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Permit #
Job Address:
Description of Work:
CITY OF SANFORD PERMIT APPLICATION
Historic District: Zoning: Value of Work: T I?
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential 10-' 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 X Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Phone:
_
Contractor Name & Address: -< N�iUS-%z/.aL ul C!�/A% _1 �i Vlee S
�� /t/rG1A/fid A�rtlf_ &0'S41VFa b S/taatte Lice/nsse Number: 6A-1 � JP/ 3 3�
Phone & Fax: JCAc — V27—)7—:5_ Z 5'l o Contact Person: Keit% 0 /1C -)P_ Phone: &7— 3 Z � —Z0y 1
JC
Bonding Company:
Address:
Mortgage Lender:
Address: '
Architect/Engineer. Phone:
Address: 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. 1 understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
y 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 permit is verification that 1 will notify the owner of the property of the requirements f Florida Lien Law, FS 713.
Signature of Owner/Agent Date ig re of Contra r/Agent Oate
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Print Owner/Agent's Name Pri ame
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Signature of Notary -State of Florida Date .Notary -State of Florida Dat
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or
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_Produced I D •Produced ID F91410wi (-030210
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APPLICATION APPROVED BY: Bldg: L JYI�_. Zoning: Utilities: FD:
��—(l utia & Date) (Initial & Date) (initial & Date) (Initial & Date)
Special Conditions:
INDUSTRIAL
BUILDING SERVICES'
www.ibs-service.com
QUOt@ # 42420720
SherriJohnson
Ph: 704847-6961
Fax: 704847-7278
10866 0635
FAMILY DOLLAR FAMILY DOLLAR
PO BOX 1017 413 E 1ST
DIRECTOR OF STORE SERVICES SANFORD, FL 32771
CHARLOTTE, NC 28201
Quote Date: 5/12/2003 Terms: I Net 30
We are pleased to quote you on repairing the following equipment.
Unit (1) Name:TRANE Model:TTA120A300AA Serial:E05194042 Tons:10 Unit Type:Splrt Unit Year:1990
This quote was generated from IBS Service WO# 0305-3033 (your PO# 185235). The facility AC system is now 50% down. It this quote is approved, the
work is estimated to be completed 14 days from receipt of quote approval.
This quote is for replacing the condensing unit which is 13 years old. This unit has a failed compressor.
Description Amount
Remove & Replace Condenser Unit, 10 Ton York High Efficiency
✓ Refrigerant recovery and disposal as per the Federal Clean Air Act
✓ Remove one existing condensing unit
✓ Modify existing unit supports to accomodate the new unit
✓ Install one new York 10 ton high efficiency condenser unit
✓ Install one new liquid line filter drier
✓ Includes all piping and welding charges
✓ Reconnect to existing electric wiring
✓ Inspect evaporator coil to insure proper unit operation
✓ Evacuate and charge system with new R-22 refrigerant
✓ Perform start-up and check system operation
✓ Includes all technician labor to perform work listed in this quote
✓ Includes manufacturers 5 year compressor warranty
✓ Includes IBS one year parts and labor warranty on condensing unit only
Sub Total... $4,889.86
✓ Includes All Crane and Rigging Charges and permit fees
Sub Total...
If you have any questions or concerns please call Ken Fuller at 407-323-2001 or fax me at 407-323-2510.
Thank you and have a great week.
$0.00
Total Amount $4,889.86
All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs
will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,
tornado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. This proposal may be withdrawn if not accepted within 30 days.
Authorized Sinnature -
Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and hereby axepted.You aro authorized to do the work as specified. Payment will be made as outlined above.
TEXAS - REGULATED BY THE TEXAS DEPARTMENT OF LICENSING 3 REGIS. P.O. BOX 12157, AUSTIN, TX 75711 140048039202
CACO16307 • CGCO41603 a EC0000961 a GA402243 a TACLA019292E
i /Im
",•"" CORPORATE OFFICE
3511 WE. 22 Avenue, F300 Fort Lauderdale, FI 33308-6226NDUSTRIAL 954-537-5544 • Fax 954-537-9582
www.ibs-seice.comBUILDING SERVI*CE'- ry
WW
AUTHORIZATION FOR AGENT
I Z—a A�l1[A?— f . do hereby autl ffm my empbyee- 11
(PAM ConbscsWs Name) (PAM Empbyee's Name
to act as my agent in waxing and signing pemnits in the City or County of L,7t1 DP AIFd�D. I understand
I am responsible for any and a0 work b my agent. I am also aware that 1 wdl be responsible far the renewal of this
form annually.
CONTRACTOR'S SIGNATURE
State of�iL�► �J ClyOf ls4i�xg�
Sworn to and subscnbed before me ttris�day of 2003 .
Comnnission:
of Notary
...........Joanne Null
=.r,= MY COMMISSION #E DD105516 EXPIRES
?AA= March 26, 2006
BONDED TNRU TROY FAIN WSURANCE INC
AIR CONDITIONING * ELECTRICAL • PLUMBING • GENERAL MAINTENANCE 9 BUILDING AUTOMATION
CAC016307 • CGC041603 a EC0000961 a GA402243. 96174 9 TACLA019292E 9 23301 9 M103691 a 37150
1-800-333-4001