134 Rockhill Dr; 16-3422; HVACW
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E C 2 20167BY:..
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ 4, ay
Job Address: %J 7C- ,!/l / / I /r
Historic District: Yes No 2
Parcel ID: 0. /i_ 0006) D Residential Commercial 11
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person:
Phone:
Name
Street:
It
City, State Zip`:
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip: _
Fax:
I
3,277l Title:
Email:
rty
Owner Information 2 %
Phone:
4/0 7'.3/" 1 — / Resident
of property? : L
Contractor
Information / r
4 _..,
1A ( Phone: 0 406 7 lJz
z Fax: -3 6 ( - at / / State
License No.: Architect/Engineer
Information Phone: Bonding
Company:
Address: Fax:
E-
mail:
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. 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: 5th Edition (2014) Florida Building Code •, Revised: June
30, 2015 Permit Application P
s
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 compliance with all applicable laws regulating construction and zoning.
r
Signature of Owner/Agent Date Signature of Con a or/ gent 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
Print Contractor/Agent's Name
Luc,
Signature of Notary -State of Flori Date
pA11=L RMWJES
l,q ppMMISSION # FF 8i M
coritractori' n to Me or
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 # of Heads
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
DeltonalDeBary DeLandRkange City
386) 6S"752 386)734-97M
Daytona Brewayd County
386) 761-8319 321) 723-2M
i 1C # CAC050422 www.naid-floridaair.com
Sanford orklindo
4(M 322-0199 (4M 628-6748
WW Sanyrna
3%) 427 9149
ALL OTHER AREAS:1-,8884MD--LAC
643-3522
Richard Coffman
r ' ek^ INSTALL UWE ittSt iTi3 3i
12/29/16
Ss a tG AVORESS r= D&'FEF %T
FPM* JLa LOCATION
134 Rockhill DR
ITYISTATF/yiP
Sanford, FL 32771
6:tk' CELL 14't1Ftf F.L+Lsg
tM"C-O CAEDAPPLY I/ FE WIT jVt;'..trWAL J L kVV._% FAJL0 W t MsMUXP VST lLERS C : ttELFER > i tk.FEr tc tzairzaL % i;A?tGe L Omer
2.5 t 21 feat Pasant Ai
aHandier _ 47-_tuts C
9 QQ He }
5_...—ic tit. Strip Drat
Pats Ccardensate
Pt=P 20x20x1 Fifer
Rack. Filter _. _. -- Ap
niaire Shmaed MISCELLANIOUS
1%
6 P* t rml gear 166 rr -nabk- 6 )
Precast urm V
Ref. Umes It rel. fine Cavan t6A
Gate line Fbish
Wd vv
0/}
PP rMod Top 2 x 4 SIuds \D Soo
Float Snitch (66 Wet Switch DUCT
SYSTEM MW
Sim __ uvpbas with darr"M e .)
Fiwrgless Duct f )
Flexsystem Direct Rehm )
did { ) Ster track g it 4 insuIate
Platform V ftemnnect
Plenum MIWELLANEOUS OR
EXTfiAS We are using customers pre-e)dsfing t 25HBC5 BREAKERS
NEEDED
Type Square
D QQQ_ Iia`k=..-.__
30 Amps 0). thck thin Outdoos._P__._
Amps (W tkkeic ( ) thin r 0 ELECTRICAL M
Hook-
up by WD-FLORIDA AlC, WC_ V. Low
Va4'tage by WD-FLORI€?AAI+C. INN, Ele by
otters it rieeded next in price___ Lqitial LIMITED WARRANTY
AND GUARANTEES ae anutactureos?
0..--year warranty on cornpressor. 10 -.yea;
vvarrartty on air other Manufacturers. parts. 2 __ __ tree
service Irmn date of start up 2—._._.}wren
warranty on all other parts irk by MID-FLAC,. INC. Warranty does
rw4 cotter Fitters Tripped Breakers or Mankitarx-a M.anukKlur+ers
warranty for onginal harrtegwrw only It is hooked
into security system. Thermostat is suitable for new system. We agree to
furnish aced ittsiak the awe described later and materiats on the terns inflated below. It is agreed
that the Vad set releases the seller €rom and that the Seiler assumes no habiI4 and shall not be reSponsibte for arty lass, daquW or deer caused by acts
of cgtternment, shi ,,k ckouls, fire. exert- t3loft; floods. taim eater damage, not, mil ccsnwKftn, vra, rxaciear dusterfungi, mold, bacteria. makc;ioM MjU;
tief Packet &jk-acks r; God . — by any cause beyond ets control and any event of cwwquential damagm it any claims or SPIWS arise it is
agreed to by the putclumer and seller that they wM be settled by a mediator_ PAYMMrTYPE: Ll CHECK CI
CASH W CREDIT CARD The customer acknowledges that
per to sigh frtss Proptosal he has S 5,150.00 read
the terms and
coed t one contained herein and hereby accepts this PnVoeal inchnirM 4lte
cnna%om on the reverse side hereof which 10D",,- WH N EQUIPMENT IS S-16%(M.00) ?
