2659 Park Ave - M17-002965 - HVACf OCT 0 20i7 CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address: s (p s /-iP% Historic District: Yes NoQr ,,
Parcel ID: %.- 210 --30 - 57keb(o-0 72/ Residential Commercial
Type of Work: New Addition Alteration Rei(Tir:9 Deno Change of Use Move
Description of Work:
Plan Review Contact Person: Title:
Phone: %`` AFax: *%`'- -Email: 014IZ4
Property Owner Information
Name //'Lf i 661i' (- Phone:
Street: 10,572 5, A44 Resident of property?
City, State Zip: S4V-1
Contractor Information
G /
Name L /` % (/ Phone: 7 c o2791,
Street: Fax: ` A e&/l/. 5--
City, State Zip: State License No.: (fly zL!2 761
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer 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: 5'h Edition (2014) Florida Building Code
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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 ofthe 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 c"stragion #Ad: aipg.
Owner/Agent .is Personally Known to Me or
Produced ID Type of ID
3d
of
Print Contractor/Agent's Name/
95
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9y p
gyp 91'9 N :JK
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Signature ofNotary -State of Flora p ^ D nde os c
Contractor/Agent .is Personally Known .to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: -Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps.
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Stories:
Plumbing - # of Fixtures
of Heads Fire Alarm Permit: Yes No
UTILITIES: WASTE WATER:
FIRE: I:i111111710"
Building & Fire Prevention Division
HVAC (NEW AND CHANGEOUT)
PERMIT GUIDELINES
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:
d 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
applicant).
A. 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.
C Certificate of insurance indicatingworker's compensation insurance coverage and naming the City ofpggty
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).
Owner Builder Statement /.Affidavit (ifthe owner is the applicant).
Must be signed in person at the Building Department)
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 ofSanford, state, andfederal code requirements.
Effective: August 1, 2017
SEMINOLE COUNTY MULTI JURISDICTIONAL
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: / .
an agent of: &YVA14 1-46 6G60
Name of company)
tobemy lawful attorney -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 permit and application for work located at: Street
Address) Expiration
Date for This Limited Power of Attorney: License
Holder Name:/%f State
License Number: /a? i 97ZI V--f MW 76 , Signature
of License He STATE
OF FLORIDA COUNTY
OF The
foregoing instrument was acknowledged before me this _day of 20,
by A vl S who is personally known to a or who
has produced. as identification and
who did (did not) take an oath. Signature
of Notary pgItIHINIlI
l PpRAOFF
173590 ; o d
Print
or type Notary name Notary
Public - State of ,1) Commission
No. My
Commission Expires: 2S
TAX EXEMPTION"NUMBERS Board Of County Commissions
FLORIDA SALES:8"013708974C-0 Seminole County, Florida
FEDERAL SALES/USE: 59-6000A.%
PURCHASE ORDER
COMMUNITY SERVICES
534 W LAKE MARY BLVD
SANFORD FL 32773-7400
PAT LYNCH CONSTRUCTION LLC
909 DENNIS AVE
ORLANDO FL 32807
1301EASTSECONDSTREEr
SANFORD FLORIDA 32T71
DELIVERY Luis Albelo 407-665-2385 Cindy Baldus 407-665-2361
PURCHASING AND CONTRACTS DIVISION - AUTHORIZED SIGNATURESANFORD, FL
hone (407) 6 for. SEMINOLE COUNTY BOARD OF COUNTY COMMISSIONERSAccts. Payable Inquiries -Phone (407} 865-7681