104 W 23 St - M17-002940 - HVACCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
F
Application No: 9
Documented Construction Value: $
Job Address: %0 q /,{J. 00 A,t l k(j2lj ,3 27 _7/ Historic District: Yes No W
Parcel ID: . „A • 6600 - O/OO Residential VP Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: e QUY- cR -S-4014 AlCAY'
Plan Review Contact Person: Y-Title: % j/ , 7 vzzotd.
Phone: Jld Y 16 9 q, / Fax: Email:
Property Owner Information
Name I% A 1 e. Pe_lj:O,u Phone: LIQ 7 a2 8 ' 1 " 0,2
Street: & /A/ A31&d A10A Resident of property? : _ es
City, State Zip:\,_A klh ld 41 ScQ 77/
Contractor Information
Name 1O—,q a Alk 7 AW1/9,1/Ll1d &A-V Phone: q6 71 dT OJ - gSOl ,
Street:. A A. 9—eOk/ el 2y Fax: City,
State Zip: O I/I e om s- State License No.: 0//m(10 y 1 3 Architect/
Engineer Information Name:
Phone: Street:
Fax City,
St, Zip: E-mail: Bonding
Company: Mortgage Lender: Address:
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, beaters, tanks, and air conditioners, etc. FBC
105.3 Shall be inscribed with the date of application and the code in effect as of thatdate: 511 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 ofpermit 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 ofsubmittal.
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.
2-,F— ("o L drQ C-,,-
Signatureof Owner/Agent Date
Print Owner/Agent's Name
Signature ofNotary -State ofFlorida Date
Owner/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: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps.
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
FIRE: BUILDING:
Revised: June 30, 2015 Permit Application
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I hereby name and appoint ( /Q(/ % ( % f e `/
An agent of: American Aix and Heat
To be my lawful attorney in -fact to act for me to apply for, receipt for, and sign for and do all things
necessary to this appointment for:
to,Q l,- 2C1 6j- A/a k-I
Address of .lob)
lExpirationdateforthislimitedpowerofattorney: l / /
MvSiqftofeJek-dC"ornitractor)
Jerry Bent, CMC049238
Printed Name of Contractor and License Number)
State of Flo, a
County of 1
S to and subs ribed before me tbis ` dy of by
Who is personally known to me or who has produced (identification)
Notary Public
Commission expires: 07 .
Print or Type Name)
BARBARA L MCGILL
MY CCMbdiSsiOV t FF 939109
EXPIRES: December 19, 2019
nonded ThruNotary Public U dervMters
Notary Seal)
HEAT GAIN
Name
Address
City, Zip
CALL INST :
COOLING LOAD (HEAT LOSS) 95 DEGREE DAY
WINDOWS ;: AREA BTU GAIN HEAT GAIN
NORTH (SINGLE) 164 25 4100
NORTH (DOUBLE) 0 20 0
EASTM/EST (SINGLE) 41 55 2255
EASTM/EST (DOUBLE) 0 50 0
SOUTH (SINGLE) 48 30 1440
SOUTH (DOUBLE) 0 25 0
SKY LIGHT 0 65 0
0 15 0
WALLS
NO INSULATION 981 8 7848
R-3 1" 4.5 0
CEILINGS '`
NO INSULATION 0 11 0
R-11 3" 0 3 0
R-19 6" 0 1.5 0
R-25 9" 940 1.2 1128
FLOORS:
NO INSULATION 0 3 0
CARPET 0 2 0
R-11 0 1 0
SLAB ON GRADE 940 0 0
INFILTRATIO0
HOME SQ. FEET 940 2.5 2350
INTERNAL`GAINS .;s' s
NUMBER OF OCCUPANTS 3 530 1590
KITCHEN/BATH ALLOWANCE 1 2400 2400
SUB TOTAL` 23111
DUCT -MULTIPLIER;# SM 1.13
Tonnage
TOTAL
y
26115 2.2
This combination qualifies for a Federal Energy
Efficiency Tax Credit when placed in service
between Feb 17, 2009 and Dec 31, 2016.
n
AHRI Certified Reference Number: 9139912 Date: 9/12/2017
Product: Split System: Heat Pump with Remote Outdoor Unit -Air -Source
Outdoor Unit Model Number: 14HPX-030-230-21
Indoor Unit Model Number: CBX25UHV-030-230-°*
Manufacturer: LENNOX INDUSTRIES, INC.
Trade/Brand name: LENNOX
Series name: MERIT 14HPX SERIES
Manufacturer responsible for the rating of this system combination is LENNOX INDUSTRIES, INC.