Ad 0 disont am a pad of
tt* Prc sal; and feather agrees to make payments as INSTALLED ou-_ 100.00(thermostat)
PMCE
t1 CLU DES
ALL MCCUXTS, 428800 BUYER'S RIGHT TO
CANCEL_ WSATESAl DIN —CENT V S $ - t€ Ifus, is a
hoarse soliata*m sale, and it you do not curet the goods or senores, you nay caravel this agreement by maiting a notice to the seller_ This notice must be postmarked
before mx1rught of the third business day after you sign the agreernent It you cancel this aunt, the seller may keep a8 or part of
any casts dmvn pastatent, not to exceed the lesser of 5 Percent of the rash price or S50- Date- 12/M16 Estimator....
Jordanuser _.__ _.__._...._._ We rezavrtend
geMri ,)vur
ftfts ¢
netted bi Wwr g --,,-- —p«amf
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service
between Feb 17, 2009 and Dec 31, 2016.
AHRI Certified Reference Number: 7017565 Date: 12/28/2016
Product: Split System: Heat Pump with Remote Outdoor Unit -Air -Source
Outdoor Unit Model Number: 25HBC530A**30
Indoor Unit Model Number: FX4DN(B,F)031L
Manufacturer: CARRIER AIR CONDITIONING
Trade/Brand name: CARRIER
Series name: COMFORT 13 PURON HP
Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING
Rated as follows.in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing:
Heating Capacity(Btuh) @ 17 F: 17000
Ratings followed by an asterisk (") indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate.
DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,.
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the
directory at www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and
confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated;
entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual,
personal and confidential reference. AIR-CONDITIONING. HEATING.
CERTIFICATE VERIFICATION REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better -
and enter the AHRI Certified Reference Number and the date on which the certificate was issued,
which is listed above, and the Certificate No., which is listed at bottom right
2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131274043371972098
L -,-
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service
between Feb 17, 2009 and Dec 31, 2016.
4 $
AHRI Certified Reference Number: 7017565 Date: 12/28/2016
Product: Split System: Heat Pump with Remote Outdoor Unit -Air -Source
Outdoor Unit Model Number: 25HBC530A**30
Indoor Unit Model Number: FX4DN(B,F)031L
Manufacturer: CARRIER AIR CONDITIONING
Trade/Brand name: CARRIER
Series name: COMFORT 13 PURON HP
Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING
Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing.-
Heating Capacity(Btuh) @ 17 F: 17000
Ratings followed by an asterisk (") indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate.
DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the
directory at www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and
confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; AMenteredintoacomputerdatabase; or otherwise utilized, in any form or manner or by any means, except for the user's individual,
personal and confidential reference. - AIR-CONDITIONING, HEATING.
CERTIFICATE VERIFICATION &
REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better -
and enter the AHRI Certified Reference Number and the date on which the certificate was issued,
which is listed above, and the Certificate No., which is listed at bottom right. =, ,.
131274043371972098.,
2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.:
SEM INOL E COUNTY MUL TI %UR /SD/CTIONA L
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hemby name andAappoiPt:
an agent of: Ly v` 6-1— / I // N
Name of Company)
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 pe it and appli Lion for work located at:
Signature of License Holder:
STATE OF FLO ID
COUNTY OF N40
The foregoing instrument was acknowledged before +me this day of C fib CJ /
20by —who is 'personally known to me of who
has produced as. identification and
who did (did not) take an oath. C
Signature
of Notary Print or type Notary name emsMMISsKuwrW
iFF9808T8 W.
p tRES: Jt¢w 15, 7AQA pubpcUndWfiftm
Notary
Public - State of R o S 1 d Ci 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.
Copy of a contract, signed by the contractor and the property owner, indicating the documented
construction value
Copy of applicable contractor's license issued by the State of Florida (if the contractor is the
ZA
pplicant).
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.
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).
Completed and signed Owner Builder Statement / Affidavit (if the owner is the applicant).
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.
Addition or alteration of duct work, including new construction installations, requires two (2) copies of a
floor plan (duct layout) showing the location of the ducts, the size of the ducts and the register sizes.
This will require a plan review
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. February 2015