1283 Travertine Tr; 18-3947; AC CHANGEOUTfth CITY OF
SkNFORD
FIRE DEPARTMENT
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: I d _39 V 1 Documented
Construction Value: $ 6806.00 Job
Address: 1283 Travertine Ter Historic District: Yes Nov Parcel
ID: 33-19-30-521-0000-1190 Residential[—] Commercial Type
of Work: New[] Addition Alteration Repair Demo Change of Use Move Description
of Work: AC Change Out Plan
Review Contact Person: Lori Title: Asst Phone:
407-602-3374 Fax: Email:lori.lockhart@protechac.com Property
Owner Information Name
Ajay Balineni Phone: 407-456-2016 Street:
1283 Travertine Ter City,
State Zip: Sanford, F1.3'1 Resident
of property? : Contractor
Information Name
Pro -Tech AC & Plumbing Service, Inc Phone: 4072911644 Street:
2425 Silver Star Rd City,
State Zip: Orlando, FI 32804 Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Fax:
State
License No.: 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: 6' Edition (2017) Florida Building Code Revised:
January 1, 2018 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 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 ofa plan review fee at the time ofpermit 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 construction and zoning.
Signature of Owner/Agent Dke Signanue of Con ctor/Agent Date
T
Print Owner/Agent's Name
19
SIfnature of Notary -State of FloricTa Date
DEBBIEBLANTON
a g MY COMMISSION # FF 178M
EXPIRES: February 25, 2019
pF N Bonded Thru Notary Public Underwriters
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print
7a, of Not State of Florida Date
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:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: January 1, 2018 Permit Application
9/14/2018 Job(2448X3264)
Customer's Name:
Tndav's Date: iJJ Valid until:
System Descri tion:
Thermostat:
Pull All Permits/Fees:
Preventative Maintenance: Comfort Club
Attic Installation:
pDGFullSystemPrice:
Pro -Tech Comfort Club Rebate*:
Manufacturer Rebate*: -(F.ck '- 200
OUC Rebate:
OUC Account #
U
P
Indoor Air Quality:
Media Filter UV Light
Electronic Air Filter
Ga Zoning Systems
R Duct System/Grills
A Comfort Club (2nd yr)
D
Electrical Upgrades
E`
Plumbing Additional ItemsS
Approved Upgrades:
Other:
Total Due to Pro -Tech:
Deposit Amount:
Balance Due:
Other Power Company Rebate:
Financing Options":
0% 721VIo 00% 60Mo
t 5.9% Equal Payments
0% 721VIo 110% 60Mo
5.9% Equal Payments
Manufacturer, Comfort Club, Cash Discounts, and Pro -Tech rebates cannot oe combines with wens rm so nnanci g.
Trane financing and manufacturer rebates eligible only on XR16 equipment and up.
Install Date: C>?Irq (6
Payment and Terms
Check/Cash: $ Financing: $ c{oD Credit Card: $
i have authority to order the work outlined above. In the event that payment is not made promptly in accordance with agreed terms, it shag be the sellees option to charge a service charge naceding1-5% a month, the first servke charge becoming due 15 days from the date of installation of our amount due on the job. In the event of collection by attomey, all attorney costs, court
k- 1a,. in the event of nonpayment, purchaser agrees to allOw seller on premises to remove equipment installed. This investmerd proposal.sbilll be
https://go.servicetitan.com/Attach/Job?name=Attaches°/`2Ff83d7Oal-5db4-4535-b2e8-27ff87d9eO6e_cdv ph0t0_001-i5pe77r92pJpg
9/14/2018 Job(2448X3264)
cost and other legal fees snap oe ~1- -7 .. -
tNndin` upon the heirs, successor, or assigns of the parties hereto. It is understood that the title to all prod
purchase pace has been paid in full and the manner of installation and/or attachment to any equipment a
nr a y manner leo ize the xl r s title, Date:
Customer
Signature O
t Date: CuS,
mer Fri d Name I
Date: Tpc
omfort Specialist Specialist https://
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MULTI JURISDICT/ONAL
Date: 4 / o
I hereby name and appoint:
arn agent of. Pro -Tech AC $ Plumbing Service, Inc.
Name of Company)
to be my lawful attorney -in -fact to act for me to apply for, 'receipt for, sign for and do all things necessary to thisappointmentfor (check only one option):
All permits and applications submitted by this contractor.
Or
The specific permit and application for work located at:
Expiration Date for This Limited Power of Attorney:
License Holder Name: Thomas T. Nixon
State License Nurnb-
Signature of License
STATE OF FLORIDA
COUNTY OF
CACO?9393
Dran,ye-
treeAddress)
The foregoing instrument was acknowledged before me this 1,0 day of
20_ /y , by %OMii A who is C'pers nally known to me or
0 who has produced as identification
and wh did (di ot) take an oath.
ANGELA L
Signet otary `nt q 1. 2019cr aee-oat
Notary Public -State of ti
Commission No.
My Commission Expires: