217 Shirley Ave - M17-000258 - HVAC & Duct Worknffl
Type of W
CITY OF SANFORDA-Z
G X'%11 BUILDING & FIRE PREVENTIONk
PERMIT APPLICATION
Application No: f3 611)
EDocumentedConstructionValue:
Residential 0 CommercialEl
El ChnneetifUsell MnveE]
T( Name % Phone:
Street: Resident of property?
City, State Zips"
Contractor Information
C, eName" Phone:
C Fax: Street:
tir C
State LicenseCity, State Zip: No.:
Arch itect/En9i near Information
Name: Phone:
Street: Fax: -
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address:
771117117117ou Prior to 010 ISSUM177. ot d PULMN, 3115 wat ait-f Wfa7#N'7VC7i XD=
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: 50, Edition (2014) Florida Building Code
Revised: June 30,2015 Permit Application
NQ—TICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that mayfoundinthepublicrecordsofthiscountU, and there ma g be additional
management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property ofthe requirements ofFlorida Lien Law, FS 713,
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A coof OWNER'
S AFFIDAVIT: I certify that all of the foregoing information is, U e and that all work will bedoneincoliancewithallapplicablelawsregulatingconstructionlzling. X-
Signatuseot`
U -i7A w. gent i5aie Sim nn- r, t —/A.—t Print
Owner/Agent's Name W SignaDate
Signature of No ERSF998962
2020
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 F1 Electrical 0 MechanicalE] Plumbingas Roof Construction Type: Occupancy
Use: Flood Zone: Total Sq Ft
of Bldg: Min. Occupancy Load: N of Stories: New Construction: Electric ®
N of Amps Plumbing - # of Fixtures Fire Sprinkler Permit:
Yes El No # of Heads _ Fire Alarm Permit: Yes El No El APPROVALS: ZONING: UTILITIES: —
WASTE WATER: ENGINEERING: FIRE: BUILDING:—
L--30 - i -7_ COMMENTS: Revised: June
30,
2015 Permit Application
SCPA ParcelView: 30-1 9- 1- 01-0 00-00040 b"
tr m"Muxrc, CIA rlp
Parcel
Information Value Summary Parcel
0-19-31- D1>0600 0.., 2017 Working 2016 Cadged Ovmer
COOPER JANE N Values
Values Valuation
Method Cost/Markett ms"t Property
Address 217 SHlRLEY AVE SANFORD, FL 32771 o1 xikli NumberDepreciated1 MaHing
217 S SHIRLEY AVE SANFORD, FL 32771-1571 Bldg
Vol 150,665 144, A5 Subdivi "
n his Depreciated E%F"C" Value 1,200 1,200 Tax
District 51-SAhlFDRCD Lana Value (Market) 28,334 2C334 DOR
Use _ e 01-SINGLE FAMILY Land Value Ag Exempt
00-FI EST 1 ) 174,119 ._ Portability
Adj Same
Our Homes Adj Amendment
1 Adj 124,
A 29,6 0 PACs
Adi w,,=t Value 145,299144,249 Tax
Amount without SdOK $2.676,96 2,
079.01 13TaxFstimaorrSave
Our a $597.95 Does
NOT INCLUDE Rion Ad Vel am Ass arras j%
w Co E try GSl 4 Legal
Description ALLL0TS4A5AN1f2OFLOTS
ELK
6 2ND
SEC MAR4VANIA PB5PG66
Taxes
Taxing
Authority Assessment Value Exempt V`MuesTaxable Value Schools
145 299 S 2 61"'.1 City
Sanford 145,2997 r aCD 1 Est } WNgSairra,
lcohns Water Mana ntp 145,299 95 299 t<
omwty Wgids„ 145,299 3,000 29 County General
Fund 146,M 60,000 06,299 Sales Descripfion
Crate
Book Pegg Amount Quallified vacArnp QUIT CLAIM
DEED 811/20DO 11W NO Intproved FINAOi.JUD
EMENT 2dir2m SI00 idea Improved WARRANTY DEED
711119M SP1; 000 yes Vacant SPECIAL WARRANTY
DEED 111/1976 100 No Vacant Land Method
Frontage
De6ath Units Units Prim Land Value FRONT FOOT
A DEPTH 127.00 136,00 0 230.00 28,334 Building Information
Description Year
Built Fixtures ActuatlEfloctive SethBassAres Total SF Liming SF Ext ecall Adj Value Repi Value Appendages tt .// r
ld t 1. l;or /' rc li t ill o.a ? ID 3 931 010 000040 11 f 017
Certificate of Product Ratings
Product: Split System, Heat Pump with Remote Outdoor Unit -Air -Source
Outdoor Unit Model Number: 4TWR5036GI
Indoor Unit Model Number: TEM6AOB3OH21+TDR
Manufacturer: TISANE
Trade/Brand name: TRANE
Series name: XR15
1177177W 110 =1. * *,L
1111 ; N 1111 # 4111011111111IV,
Cooling Capacity (Btuh): 35600
EER Rating (Cooling)- 12.00
SEER Rating (Cooling): 14.50
Heating Capacity(Btuh) @ 47 F: 33600
Region IV HSPF Rating (Heating) 9,00
Heating Capacity(Btuh) @ 17 F: 21000
W„ " -J, ai , ""fl, " I 11W l W I IVO W,t" d dx, 'AA,' vhw, , Zj k, X
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 produchs), 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.ahridirectury org
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for Individual, personal and "IMP
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, Russ 1110 id
personal and confidential reference. MR-C(1N0iTWNMG, Hi MM6
CERTIFICATE VERIFICATION & 3,1t,rRiGF'RATi0N INSTHUfl
The information for the model cited on this certificate can be verified at www,ifirldirectory.org, click on "Verity Certificate' link
and enter the Artist 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,
131295867523868677
@2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.:
State Cert CAC032448
SHIRLEY .
