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HomeMy WebLinkAbout193 Brushcreek DrCITY OF SANFORD �=CEIV ' BUILDING & FIRE PREVENTION PERMIT APPLICATION �JUN 21 2016 BY. Application No: Documented Construction Value: $�7y Job Address: f ! 3 /��l�S� C/C.C.�� - I /// Historic District: Yes ❑ No [' Parcel ID: D-1 `��-3U�$"/�f'-DOOd -e,2, 0/0 Residential Commercial ❑ Type of Work: New Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use❑ Move ❑ Description of Work: Plan Review Contact Person: WE Phone: ; `s% U5, Fax: 3 ee, -G(, � G y�{� Email: 1 roperty Owner Information Name e CJ Phone: D 7^ U % Street: 3 _ ~' . Ae. Resident of property? ,..ir City, State Zip t�,%y~A�`%� 'zz .,,, Contractor Information Name / I /�J y /I & �/ iZ - Phone: 35b Street: 116 /0&_/ , - / o;� Fax: 3A - v G 71 Title: If-/. 6) 112LLA o X 0M City, State Zip: c:: b6v 71 State License No.: G�iG U`7 O Architect/Engineer Information Name: Phone: Street: Fax: City, St, Zip: E-mail: Bonding Company: Address: Mortgage Lender: 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. 1 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: 5t° 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'verifttation 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 compliance with all applicable laws regulating cgipstruction anal zoning. Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID Signature of tractor/Agent Date at l _ `tv`_n d �,r� Print Contractor/Agent's Name � �p \V 12021-- �JG Siem ire nfNeta (� UYCOMMOS MOFFOM EWM Am 15. 2W Contractor/Agent is V Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑ Construction Type: Occupancy Use: Flood Zone: Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑ APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: WASTE WATER: BUILDING: Revised- June 30, 2015 Permit Application Deltona/DeBary (386) 668-8752 Daytona (386) 761-8319 LIC # CAC050422 DeLand/Orange City (386)734-9770 Brevard County (321) 723-2040 ' R/DA AIR CONDITIONING, INC. Sanford Orlando (407) 322-0199 (407) 628-5748 New Smyrna (386) 427-9149 ALL OTHER AREAS:1-888-MID-FLAC 643-3522 NAME/; REFERRED BY I�ISTAI�p/17Ef� INSPECTION DATE / N T Filter ( ) Aprilaire ( ) Shroud ADDRESS BILLING ADDRESS IFDIFFERENT ( ) 2 x 4 Studs FROM JOB LOCATION ( Wet Switch DUCT SYSTEM CrYISTATEMP` 32 I !7It CITYISTATEOP HOMEPHONE CELL WORK EMAIL ITEMS CHECKED APPLY IFERMrr O MANUAL J O MANUAL D Xj INSTALLER O 21NSTALLERS O 1 HELPER O 2 HELPERS O HORIZONTAL O VERTICAL ( ) Package Unit tons ( ) Heat Pump ( ) s. cool Brand (%d Condenser tons ('A Heat Pump ( ) s. cool Brand C*4 ___L_Air Handler tons cIm (;,) vert. ( ) horiz Model # I coil yy'� tons SEER _1 HSPF �_LA-1, k ng Drain Pan w. stnp ( ) Condensate Pump Locking Gas Caps t4 Hurtican Mounting Kit ( ) Filter Rack Filter ( ) Aprilaire ( ) Shroud MISCELLANIOUS Thermostat wall type ( ) no"rogrammable (N4 programmable Precast slab for condenser unit ( ) ret. line cover Flush Kit J. eardw Plans - Clean-up �j Plywood Top ( ) 2 x 4 Studs (� Float Switch ( Wet Switch DUCT SYSTEM ( ) New System supplies with dampers ( ) Fiberglass Duct ( )Flex System Direct Return ( ) ducted ( ) filter back grill Insulate Platform Reconnect Plenum (?q> Mastic _ MISCELLANEOUS OR EXTRAS: f-£%yW%)1 f' EXIS TNG BREAKERS BREAKERS NEEDED Type �Gtc.A2e 0 W- rL TY Indoor BIZ Amps (Thick ( ) thin Indoor Amps ( ) thick ( ) thin Outdoor -Amps (74 thick( ) thin Outdoor�_Amps ( ) thick ( ) thin ELECTRICAL (}y Hook -Sp by MID -FLORIDA AIC, INC. Low Voltage by MID-FLORIDAA/C, INC. Electrical by others it needed not in price Initial LIMITED WARRANTY AND GUARANTEES Manufacturers year warranty on compressor. 10 year warranty on all other Manufacturers parts. free service from date of start up �— year warranty on all other parts installed by MID -FL A/C, INC. Warranty does not cover Filters, Tripped Breakers or Maintenance Mapufacturers warranty for original homeowner only We agree to furnish and install the above described labor and materials on the terms indicated below. It is agreed that the purchaser releases the seller from and that the seller assumes no liability and shall not be responsible for any loss, damage or delay caused by ads of government, strikes, lockouts, fire, explosion, theft, floods, rain, water damage, riot, civil commotion, war, nuclear disaster, fungi, mold, bacteria, malicious mischief, picket lines, ads of God, or by any cause beyond its control and any event of consequential damages. If any claims or disputes arise it is agreed to by the purchaser and seller that they will be settled by a mediator. V" rusnavalm a mwrn PAYMENTTYPE: O CHECK 0 CASH I$ CREDIT CARD The customer acknowledges that prior to signing this proposal he has $ ,47 5 • of read the terms and conditions contained herein and hereby accepts $ — (# $rj, po NI; D FLA this proposal including the conditions on the reverse side hereof which are a part of the proposal: and further agrees to make payments as 100% WHEN EQUIPMENT IS $ follows: INSTALLED $ ` PRICE INCLUDES ALL DISCOUNTS, REBATES AND INCENTIVES °BUYER'S RIGHT TO CANCEL.