223 Meadow Hills Dr - M18-004759 - HVAC0, O
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
00V75? ation, No: Applic
Documented Construction Value: $ 6,100.00
Job Address: 223 MEADQW HILL5 DB 5 EORD. EL 32773 Historic District: Yes [I No
Parcel ID: 10-20-30-5CS-OEOO-0150------------------., Residential CominercialEl
Type of Work: New E] Addition El Alteration EJ Repair H DemoEl Change of UseEl Move El Description of
W01-1j: Size for Size HVAC Change -Out with New 3 Ton 14 SEER H/P
split system with 8 kw heater. Plan Review
Contact Person: Andy Maldonado Title: Permit Tech Phone: 407-
299-0068 Fax: 407-299-0320 Email: PermitsOrlando@ars.com__4 vA K -Vv,A0APropertyOwner
Information " koa:k Name CARRIE
BERGNER S(,.,,Ct:
223 MEADOW HILLS DR City, State
zip: SANFORD, FL 32773 Phone: (321)
331-7707 Resident of
property? : Yes Contractor Information
Mull, ARS
Orlando - Dennis Zacek none: 407-299-0068 Street: 301.
2 Mercy Dr Fax: -- 407-299-0320 City, State
Zip: Orlando, FL 32808 State License No.: CMC1249753 Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: E-mail: Bonding Company:
Address: Mortgage
Lender:
Address: WARNING
TO
OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMINIENCENIENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .JOB SITE BE WORE 'I'll E FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT11 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 permit and that all work will be performed to nice( standards of all laws regulating construction in this
jurisdiction. I understand that a separate perruil must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers,
heaters, tanks, and air conditioners, etc. FBC 105.
3 Shalt be inscribed with the date of application and (lie code in effect as of that (late: 51" Edition (2014) Florida Building Code Vevistd: )unc
30, 2015 Vennit 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 1 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 orsubmittal.
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 oVvtler gent Date Signature of, Print
Owncr/Agent's Name P
Signature
of Nutary-State of FloridaDate Na
4"
q
4ex
llz' Owner/
Agent is Personally Known to Me or Contractor/Agent is ersonally 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 F Construction
Type: Total
Sq Ft of Bldg: Date
Dennis
Zacek Print
Contractor/Agent's Name Si
tature of Nota -Store of F td Date Occupancy
Use: Min.
Occupancy Loud: New
Construction: Electric - # of Amps Fire
Sprinkler Permit: Yes No 0 # of Heads APPROVALS:
ZONING: UTILITIES: ENGINEERING:
FIRE: COMMENTS:
Revised:
June 30, 20 t S Flood
Zone: 0
of Stories: Plumbing - #
of Fixtures Fire
Alarm Permit: Yes No[,'-' WASTE
WATER: BUILDING:
Permit
Applicatim
Home improvement Agreement: Page 1
Home Depot License #'s - For the most current listin visit www.Homet
E6Z440. =1614013. CR S0, CAC10137i7, CFC1426021, CFC1427642, 22MO, CAC 1010031. CCC1331113, CCC4331130;
Home Depot U.S.A.,Inc.("Home Depot") or Service Provider named below will furnish, install and/or
service the equipment listed below at the price, terms and conditions as outlined on this form.
BERGNER t ARRIE 0264 1-23674731348
Customer Last Name Customer First Name Store # / Branch Name Customer Lead/ PQ#
223 MEADOW HILLS DR SANFORD I 32773
Customer Address City State Zip
321-331-7707 j COUNTRYGIRI.ATHEART44@HOTMAIL.COMl
Home Phone# Work Phone# Cell Phone# Customer Email Address
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
69-LIGATIQN BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
3012 Mercy Dr Orlando
pity ___._ State Zip
Or Email: iCsalcidnOars earn
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.
YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE
SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED
TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN
SHIPMENT AT HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOURRIGHT TO CANCEL. Acknowledged
by: Customers
igna re at Contract
Price and Payment Schedule: Payment of the Contract Price is due upon signing unless a different
payment schedule is required by law, specified below or in a payment addendum. Contract
Price: $ 6100 Includes all applicable taxes. Excludes finance charges.* Sales
Tax: $ Included (If applicable) Maximum
deposit ONLY applicable in MD, MA, ME (33%), NJ, Wl (99%) Dep.
0 % Deposit Amount $ 0 Remaining Balance $ 6100 The
Home Depot - 2455 Paces Ferry Road, N.W. Bldg. 8-3, Atlanta, Georgia 30339 • Customer Care: 1-8004166M37 M
wvAc' tu7 Avg t titC 1 u e,110