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:
Coolin
jgy
Capacity (Btuh): Y 28600
EER"Rating (Cooling) _ 12.50 r
EER
4= 32
Rating (Cooling 15.D0.
i Heating Capacity(Btuh) @ 47 F: 25600
Region IV HSPF Rating (Heating): 8.50 :
Heating Capacity(Btuh) @ 17 F: 16400
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 orperformance of the product(s), orthe
unauthorized alteration ofdata listed on this Certificate. Certified ratings are valid only for models and configurations listed In the
directory at www.ahridirectafy.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 uses'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, clickon "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.: 131497157495040693
fYYYYAfc:"K " CERTIFICATE OF LIABILITY INSURANCE 7117/2017° '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements .
PRODUCER CoNTA T
NAME:
3lackadar Insurance Agency, Inc. PHONE -831- 832 FAXNo : 811436NRonaldReaganBlvdE-MAIL
ongwood FL 32750 ADDRESS:D
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURER A
INSURED AMERAI R-01 INSURER B
INSURER CAmericanAir & Heat, Inc.
502 S. Econ Circle
Oviedo FL 32765 INSURER D
COVERAGES CERTIFICATE NUMBER: 917RAAlgA Rr-M-RION NIIMRFR-
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.
1 7R TYPE OF INSURANCE - INNS
L
WVD POLICY NUMBER POLICYEFF MMILDD EXP LIMITS
B GENERALUABIUTY 60362417 7/22/2017 7/22/2018 EACH OCCURRENCE 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
PREMISES Eaoccurrence 100.000
MEDEXP (Anyoneperson) 5,000
PERSONAL & ADV INJURY 1,000,000
GENERAL AGGREGATE S2,000,ODO
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 2 000.000
POLICY PRO-
LOC
B AUTOMOBILE UABILITY 60362417 7/22/2017 7/22/2018 Ea accident 1 000 000
BODILY INJURY (Per person) ANY AUTO
AAUTOS
WNED X SCHAUTOS BODILYBODILY INJURY (Per accident) S
X HIREDAl1rOS X NON -OWNED
AUTOS PROPERTYDAMAGE
Per accident S
UMBRELLA UAB OCCUR EACH OCCURRENCE S
AGGREGATEEXCESSLIARCLAIMS -MADE
DED I RETENTIONS
C WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / NLIM
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? NIA
WC84000170502017A 7/22/2017 7/22/2018 IM1iC STATU- OTH-
E.L. EACH ACCIDENT 100,000
E.L. DISEASE - EA EMPLOYEO 100,000MandatoryInNH)
Ifyes, describeunder
DESCRIPTIONOF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S500,000
A Business Services Bond OBS0539627 2/17/2017 1 2 I7120111 Limit $25.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Ifmore space Is required)
Blanket Additonal Insured with respect to the General Liability when required by contruction agreement and Business Auto when required by
written contract. Blanket Waiver of Subrogation applies to Workers' Compensation and Business Auto when required by written contract.
CFRTIFICATF 1Ir71 nF;P t AkW'=1 I A'rinki
CITY OF SANFORD
P.O. BOX 1788
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
SANFORD FL 32772-1788
USA AUTHORIZED PRESENTATIVE
v
W uatst$--LU'IU AL;UKLJ GUKNUKATIUN. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
f 1iiOTl41' IM S Y i-ICM61IN' E'' BOARD (850) A874SM 1940NORTHMONROESTRE ;'ii' TALLAHASSEE
FL32309-0783 MENME
d Y Ati1
AIR 1''JF-ATIi 603
Iom F-CamCAP.CLEOVIFDQ
9 32765 SEMINOLE
COUNTY BUSINESS TAX RECEIPT 1
JOEL M. GREENBERG, SEMINOLE COUNTY TAX COLLECTOR PO
BOX 630 I SANFORD, FL 32772 ! 407-665-1000 WWW.
SEMINOLE000NTY.TAX VALID
THROUGH 09130f18 AMERICAN
AIR & HEAT INC 502
S ECON CIR OVIEDO,
Fl- 32765 MATTHEW
A BONI (OFFICER) 10432017082227728
Account #:
067098 REGULATED
License # -
CMC049238 Qualifier-
JERRY BENT Amount
Paid: $ 49.50 Data Paid:08/22/2097 r •
L+
pA j i ! Q '.,'.E
OFuFFlI,p4{RRA.E *
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111 LF1;.f11., S REiARY tiC-."-:-.
