HomeMy WebLinkAbout19-21315 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21315
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 21315 Address: 6337 SILVER OAKS DR
Permit Type: MECHANICAL ZEPHYRHILLS, FL.
Class of Work: A/C CHANGEOUT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: SILVER OAKS
Est. Value: Parcel Number: 03-26-21-0120-00000-1100
Improv. Cost: 5,774.00 OWNER INFORMATION
Date Issued: 6/14/2019 Name: MORALES, PETER & FLOREZ JACQUELI
Total Fees: 70.00 Address: 6337 SILVER OAKS DR
Amount Paid: 70.00 ZEPHYRHILLS, FL 33542-4814
Date Paid: 6/14/2019 Phone: (352)460-7634
Work Desc: A/C CHANGE OUT 3 TON
CONTRACTORS APPLICATION FEES -
DEL AIR HEATING A/C AND REF A/C CHANGEOUT 70.00
1
Ins ections Required
DUCTS INSTALLED
DUCTS INSULATED
FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there maybe 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, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
C NTRA S GNATURE PERMIT OFF[ R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
Phone Contact for Permitting ) --
Owner's Name rr,^22! Owner Phone Number
Owner's Address VJJ% Sf l y/ br. Owner Phone Number
Owner Phone Number
JOB ADDRESS 19�J 1 C���Ve OQLrS 4J1 ZC'iP�1`(� ���5 'I J�S LOT#
SUBDIVISION PARCEL ID# —,)1-0 --00000-I I190
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED R NEW CONSTR e ADD/ALT SIGN = DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR 0 COMM = OTHER
TYPE OF CONSTRUCTION BLOCK 0 FRAME = STEEL =
DESCRIPTION OF WORK 0-f
BUILDING SIZE SQ FOOTAGE= HEIGHT
............
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ AMP SERVICE = DUKE ENERGY = W.R.E.C.
=PLUMBING $
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS = ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License#
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
MECHANICAL COMPANY DPJ_—A UAc
SIGNATURE REGISTERED Y N FEE CURRE Y/N
Address License# C AC,0t&I(Itr7
OTHER COMPANY
SIGNATURE F REGISTERED Y/ N FEE CURREN
Address License#
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite, Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application, notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
** Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone W" unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached `permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C CEMENT.
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTOR
Subscribed and sworn to(or affirmed)before me this Subscribed ands to(or affirmed)bf�ffo�"re me thi
by by�f*_e,`4_ C�• k-t'�I 17 R c)SSA_
Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced
as identification. as identification.
/� /�0 h34t&
Notary Public 1/ 0& Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of {y
Ptrrc�cs KARILYN BARTLES
: MY COMMISSION#GG162762
r EXPIRES:November26,2021
Bonded Thru Notary Public Underwriters
DFLmAINR
Never Any Overtime Charges-Call Today!
(888) 831-2665
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'w�7►AYMG-AIR CCNI3MHiNG
Customer's Name: Job Address Date:
Peter Morales 6337 Silver Oak Dr 05/02/2019
Zephyrhills, Florida 35542
Customer's B€`:.ling Address: City,State,Zip: Customer#:
6337 Silver Oak Dr Zephyrhills, Florida 35542
Hcme Phone: k4obile Phone: Email(s): Job k:
352-460-7634 prpetel9@gmaii.com
Serving Florida Since,1983
• 100%Employee Owned.As an-employee owned company,each i ALL Major Brands.Del-Air.sells and services ALL major brands to"';.
and,every employee is an,owner•and is committed to'provid"ing,a help customers find the best solutions for their unique air
quality service in,a timely manner,treating'your home.as if it were conditioning and heating needs:
ours. •, Expertly Trained Technicians.Our professional,nationally
Financing Available.Del-Air Heating and Air Conditioning offers certified and factory'trained technicians have years'of installation
attractive and affordable financing.options.:. and service experience to get the job done'right the first time.-
t
Option 2
Carrier Comfort 15 25HBC537 Heat Pump Trani?XR16 4TWR6036H1000XHeat Pump -
• 3 Tons • 3 Tons
15.5 SEER,8.5 HSPF. 16 SEER,13 EER,9 HSPF,
10 Year Parts:Warranty . 10 Year Parts Warranty .
• 1 Year Labor.Warranty ., 1 Year Labor Warranty .
