315 San Lanta Cir 17-1044; HVACI'VE
APR 7 2017
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No •
Documented Construction Value: $ l7 ;, zl) &)
Job Address: j SCE L r4, t1 ;` Historic District: Yes No
Parcel ID: ,31 I q3 1 () 6 !> oy d 6 H7 D Residential Commercial Type
of Work: New Addition Alteration Repair Demo Change of Use Move Description
of Work: Plan
Review Contact Person: Phone:
Fax: Email: Property
Owner Information Title:
Name
rl Phone:,2_ l Street:
lfA . J / Resident of property? City,
State Zip: i L.
771 Contractor
Information Name
i/t { I/ .;/ Phone: A& fir- 3 Street:-
2- 1 d / f 174rp J, A i z Fax: P
City,
State Zip: ,,s I,S ,GL State License No.: e.*e 3 Z qrl Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Arch
itect/Eng1neer Information Phone:
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: 51 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 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.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
21411, T
ature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID 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
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
Office Location: ORLANDO
Proposal Date 04/12/2017 Job Number 2197S804
e
Sears Home Improvement Products, Inc.
Customer Name
pm
P.O. Box 522290
MARIA RODRIGUEZ Ssl iwlll 1
Home Improvement Products
1024 Florida Central Parkway
Longwood, FL 32750-7579Customer's Home Phone Customer's Work Phone
321) 578-1803 phone 800 4694663
Street Address ESTIMATE AND PROPOSAL Contractor LicensetRegistration Number
315 SAN LANTA CIR FL (CGC012538, CMC1249510)
Heating &CoolingcityStateZipCode
SANFORD FL 32771 Is installation within city limits?
Yes/No): YESInstallationAddressCountySEMINOLE
Billing Address (if different from above) City State Zip Code Project Consultant Name & License No. (if applicable) I DAN O'CONNOR
Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed
SYSTEM INFORMATION: Equipment Brand: KENMORE Split System/Package/Dual Fuel/Straight CooVHeat Pump/Fumace):
SEER: 15.50 Cooling BTU: 28600.00 KW: AC AIR HANDLER 0 R-410A
EQUIPMENT SPECIFICATIONS: FURNACE FUEL: (Gas/Oil/LP Gas/Electric):
Existing New MODEL# OF NEW COMPONENT AFUE (up to): Heating BTU:
ELECTRICAL: 0 FURNACE/FAN COIL FXM4X3000AL
0 CONDENSER UNIT NxA630GK* CONNECT TO EXISTING ELECTRICAL
EVAPORATOR COIL INSTALL NEW AMP MAIN PANEL
PACKAGE UNIT NEW DISCONNECT FURNACE CONDENSER
0 THERMOSTAT 1F95EZ-0671SE NEW GFI OUTLET ATTIC LIGHT & RECEPTACLE
HUMIDIFIER Other:
DUCT WORK: AIR CLEANER
UV LIGHT 0 RE -USE EXISTING DUCT SYSTEM
EVAP COOLER INSTALL NEW DUCT SYSTEM WITH # NEW RUNS
MISCELLANEOUS: 0 REBUILD PLENUM (Supply/Retum): SUPPLY
0 LINE SET 0 PAD 36.00" X 36.00" NEW TRUNK LINE(S) (Supply/Return):
0 DRAIN LINE CONDENSATE PUMP NEW RETURN GRILL(S) X X
AUXILIARY DRAIN PAN Other EXISTING RETURN GRILL SIZE
INSULATION: REPLACE REGISTER(S)#
Batt/Blown): R-Value DUCT CLEANING
Other: BREAKER FOR CONDENSER
FLUE VENTING AND/OR CHIMNEY: Use existing vent or chimney Install new chimney liner Size:
PVC Vent Pipe for High -Efficiency Furnace Horizontal Vertical Type-B Vent Pipe Stainless Steel Vent Pipe
1 Pipe Installation 2 Pipe Installation Combustion Air Existing Modify
SPECIAL INSTRUCTIONS: NEW PAD, NEW SUPPLY PLENUM, NEW PLATFORM TOP
All of the above check boxes and "Special Instructions" section have been reviewed and Customer(s) initials Plojw 64""\
explained to me.
SH1+L (Dig.) Rev 6/16/2016 Page 1 of 3
Job Number; 21975804
NOTICE TO OWNER
1. 00 NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION
ARE LEFT BLANK.
2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS.
3. THIS HOME IMPROVEMENT CONTRACT MAY CONTAIN A MORTGAGE OR OTHERWISE CREATE A LIEN ON YOUR PROPERTY THAT COULD BE
FORECLOSED ON IF YOU DO NOT PAY. BE SURE YOU UNDERSTAND ALL PROVISIONS OF THIS CONTRACT BEFORE YOU SIGN.
4. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL BE ENTITLED TO
A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES.
5. YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY [FIFTH BUSINESS DAY IN ALASKA,
FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE AGE 65 OR OLDER] AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED
NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT
INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS
NOTIFICATION BY WRITING "I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLICATE OF THIS RECEIPT IS PROVIDED BY
THE SELLER FOR YOUR RECORDS.
6. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO
REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT.
PAYMENT MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND, UP TO A LIMITED AMOUNT, IF
YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA
LAW BY A LICENSED CONTRACTOR. FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA
CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: CONSTRUCTION INDUSTRIES
RECOVERY FUND, 1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399; TELEPHONE: (850) 921-6593.
ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW (SECTIONS 713.001.713.37, FLORIDA STATUTES), THUSE YUHU
WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT
TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION
LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB -SUBCONTRACTORS,
OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT,
EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR
CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD
BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR
A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT
THAT BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN
RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A "NOTICE TO OWNER." FLORIDA'S
CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY.
04/12/2017 04/12/2017
Customer's signature Date ----Customer's signature Date
Accepted by Sears Home Improvement Products, Inc. ("Sears") on 04/12/2017 by; p ,,
Date Management Representative
SH3-FL (Dig.) Rev 6/16/2016
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