HomeMy WebLinkAbout207 Odham DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: - a _ /�S I Documented Construction Value: S 4�9e ���
Job Address: -2O% L'9d Gam* p°-• Historic District: Yes ❑ No ❑"'�
Parcel ID:
Description of Work:
0
Zoning:
Plan Review Contact Person: Title:
Phone: Fax:
E-mail:
Property Owner Information
Name /Si�� d Phone: 7y� 6�7' 3012(f
Street: 2-07ya' Or' Resident of property?
City, State Zip: _�°�„� �'o�o� A -.!TZ 77
Contractor Information
Name Phone:
Street: /23 Fax: TGA 6o -Offs
City, State Zip: �G.�,�.-� ,� 32 77 3 State License No.: 2A' /X1� 6G�
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
40
Mortgage Lender:
Address:
P� M"!
T. FORMATION
�
Building Permit -
roO a ,,,,�,. uuwl^
�S►:^ �3 gym' u�tH
Square Footage: a:a `"'''" ' o s ruction Type:
No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical O Plumbing O
New Service No. of AMPS:
I/d
Mechanical (Duct layout required for new systems)
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 0 No. of heads:
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. 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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
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 Type of ID
APPROVALS: ZONING:
COMMENTS:
Rev 11.08
�7 I'— 1a -z r- / /
SignasdFe of Contractor/Agent Date
UTILITIES:
ENGINEERING: FIRE:
Print Contractor/Agent's Name
of Florida Date
DEBBIE BLAN70N
Notary Public - State
of Y Comm. Expires Feb 25 20 Floridaa
�"r% . F Commiaslon I EE 60182
bonded ThrotgA NaBonal Now. A—
Contractor/Agentis
Produced ID Type of ID
WASTE WATER:
BUILDING:
wn to Me or
tom,,yr -ti ro
CHECK LIST
FAN AND MOTOR
O AMPS / RATED
O ELECTRICAL CONNECTIONS
O CONTACTS — CLEAN d TIGHT
O CIRCUIT BOARD O FUSE
O PULLEY/BELT
O ADJUST BELT
O CHECK, LUBE BEARINGS
d MOTOR
O OILED O SEALED
ELECTRIC HEAT STRIPS
O INSPECT CONNECTIONS
O AMPS / RATED
O KILOWATTS -
O RV VALVE
EVAPORATOR COIL
O CLEAN O RUSTED
O AIR INF
O AIR OUT °F
O TEMP./ DIFF. °F
O TXV O PISTON •
f CONDENSATE AREAS
O INSPECT & CLEAN DRAIN PAN
O INSPECT & CLEAN DRAIN
O CLEAR LINE
AIR FILTER
O CLEANED _X—X—
O REPLACED _X—X—
THERMOSTAT
O O.K. O REPLACE
O RELOCATE,
COMPRESSOR
O SUCT. / PSIG
O DISC. / PSIG
O VOLTS _C310 O30
O AMPS / RATED
O DEFROST BOARD
O ELECTRICAL CONNECTIONS
O CONTACTOR POINTS
O FAN A. / RATED
O BOX OILED O BOX SEALED
t•
CONDENSER COIL
O CLEAN O AMBIENT_°F
O FIN CONDITION
O TEMP. / DIFF. - °F
REFRIGERANT
O LEAK
O O.K. O R-22 0410-A
NOT
RESPONSIBLE
FOR ANY
WATER
• DAMAGE
PARTS WARRANTY
All parts as recorded are warranted as per manufacturer specifications.
LABOR GUARANTY - SERVICE
The labor charge as recorded here relative to the equipment serviced as noted, is guaranteed for a
period of 90 days unless otherwise specified.. "No charge" warranty work will be provided only
during normal work hours.
ENVIRONMENT CHECK LIST
R CHRG. TYPE SYSTEM CHANGED O O
E CODE REFRIO. OTY. C OUT (OR
F O RECOVERED? O O OTy. IJ REPLACED)? YES NO
YES NO I DISMANTLED? Q Q
O RECYCLED? O O OTY. M
YES NO
O E REFRIGERANT DISPOSAL
G .� RECLAIMED? O O CITY. T
E RETURNED TO O O OTY.
R THIS SYSTEM? YES NO •
A ® DISPOSAL ACCEPTED DECLINED
TNON USABLE O O OTY.
®YES NO
DISPOSAL
A/C Services
Air Conditioning & Heating
321-262-8707
Ltc CAC �sttos Email: ac-services@hotmail.com
i
A& ds
07 UCI A- G Vf- .
rIS `i^4� s- ZIP c 32 773
MAKE MODEL SERIAL NUMBER
ILOCATION
DESCRIPTION OF •-
ISTOMERREOUEST ! A, /rpp jam.. �.
I
Aez 12
0Hd O11
001128
U-z;;I-i/
HE
PHONE
WARRANTY
CONTRACT
SERVICE CONTRAC
GORMAL
KES. Q COMM.
ro _
of h) yG1J! IF 59"Alrolle I I
CHARGES MRS. 0 / HR. "
TECHNICI CERT. •
SIGN �!•� r °
AfERMS: DUE UPON COMPLETION '
I acknowledge that repairs have been performed in
a manner satisfactory to me. In the event payment TRIP
is not made as agreed, Purchaser agrees to pay all CHARGE
costs of collection, including a reasonable amount
as attorney's fees. InteresLaat the rate of 18% per
annum will be wMed to all delihquent balances.
UTHOti
ZED'S4NATURE + �.
ABOVE
X_
I ACKNOWLEDGE RECEIPT OF MY COPY.
DATE
/ ;If/