iding the equipment and materials listed on proposal. Materials not listed are not included,
nm
wners are responsible to stay home for one (1) full day for the Building Department Inspection,
ives no guarantee for anX e)d no conditions such as, but not limited to, ore-eAstino Electrical, Ductwork, Mechanical Equipment
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JANE COOPER
contract« purchase price
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In the event payment is not made promptly in accordance with
agreed terms, it shall be sellers option to charge a service
charge not exceeding two (2) percent per montK The first
Jan,25-2017 10:57AM Professicnal Insurance Center No,9411 P, 1/1
GATE NINVIDOMCERTIFICATEOFLIABILITYINSURANCEi1/25/2017
a ZANKJUIEIAIAMI I
RODUCER--- Phone: (8 1' )25 t -4900 CONTAC' MaLthev,41rciacinClernentsNAMeFax: (8 11)2532676 PHONE
Prol'escional lasurance Cotner, Inc. I
MA'L2003NVestKennedyBlvdABESS'
TaInipa, Florida 33606 AFFORDING COVERAGE NAIC A
INSUeEe It: Grenada Insurance Company 16870
INSURED NS11RER a
BLACK CAR ORLANDO SERVICES UC SLIFIF C-
6508 PICCADILLY LAINTE rNI ; . D
ORLANDO, FL 32835 F
INSURER ,
COVERAGES CERTIFICATE NUMBER: I t33 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SUBR POLICYEFF POLICYEXP
TYPE OF INSURANCE POLICY NUMBER -02IM20-y1n IMMMOXY-n LIMITS
COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ Ej
DAMAM-T0WNTW--- CLAIMS -
MADE OCCUR MED
FAR (Any one person) $ PLFR50ALINJURY
GENT AGGREGATE
LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO - POLICY [
i] JECT L. PRODUCTS - 09MEIDtAG OTHER: - - AUTOMOBILE
LIABILITY
0185FL00090988-0 1/5/2017 75/2018 MBINED.IN LE LIMIT $ 1,000,600 Jto A ANYAUTOBODILYINJURY (
Pw person) $ OWNED SCHEDULE) OWNED SCHEDULED
OVV 0NBODILYINJURY (Per
amdent) $ AUTOS AUTOS ONLY AUTOSAONLY0 _OWHIREDL
NON -OWNEDIT
9S
PROPERTYDAMAGE $ AUTOSONLYAUTOS ONLY 11
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X B A MAGGREGATEDEDRETENTION $ DFU WORKERS COMPENSATION
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in NH) E,L, DISEASE- EA EMPLOYEE $ If yes, desmbe under'E.
L. DISEASE- P01 ICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS
I VEHICLES (ACORD 101, Additional RemarksSchedule, may be attached if more space is required) CERTIFICATE HOLDER IS LISTED AS
AN ADDITIONAL INSURED: 2007 - CHEVROLET C1500 SUBURBAN - 3GNFC16067G!
76143 2012 - (,ADILLAC ESCALADE - IGYS3GEFSBR285759 rFRTIFIrATF
HID1 DER CANCELLATION I
loildcrX Nature ol'Interest
Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE
VVILL BE DELIVERFD IN City Of Sanford ACCORDANCE WITHTHEPOLICYPROVISIONS, 300 N Park Sanford, FL
32771 AUTHORIZED REPRESENTATIVE
C 1988-20116 ACORD CORPORATION.
