. tx ° y s> RECOMMENDATIONS sI+'S.tr CLEANED COIL ADJUSTEDi==YG3i•?i i'x1.^< _ a =til_'M%.'.P:4.+kt't.YF..s'1:.G:. n tTOTAL MATERIALS LEVE LELECT.HTR. CLGTOWER tS-},•,..C Gov o /S y,,,+d4 N ?,} ;tri TPI:'.a '• AMOUNT.• REPLACED LINK CLEANEDa'•,.;-1;,:v,r',. _:'t'u,. b-;rr,;, s.. ,a'L.•.,ser-,: .:-rl,ax'u^ ' r 00REPLACED KLIX. REPAIRED WIRE PUMP(S) A REPLACED CONT. GREASED rroll S-fo pc jQ Gn r(1 WI n _ - 6 REPAIRED MATERIALS 6 LABOR MAY BE FILTERS CLEANED REPLACED CONTINUED ON OTHER SIDE TOTAL LABOR LIMITED WARRANTY: All materials, partsa:.f}L:rti;A'T};a and equipment are warranted b the ' "`' TERMS manufacturers' or suppliers' written warrantyt,ir:`Ar SfiJ RY,r only. All labor performed by the above named TOTAL company is warranted for 30 days or as MATERIALS otherwise indicated in writing. The above named TOTAL company makes no other warranties, express LABOR I have authority to order the work outlined above which has been satisfactorily completed. I agree that or implied, and its agents or technicians are Seller retains bile to equipmenVmatenals furnished until final payment Is made. If payment Is not made not authorized to make any such warrantiesasagreed, Seller can remove said equipment/materials at Seller's expense. Any damage resulting from on behalf of above named company. said removal shell not be the responsibility of Seller TRAVEL J REGULAR WARRANTY CHARGE SERVICE CONTRACT —_ TAX CUSTOMER SIGNATURE DATE Sw TOTAL CITY OF SANFORD One Time Credit Card Payment Authorization Form Sign and complete this form to authorize City of Sanford to make a one time debit to your credit card listed below. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account. Please complete the information below: I 1 S r authorize the City of Sanford charge my credit card fulJame) n L) U account indicated below for V on or after —I l (1)This payment is for amount) (date) address or parcel ID Billing Address p D bw 39 ) D5q City, State, Zip De [*)o4 3a 3q Phone# Email PS Q W' U/flw, c -) Account Type: D KVisa MasterCard AMEX Discover Cardholder Name rf) SA( I 1 K Account Number 1 -1 '1 l 5' lJ O ( U 3a a Expiration Date CCV S Billing Zipcode 3a 7 SIGNATURE AK— DATE 9 . 1 0 I authorize the above named business to charg fie credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.