10 Year Compressor Warranty,, " : 10 Year Compressor Warranty
Carrier,.Comfort FX4DNF037LO0 Air Handler Trane M-Series TEM6AOC36H31SB Air
10•Year Parts Warranty Handler-
1 Year Labor Warranty . 10 Year Parts Warranty
CE2401 C05 Electric-Heater • 1-Year Labor Warranty
• 5 kW, BAYHTR1505BRKC Electric�Heater , -
AHRI#10487322 • 5 kW.
AHRI#7562981
Notes
(BAYSF12358AA)in Accessories AHRI
System BTU(33000)
Accessories
Required Thermostat,-HoneYw ell Required Thermostat-Honeywell
3htg/2clg Programmable-Included 3htg/2clg Programmable:-.Included.
(TH6320U2008INC), ; i (TH6320U2008INC)
• .UV Air Cleaner-Premier One Bronze • UV Air Cleaner-Premier One Bronze"
24 volt UV Light 55 Microwatts(ER- 24 volt UV Light 55 Microwatts(ER=
UV-14-24V)H044258 UV-14-24V)H044258 "
May 2, 2019 9:32:14 AM Page 1 of 4
Additional Services
• Required Drain Line-Reuse Existing Required Drain Line-Reuse Existing
Drain Line Clean With Drain Line Drain Line Clean With Drain:Line
Cleaner Cleaner .
• Required Indoor Unit-Horizontal Air Required Indoor Unit-Horizontal Air
Handier In Attic Handler In Attic
• Required Permits.-Electrical Permit • Required Permits-Electrical Permit
Included if Electrical done by Del-Air Included if Electrical done by.Del-Air
• "Required Outdoor Breaker.Brand- • Required Outdoor Breaker Brand-
Existing Indoor Unit Breaker Brand . Existing Indoor Unit Breaker Brand
Siemens Siemens
• Required Outdoor Breaker Existing • Required Outdoor Breaker Existing
Size-Existing 30 Amp Outdoor Size-Existing 30 Amp Outdoor
Breaker Breaker
•,'Required Indoor Breaker Brand_- • .Required Indoor Breaker Brand-
Existing Indoor Unit Breaker Brand Existing Indoor Unit Breaker Brand
Siemens Siemens
• "Required,Indoor Breaker Size-< Required Indoor Breaker Size-
Existing 50 Amp"Indoor Breaker Existing 50 Amp Indoor Breaker
Included Material-Included-Clean Included Material-Included-Clean
Work Area At Job Completion ., - Work Area At Job Completion
;Included Material-Included-Dispose • Included Material-Included-Dispose
Of Old Equipment Of Old Equipment
.' Included Material-Included-New Included Material-Included-,New
Code Approved Hurricane Straps Code Approved Hurricane Straps
• Included Material—Included-New • Included Material-Included-New
Galvanized Seconday Drain Pan Galvanized Secondary Drain Pan
Included Material-Included-New In- . Included Material-Included-New In-
Line Safety Float Switch Line Safety Float Switch
•. Included Material-Included-New Pan • Included Material-Included-New Pan
Safety Float Switch Safety Float Switch-
Included Material=Included-Permit. Included Material-Included-Permit
Included Material-Included- Included Material-Included-
Reconnect&Clean.Existing Drain.Line, Reconnect&Clean Existing Drain Line
• Included Material-Included- • Included Material-Included _
Reconnect Existing Return Duct to Reconnect Existing Return Duct to
New Unit using 1-112"Antimicrobial. New Unit using 1-1/2"Antimicrobial
Insulation Insulation
Included Material.-Included- Included Material-'Included-
Reconnect Existing Supply Plenum to_ Reconnect Existing Supply Plenum to
New Unit using'l-1/2"Antimicrobial New Unit using 1-1/2"Antimicrobial
Insulation Insulation
• Extended Warranty-2nd Year Labor . Extended Warranty-2nd Year Labor
Warranty Warranty
Outdoor Unit-New Hurricane Rated Outdoor Unit-New Hurricane Rated
Condenser-Pad 40 X 40(H022745) Condenser Pad 40 X 40(H022745)
Option 2 Total Investment
w Total:$5,774 Total:$6,456
Estimated Payment:$320.78 Estimated Payment:$358.67
Payment:Synchrony(253)18 Month No Payment:Synchrony(253)18 Month No
Interest with Monthly Payments Interest with Monthly Payments
Option,2 After Rebate
,Total:$5,774 Total:$6,456
Duke Energy,Rebate:$200 Duke Energy Rebate:$200
Net:$5,574 Net:$6,256
May 2, 2019 9:32:14 AM Page 2 of 4
.fit.. f,.qy '6�• ":` .\. F'{:.. :h� < �' '�; ..... .`.. ,' l•., <e .A 'sy. z
.....wUG .n ..d..m...:....._...._•w<... .......>.,<...................._. .:....;.:..'^.'3...,;,a."„,..a,o:aaa`° .J..uw.... �_,..;,...�a"`,xE^�".�' t4 - .'e'Y :x -rhf:^ ,.....a._..-,.w.a..::.,.....,w:.,.•...e`
Total Investment(Before Discount) '$6,879
Less Del Air Discount• (-)$1.;105
Less Down Payment (-)$0
Remaining Balance" $5,774
PA
Optional:Estimated payment of$320.718 Synchrony.(253)`18 Month No'Interest.witfi Monthly Payments(approval required).