All rights reserved. ACORD 25 (2016/03) The
ACORD name and logo are registered marks of ACORD
Z x 3 Of Xjt
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RMEWED FOR C,E COMPLIANCE
P' DNS EXAPAINER
DATE
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A 0NF RD BULDING DIVISION
HOFFICIAL FROM THEREAFTER PEOUIR-
ING A CORRECTIONERRORS IN PLANS, CONSTRUCTION
OR WOLATIONSOF THIS CODE
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IL LhC'ENSE DO PROCEED WITH THE WORKAND NOT AS
PJ41
AlUITHORITY TO VIOLATE, CANCEL, ALTER OR SET
ASIDE ANY OF'-INHIE PFGVPSl0NS OF THE TECHNICAL
CODES, NOR SHALL IS IJANCE OF A PERMIT PREVENT
THE BUILDING OFFICIAL FROM THEREAFTER
QUIRI G .A CORRECTION Cf ERRORS IN PLANS,
STPUCTION OR VIOLATIONSTHIS CODE
FIRE INSPECTIONS CITY OF SANFORD
407,562,2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855,541.2112 SANFORD FL 32771
DRIVEWAYS -SIDEWALK 407,688.S080
Application Number . . 17-00000258 Date 2/09/17
Application pin number 321458
Property Address 217 SHIRLEY AVE
Parcel Number 30.19.31.501-0800-0040
Application type description MECHANICAL PERMIT
Subdivision Name
Property Zoning . . . SINGLE FAMILY
Application valuation . . 8184
Application desc
HVAC C/O WITH DUCT WORK
Owner Contractor
COOPER JANE N DEL AIR HEATING A/C & REFRIGER
217 SHIRLEY AVE 531 CODISCO WAY
SANFORD FL 32771 SANFORD Fl, 32771
407) 333-2665
Permit I I . I I MECHANICAL PERMIT -RESIDENTIAL
Additional desc .
Phone Access Code 971556
Permit pin, number 971556
Permit Fee 110.00
Issue Date 2/09/17 Valuation 8184
Expiration Date 8/08/17
Qty Unit Charge Per Extension
BASE FEE 110.00
Special Notes and Comments
Rejected inspections require payment of
a re -inspection fee prior to scheduling
another inspection.
Normal hours for inspections are from
7:30 through 4:30 Monday through
Thursday. Please be aware you must
contact the Building Official to
schedule a Friday or after hours
inspection. This is required since not
every inspector is licensed to do every
type inspection. Communication is the
key, so please contact the Building
Official if you have any questions at
407.688.5058 or at
dave,aldrich@sanfordfl.gov
Other Fees --01-APPLCTN FEE -MECHANIC 25,00
01-BLDG PLAN REVIEW 27.00
01-BLDG DCA SURCHARGE 2.43
01-BLDG DBPR SURCHARGE 2.43
Fee summary - Charged Paid Credited Due
Permit -Fee Total 110.00 .00 .00 110,00
Other Fee Total 56,86 '00 .00 56,86
Grand Total 166,86 .00 .00 166.86
FAILURE TO COMPLY WITH MECHANIC'S LEIN LAW CAN RESULT IN THE
PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
NOTE: ALL FEES MUST BE PAID PRIOR TO C.O. BEING ISSUED.
NOTE: PLEASE BE ADVISED ALL PERMITS MUST BE INSPECTED.
FIRE INSPECTIONS CITY OF SANFORD
407.562.2786 BUILDING & FIRE PREVENTION
BUILDING INSPECTIONS 300 N PARK AVE
855.541.2112 SANFORD FL 32771
DRIVEWAYS*SIDEWALK 407,688,5080
Page 2
Application Number 17-00000258 Date 2/09/17
Property Address . . . . . 217 SHIRLEY AVE
Parcel Number 30.19.31.501-0800-0040
Application description MECHANICAL PERMIT
Subdivision Name
Property Zoning SINGLE FAMILY
Permit MECHANICAL PERMIT -RESIDENTIAL
Additional desc
Phone Access Code 971556
Permit pin number 971556
Re ired Inspections
Phone In
Initials DateSeqInsp# Code Description
1000 410 MH02 MECHANICAL FINAL
CITY OF SANFORD
R E P R I N I
COSTWR RECEIPT
Oper: BLANDA Type: OC Drawer: I
Date.- 249/17 01 Receipt no: 71784
Year Number Amount
2617 258
217 SHIRLEY AVE
SANFORD, FL 32771
BP BUILDING PERMIT RECEIPTS
166.86
092299
Tender detail
CK CHECK
Total tendered
Total payment
Trans date: 2/09/17
4