° 'If this is a home solicitation sale, and if you do not want the goods or services, you may cancel this agreement by mailing a notice to the seller. This notice must be postmarked before midnight of the third business day after you sign the agreement. If you cancel this agreeme the seller may keep all or part of any cash down payment not to exceed the lesser of 5 percent of the cash price or $50.' An Date Purchaser EsUmator -cA We Recommend the Power Company Test Your Ducts For Leaks IN FPL 0 DUKE ENERGY PHONE 1-M6-712-3413 0 ACORO" CERTIFICATE OF LIABILITY INSURANCEF12/22/2015 DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Lassiter -Ware Insurance of Tampa Bay 1300 N. Westshore Blvd Suite 110 Tampa FL 33607 O ACT Eryn Zak PHONE (800) 845-8437 1FAx t8ee>8e3-0e00 SIL .E rynZQlassiter-ware.com INSURERS AFFORDING COVERAGE NAIC0 INSURERA:United Fire b Casualty Company 3021 INSURED Mid -Florida Air Conditioning, Inc. Hall & Hall LLC 116 S. Charles Richard Beall IDeBary FL 32713 INSURER B: INSURERC: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER -16-17 GL/Auto/Umb REVISION NUMRFR- THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE 21111 POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 $ 100,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE DR OCCUR 60471097 2/31/15 /1/2017 MED EXP (Any one son) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s 2,000,000 }{ POLICY PRO- LOC S AUTOMOBILE LIABILITY, en IN L LIMIT1,000,000 BODILY INJURY (Per person) s A X ANY AUTO WNED SCHEDULED AUTOS AUTOX 0471097 2/31/15 /1/2017 BODILY INJURY (Per accident) s PROPERTY DAMAGE $ (Peraccident) HIRED AUTOS X NON -OWNED AUTOS Medical payments S 2,000 XUMBRELLA UAB[I OCCUR EACH OCCURRENCE S 1,000,000 AGGREGATE $ 1,000,000 AI EXCESS UAB CLAIMS -MADE 60471097 2/31/15 /1/2017 DED X RETENTIONS 10,00C S WORKERS COMPENSATION WC STATU- OTH. FR AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? El / A E.L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE S (Mandatory In NH) It Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S Contractor's Pollution Each*Pollubon Condition' 100,000 A Legal Liability 60471097 2/31/15 /1/2017 AgpoepeleLimit ofInsurance 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addlllonal Remarks Schedule, If more space Is required) City of Sanford P. 0. Box 1778 Sanford, FL 32772 ACORD 25 (2010/05) INRfYlR romrwn%m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Childers/DAWNS ©1988-2010 ACORD CORPORATION. All rights reserves. The Annon n2ma onrf Inn^ are rania►arart mnrka ^f Ar :mill a CERTIFICATE,OF LIABILITY INSURANCE 06;oeno;fi /YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polky(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Bell of such endorsement(s). PRODUCER CONTACT 150 SAWGRASS DRIVE AGENCY, INC. AX Arc No. EXTI: 877-266-6650 lac, Noy 585-389-7426 E-MAIL ROCHESTER, NY 14620 INSURERS) AFFORDING COVERAGE NAIC b INSURED INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY 23817 INSURER B: Paychex Business Solutions LLC Mid Florida Air Conditioning Inc INSURER C: 911 PANORAMA TRAIL SOUTH ROCHESTER, NY 14625-0397 INSURER D: INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR 41AY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S TYPE OF INSURANCE NBDRL �BDR POLICY NUMBER POLICY EFF NOICY EXP LIMITS GENERAL UABILITY EACH OCCURRENCE S rCOMMERCNL GENERAL LIABILITY DAUM TO RENTEDs MED EXP (Mry orv, pawn) f PERSONAL a ADV INJURY f GENERAL AGGREGATE S AGGREGATE LIMIT APPLIES PER: ►oucr O raoactO roc PRODUCTS cOMPiOP AGO 1 1 AUTOMOBILE LIABILITY ANY AUTO ALL OWNILD O 8049ouuD AVTos AVIoa wwao Auroo A"u°�o$'v"ao Q COMBINED S003LE LIMIT S (Ea aoddent) (Per RAW1 IML-ywNJIJRY M PROPERTY DAMAGE 1 (Per aaddent) s oraRILAwe OoDwR EACH OCCURRENCE f uCRISLue Or:wuaVADa AGGREGATE 1 Dao I I KWFWnas N 1 OOR,tant OOIIVa"SaTtoR "a a—oveRrttaatury 015722001 06/01/2016 06/01/2017ffR X ICC ti.�7u oTa E.L. EACH ACCIDENT S 1.000.000 00 Arn rRorRmotvrARTwR,uscvrka O•rwaR.wawalta=&uoco?rEL. Pueaawr m tut LN NIA .DISEASE -EAEMPLOYEE t 1,000,000.00 04SEASE • POLICY LIMIT $ 1.000.000.00 a sur. enve�,ren DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES Mach ACORD 101. Additional Reruta /chMula. If mon space b n tub" Workefs Compensation coverage Is provided to ony those empbytes teased to, but not subcontractors of the named Insured. Waiver of Subrogation `ranted In favor of the certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN ACCORDANCE WITH THE POLICY CITY OF SANFORD BUILDING DEPARTMENT PROVISIONS. BUT FAILURE TO WA SUCH NOTICE SHALL IMPOSE NOOBUOATION OR PO BOX 1778 LIABILITY OF ANY IOND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. SANFORD, FL 32772 AUTHORIZED REPRESENTATIVE �••t.,t n..�.� _�' .r.-_..._..rte ACORD 25 (2010105) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �+N•� 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HALL, MICHAEL JORDAN MID-FLORIDAAIR CONDITIONING INC 116 S HWY 17-92 DEBARY FL 32713 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myftoridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's' initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new licenser DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF. BUSINESS AND PROFESS'10W AL•REGULATION CAC050422 ;;ISSUED: 05/29/2014 CERTIFIED Alit OND ICONTR HALL, MICHAELjQ�AN". ; MID-FLORIDAAIRaCDNDII?IQNING INC IS CERTIFIED under the provisions of Ch.489 FS. Fxpballon dale : AUG 31, 2016 L140529OW1087 KEN LAWS.ON, SECRETARY STATE OF FLORIDA DEPARTMENT OF, BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE N1.1r.15ER � i r The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 HALL, MICHAEL JORDAN MID-FLORIDAAIR CONDITIONING INC 116 S HWY 17-92 DE BARY ' FL 3279.3-2505 ❑�:� ❑ _zl l 45 -40t Date: I hereby nan an agent of - SEEMINOLE COUNTYMULT/%URISDICTIONAL LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, . Seminole County, Winter Springs to be my lawful attomey-in-fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for (check only one option): ❑ All permits and applications submitted by this contractor. Or The specific permit d application for work located at: (Street Address) Expiration Date for -This Limited Power of-Attomey / / - - -- --- - License Holder Name: Al I C`/ /4r e/c f Zk�� State License Numbe Signature of License V STATE OF FLORIDr, COUNTY OF I . ��� li'S 0'— The ' - �� The foregoing instru ent as acknowledged for e this OU day of � J i KE , 20 , by i�f✓\ �� who is @ personally known to me or O who has produced as identification and who did (did not) take an oath. q4WAc ry \-CU-A w, Signatuhl o No 1r, Print or type Notary name Notary Public - State of Commission No. _ My Commission Expires: WJ=L RWR=W N/FF9A0979 WOOIMIN I'' 9pd�071ruNptryPUDOoIlndnwlbre Print or type Notary name Notary Public - State of Commission No. _ My Commission Expires: " City of Sanford HVAC Permit Application Checklist All permit application packages must be complete prior to acceptance. You must check each ` . '' box to the left or indicate n/a on this submittal. A complete application package shall / include the following: Building Permit Application completed, signed and notarized. Application must include correct address and complete parcel I.D. number. PJ Copy of applicable contractor's license issued by the State of Florida (if the contractor is the applicant). A site specific notarized power of attorney shall be required from the licensed contractor if /he/she appoints an employee of his/her company to sign the permit application as the contractor. D' Certificate of insurance indicating worker's compensation insurance coverage and naming the City of Sanford as certificate holder, or a copy of a worker's compensation exemption issued by the State of Florida (must be submitted with each application if contractor is the applicant). O Completed and signed Owner Builder Statement/ Affidavit (if the owner is the applicant). O One (1) copy of equipment sizing calculations — for new construction installations: o Residential - ACCA Manual J-2003 or other approved heating and cooling calculation methodology. o Commercial - ACCA Manual N-2005 or other approved heating and cooling calculation methodology. These guidelines were compiled to assist the applicant in preparing a HVAC change out permit application and may not be complete. The applicant is required to meet all City of Sanford, state, and federal code requirements. Revised: March 2014