HomeMy WebLinkAbout302 Reio CtCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
'
Application No: l G` J�'� Documented Construction Value: $ 9S�
Job Address: "36),RIC _e / o C Historic District: Yes ❑ No ❑
Parcel ID: Zoning:
Description of Work: GP,(,klg 67 p,119cen'lQv-1
Plan Review Contact Person:
Phone:
Fax:
E-mail:
Property Owner Information
Title:
Name (%Ci�'1L1� I/�A Phone:
Street: 3 *Ze r a Resident of property?
City, State Zip: /
Contractor Information
Name►/l/i 1` /�`%'Z T Phone: 3a�' �Jl' /36�.
Street: pp ���� �qmav � ' Fax:
c�
City, State Zip: /G%yo F( State License No.: CA'f /915�90':Z27
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
t PERMIT INFORMATION
Building Permit O
Square Footage:
No. of Dwelling Units:
Electrical O
New Service — No. of AMPS:
Construction Type: No. of Stories:
Flood Zone:
Mechanical 0 (Duct layout required for new systems)
Plumbing ❑
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:
ENGINEERING:
COMMENTS:
Rev 11.08
Signatureor/Agent Date
Print Contractor/Agent's Name
P----
-- - DEBBIE BLANTON -- -
=o�, Notary Public - State of Florida
My Comm. Expires Feb 25, 2015
•s'c Commission # EE 60182
%f.°,°„��, Bonded Through National Notary Assn.
Contractor/Agent is Personally Known to Me or
Produced IDType of ID f��Leyp•
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
FX4DNF03IT00AAAA MFG CODE I CODE DE FAD / CODIOO Of
IYI�III�I�IIII�IIN��YBI�
� HVAC SERVICE ORDER
INVOICE
'1568
BILL TO
UNIT UNIT
Y
l 1
LODEL8C 310 � I
6ERML NUMBER .eNIAL NUMBER
NAM'M / ENVIRONMENTAL CHECK LIST WORK PERFORMED
1%60
DATE CONDENSING UNIT OTY. TYPE/DISPOSRION CONDENSING UNR FURNACEIELEC.HTA
RPLCD uNrt PI.CD wart
CITY v 'SED ❑RECOVERED'
CHNGD COMPRESSOR RPLCD GLS VALVE
N-TCH
E) NONE twORKISC.E❑ RECYCLED
TIME D ; PM. CHNGD MOTOR TM� oUP�
D RECLAIMED
TE &N CHKD CHARGE CWDBURNERS
I ❑ RETURNED ADDFREON CHNGD MOTOR
WORK TO BE PERFORMED
C JP / I ❑DISPOSAL CWD CAIS CLND BLOWER
❑ DISMANTLED REPAIRED LEAK RPLCD LIMIT
❑ CHANGED OUT/REPLACED TOTALS
OILED MOTOR RPRD WIRING
DESCRIPTION OF WORK PERFORMED
///'''��� /� RPLCD FUSE LIT PILOT
Ij)^61uo �/ 6&CA( �' ���GC' L04,
A/_ a JO(-�C s //vi r&i INSTALL DISCONNECT RPLCD TRANSFORMER
jZ—/IA/ 1'r�yJ �/ VVVI►I /7, �T% �,/ V " ' (/E'{� (/(//� PK RPRD WIRING NEW HEAT KIT
' .V ! N ��rVL � �. �� C.Qia/ 1 • {iI7 C �%� S � � g � RPLCD CONTACTOR AMSTMENT
c&vz n, oo. S" fill 2 y (o1. C,C&? PL CAPACROR CO TEST
A P�W M P 7 --.V v Vyj S UZ ee / 777 b9t-/ , OILED MOTOR
+yjovol ^/O
NEW FILTER/DRIER RPLCD LLIIMIITTTDI DISK
Se&4�,, A,r� /�/ ���U� • RPRDWIRINO
f HARD.START KIT
EVAPORATOR COIL CHNGD COMPRESSOR
CITY MATERIALS & SERVICES UNIT PRICE AMOUNT HRS LABOR RATE AMOUNT RPLCD UNIT RPLCD THERMOSTAT
REFRIGERANT R- LBS.TIMER
RPRD LEAK RPLCDDEFROST
SEAL RPRD LEAK
FILTERS X X
RPLCD EXP DEVICE ADD FREON
rd/ G f ' ' CLNDCOIL CLND/DEFR COIL
TOTAL LABOR CWD DRAIN ADJUSTMENT
�/ — T , ` • S� RPLCD PAN RPLCD H TRS
,� RECOMMENDATIONS RPLCD we WINDOW UNIT
�
UN 1 , 1 � �t �I Y `�, DUCT RPLCD UNIT
ADJUSTED CLEANED
V INSTALLED ADD FREON
TOTAL
'MATERIA ,yTHERMOSTAT RPLCD sTAT/swrtcHigf 11�OV
0M7fJ
�ADJUSTED CHNGD COMPRESSOR R�9ti5�Ol
A' g REPLACED CHNGD FAN MOTOR
�5 �•V �Ji �� I / I' `, CWV FILTERS ❑CLEANED REPLACED
w
� / ` V ` � 18
TOTAL SUMMARY
I have authority to order the work oumne asovo wnrch nog seen eawfectorny
Camoletad. I spree that Sailer Felolne tide to eq Wpmenl/matenple furnished until Illlal
Payment re made If payment is not mode ee agreed. Solver can remove core
equipment/mDIerlAls at Seller's UpeMe end/or ImpoN a tri Ilqultlallpn IN on the snug
amount contel5d in the sillier/Buyer transaction Any damage rogultrnp from gold
re vet ehoi se the .Moonyo ger
LINT ED WARRANTY: All malerlelS, parts and a ui menl are
Q D
wary filed by the manufacturers' or suppliers' written warranty
only All labor performed by the above named company is war-
rented for 30 days or as otherwise indicated in writing. The above
named company makes no other warranties. express or implied,
and its agents or technicians are not authorized to make any
such warranties on behalf of above named company
TOTAL
MATERIALS
TOTAL LABOR
' 3 MER$GNATVRE DATE
TRAVEL CHARGE
METHOD OF PAYMENT
0 REGULAR O WARRANTY
TAX
❑ CASH ❑ CHECK DRIVERS LIC NO
CREDIT CARD ❑ MC ❑ VISA ❑ AMEX EXP DATE
cc No
O SERVICE CONTRACT
�iUrLkw
TOTAL