1000 E 1 St - M11-002095 - HVACAUG 1 b Z011
FadD' BY: CITY OF SANFO D
BUILDING & FIR RFVENTION
PERMIT APPLICATION
Application No: -C t) Documented Construction Value: $ 4SSU,C1 I
Job Address: ICOO E I5i Historic District: Yes No 91
Parcel ID: `90— IGI — Sk —SOU, —01 00 —OOSO Zoning:
Description of Work:
Plan Review Contact Person: CV1ri sA% Title:
Phone: 40-4 - 2q 1— k In 4 4 Fax: 40-4-522- O y 4 S E-mail: ChYiS+i Aa . n.2uumn4wj, Property
Owner Information AC
Corr Name
Ylzxc) Tri horS M SS or) kne_. Phone: 4o-4 - 23-343b Street:
1000 e V S* C+ • Resident of property? City,
State Zip: _SoLn-S O,r . 1L 323=7 Contractor
Information Name '
P0.7r7;-1tjr-, 14 y- ChrUa -1;Oro (l9- Phone: 404 - °Lq l— l U44 Street:
2425 Q' ilvjLr n0.l Fax: A(pq - S22-- 0445 City,
State Zip: Orlaun-o, SSbD+ State License No.: W(Q1--9 3g3 Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Building
Permit O Square
Footage: No.
of Dwelling Units: Electrical
O New
Service — No. of AMPS: Phone:
Fax:
E-
mail: _ Mortgage
Lender: Address:
PERMIT
INFORMATION Construction
Type Flood
Zone: No.
of Stories: Plumbing
0 New
Construction - No. of Fixtures: Mechanical
ID (Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
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.
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.
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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
pen -nit is released. I
0*
Signature of Owner/Agent Ooo0l Date
lit/, &, o'22 kI r v
Prim Owner/Agent's Na e 7
Stgnatur • Notary -State of Florida
r•VVILLIAM rCHgRNLEYComm# DD0832075U
Expires 10/1912012
Florida Notary Assn.. Inc
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Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Signature of on ctor/Agent ate
Print
StWKre of Notary -State of Florida
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Expires 1011912012
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Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
eanon
CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY)
12/21/2010
NIS 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
OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
tESENTATIVE 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 endorsement(s).
PRODUCER
GENTRY INSURANCE AGENCY, INC.
17S East Main Street
PO BOX 2046
APOPKA, FL 32704-2046
CONTACT
NAME:
ac°NloExt:407.886.3301 acNo:407.886.9530
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID
INSURER(S)AFFORDING COVERAGE NAICa
INSURED
Pro -Tech A/C & Heating Service Inc.
2425 Silver Star Road
Orlando, FL 32804-3311
INSURER A: Southern -Owners Ins. Co. 10190
INSURERS: Auto -Owners Ins 18988
INSURERC: Bridgefield Employers Ins. Co.
INSURERD:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 01-01-2011 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.
INSRLTR TYPE OF INSURANCE ADDLINSR UBRWVD POLICY NUMBER POLICY EFF
MMIDDrrM
POLICY EXP
MM/DDIYYYY LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
A
EML AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
727366461 01/01/2011 01/01/2012 EACH OCCURRENCE S 1,000,000
DAMAGE RENTED 300,000
MED EXP (Any one person) 10,000
PERSONAL & ADV INJURY S 11000,000
GENERAL AGGREGATE 2,000,000
PRODUCTS - COMP/OP AGG 2,000,000
B
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
9S4302260 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT
Ea accident) 1,000,000X
BODILY INJURY (Per person) S
BODILY INJURY (Per accident)
PROPERTY DAMAGE
Per accident) SX
X
UMBRELLA LIAB
EXCESS LIAR
OCCUR EACH OCCURRENCEHCLAIMS-MADE AGGREGATE S
DEDUCTIBLE
RETENTION $
S
C
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY Y
ANY
OFFICER/MEMBER
R
EXCLUDED
ECUTNE a
Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
0830-2975 01/01/2011 01/01/2012 X I wcyTA,,TU-I IOTRH
E.L. EACH ACCIDENT 1,000,000
E.L. DISEASE - EA EMPLOYEE 1,000,000
E.L DISEASE -POLICY LIMIT 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morespace is required)
CERTIFICATE HOLDER CANCELLATION
FAX: 407.688.5251
City of Sanford
Licensing Division
Attn: Joanne Johnson
P 0 Box 1788
Sanford. FL 32772
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE -b d
Debra Li
ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
P864mim
AIR CONDITIONING 8 HEATING SERVICE, INC.
AVAC Ccnuaeloss • Sine (>r ihad 14CACO29393
Delivering comif;rr, lricv, confidence & quality since 1901
Proposal
08/12/2011
Valid until 09/12/2011
Customer Name: New Tribes
Site Address: 1000 East 1 st Street
Sanford, Fl 32771
Date: 08/ 12/2011
Submitted By: Greg Meisenburg
Proposal For: Unit Replacement
Qt y Description Unit Price Total
I Replace Carrier system with a new 13 seer Carrier
split system.
Air handler Model # FV4CNF003T00
Condenser Model # 24ABB336AO03
4,556.91
Subtotal
Discount
Shipping
Total 41556.91
Comments
2425 Silver Star Road, Orlando, Florida 32804
Service: 407-291-1644 . Fax: 407-291-2631 . Commercial: 407-291-1642 • Fax: 407-522-0445
Main Office: 407-291-1643 • Fax: 407-522-0445 9 www.protechac.com
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 11
I hereby name and appoint: "'%w cko-yYl\g t,
an agent of: Tn _ ]I,,- Onr
Name ofCompany)
to be my 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):
XAll permits and applications submitted by this contractor.
D The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: --—Vio t'Y as ni xis n
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this 12 day of,
200' I , by '1(OmaS h% ,nh who is)xperson lly known
to me or o who has produced as
identification and who did (did not) take an oath.
Z no
GREGORY MEISENBURG Signature
NOTARY PUBLIC Cj-
ST
t
TE F FLORIDA r 1
D0936897
Expires 10/29/2013 Print or ty a name
Notary Public - State of _
Commission No.
My Commission Expires:
Rev. 3/27/07)