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sa
tz eza s DISPLAY AS REWAREX) BY RAW s a 1 r IQa4ts a
gsXNFORDFIREOEPARTMENT
Building & Fire Prevention Division
Residential Permit Card
PERMIT NO. /7-*07 9 L ISSUE DATE: V• o s
CONTRACTOR: a e//
JOB ADDRESS:
TYPE OF WORK:
o7.Iro Sf Post this
permit in a conspicuous location outside Approved plans
must be posted with permit for inspection Leave all
work uncovered until inspected and approved Permit expires
6 months from date of issue or last approved inspection PROTECT FROM
WEATHER BUILDING INSPECTION
TYPE
APPROVED REJECTED INSPECTOR ELECTRICAL INSPECTION
TYPE
APPROVED REJECTED INSPECTOR FOOTER INSPECTION
ELECTRIC UNDERGROUND STEMWALL FOOTER/
SLAB STEEL BOND FORMBOARD SURVEY
T.U.G. / PRE POWER SLAB / MONO -
SLAB ELECTRIC ROUGH LINTEL / TIE
BEAM ELECTRIC FINAL SHEATHING - ROOF
MECHANICAL INSPECTION TYPE
APPROVED REJECTED INSPECTOR SHEATHING - WALLSFRAMEMECHANICAL
ROUGH INSULATION ROUGH
IN IMECHANICAL FINAL DRYWALL/SHEETROCK
PLUMBING INSPECTION TYPE
APPROVED REJECTED INSPECTOR LATH INSPECTIONFINALSTUCCO/
SIDING UNDERGROUND ROUGH FIREWALL SCREW
TUB SET FIREWALL FINAL
SEWER INSULATION FINAL
PLUMBING FINAL FINAL SFR
GAS INSPECTIONS INSPECTION TYPE
APPROVED REJECTED INSPECTOR ROOF INSPECTION7TPE
APPROVED REJECTED INSPECTOR GAS UNDERGROUND PIPE ROOF DRY -
IN GAS ROUGH-fN FINAL ROOF
GAS FINAL MISCELLANEOUS / FINAL
INSPECTIONS INSPECTION TYPE
APPROVED REJECTED INSPECTOR INSPECTION TYPE APPROVED REJECTED INSPECTOR FINAL DEMO
FINAL DOOR FINAL SOLAR
PANELS FINAL WINDOW FINAL POOL
SCREEN FINAL SCREEN ROOM FINAL UTILITY
BUILDING FINAL BUILDING OTHER MOBILE HOME
TIE -DOWN MOBILE HOME FINAL 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. 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 FBC
105.3.3 REVISED: 4-
17 Inspection Line: 407.792.6069 or 855.541.2112
TO SCHEDULE AN INSPECTION:
Dial 407.792.6069 or 855.541.2112
Provide the items requested during the message
The type of inspection requested must be scheduled under the appropriate permit type
Follow the prompts
To Schedule Fire Inspections: Please call 407.562.2786 ***
PLEASE NOTE: Inspections scheduled by 5:00 p.m. will be conducted the next business
day. If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am -
5:30 pm for assistance.
AUTOMATED INSPECTION SYSTEM CODES
BUILDING ELECTRICAL
FOOTER 104 ELECTRIC UNDERGROUND 211
STEMWALL 102 FOOTER / SLAB STEEL BOND 221
FORMBOARD SURVEY 147 T.U.G. 216
SLAB / MONO -SLAB 103 PRE POWER FINAL 218
LINTEL / TIE BEAM 105 ELECTRIC ROUGH 212
SHEATHING - ROOF 106 ELECTRIC FINAL 213
MECHANICALSHEATHING - WALLS 115
FRAME 109 MECHANICAL ROUGH 409
INSULATION ROUGH -IN 110 MECHANICAL FINAL 410
PLUMBINGDRYWALL / SHEETROCK 131
LATH INSPECTION 132 UNDERGROUND ROUGH 322
FINAL STUCCO / SIDING 130 TUB SET 312
FIREWALL SCREW 120 SEWER 311
FIREWALL FINAL 143 PLUMBING FINAL 313
GASINSULATIONFINAL113
FINAL SFR 138 GAS PIPING UNDERGROUND
GAS ROUGH -IN
328
314ROOF
ROOF DRY -IN 116 GAS FINAL 315
FINAL ROOF III
MISCELLANEOUS / FINAL INSPECTIONS
FINAL DEMO 126 FINAL DOOR 136
FINAL SOLAR PANELS 134 FINAL WINDOW 137
FINAL POOL SCREEN 139 FINAL SCREEN STRUCTURE 127
FINAL UTILITY BUILDING 124 FINAL BUILDING - OTHER 112
MOBILE HOME TIE -DOWN 145 MOBILE HOME BUILDING FINAL 146
Miscellaneous Notes:
REVISED: 4-17 Inspection Line: 407.792.6069 or 855.541.2112
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 . . . . 17-00002940 Date 10/04/17
Property Address . . . . . 104 W 23RD ST
Parcel Number . . . . . . . 36.19.30.532-0000-0100
Application description . . MECHANICAL PERMIT
Subdivision Name . . . . .
Property Zoning . . . . . . MULTIPLE FAMILY
Permit . . . . . . MECHANICAL PERMIT -RESIDENTIAL
Additional desc . .
Phone Access Code 1005552
Permit pin number 1005552
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
1000 410 MH02 MECHANICAL FINAL / /