Customer Acceptance: Date:
Company Approval: Date: 05/1 6/201 9 5:34 PM
Company Representative:Scott Richardson, SRichardson@delair.com, (813)323-1852
Install Date: 05/21/2019
_. .
Nbtes
It is the eesponsibllity of the.-Homeowner to registerthe unit'for the Extended Manufactures Parts Warranty -:
10 yearcompressor and coil`and 1 year labor is not transferable. It is only good to•the originalowner''. "
Trane will transfer warranty if.within 90 days from the'sale of the home
Homeowner is responsible tostay home(1)full day for.the Building Department Inspection
All applicable,sales and local taxes are included:
Proposal valid 60 Days:,
All necessary materials and.supplies to complete installation are included.
Operational ductwork,venting
,g,electrical wiring and drains.are.used as needed. ,
Used(replaced)equipment'is"removed and recycled as appropriate. ,
Used refrigerant is,reclaimed and recycled in accordance with EPA Standards.
Work area is cleaned upon completion. ;
Proper operation is ezplained'to you:
Installations include:
New code approved hurricane straps ,
New pan safety float'switch,
May 2, 2019 9:32:14 AM Page 3 of 4
Terms&Conditions
Homeowners are responsible to stay home for one (1) full day for the Building Department
Inspection.
Del-Air gives no guarantee for any existing conditions such as,but not limited to,pre-existing Electrical,Ductwork,Mechanical Equipment&House
Structure
Florida's Lien Law
ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW(SECTIONS 713.001—713.37,FLORIDA STATUTES),THOSE WHO WORK ON YOUR
PROPERTY OR PROVIDE MATERIALS AND ARE NOT PAID IN FULL HAVE THE RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST
YOUR PROPERTY. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS,SUB-SUBCONTRACTORS,OR
MATERIAL SUPPLIERS,THE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT,EVEN IF YOU ALREADY
PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR,YOUR CONTRACTOR MAY ALSO HAVE ALIEN ON YOUR
PROPERTY. THIS MEANS IF A LIEN IS FILED,YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR,MATERIALS,
OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF,YOU
SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE,YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU
WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A"NOTICE TO OWNER."
'FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX,AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY.
Estimator:
It is understood that the title of all products and equipment covered by the contract remains solely in the seller until the entire purchase price has
been paid in full and the manner of installation an/or attachment to any equipment and/or any portion of the building structure in which the installation
is made shall not in any manner jeopardize the seller's title.
Payment
In the event payment is not made promptly in accordance with agreed terms,it shall be seller's option to charge a service charge not exceeding two
(2)percent per month.The first service charge will be due 15 days from the date of the billing of our amount due on the job. In the event of collection
by an attorney,all attorney fees,court costs,and other legal fees shall be borne by the buyer;in the event of non-payment,purchaser agrees to
allow seller on premises to remove equipment installed. This sales agreement shall be binding upon the heirs,successors,and/or assigns of the
party hereto.
Proposal is valid for 30 days.
HVAC License:CAC032448
May 2, 2019 9:32:14 AM Page 4 of 4
DE L-AR .
Heating-•: Air-Con'ditioning
Refri-g'erati.on, (>7c..
:LIMITED POWER O.FATTC1f?NEY.
Date:.
This letter is-written to give-authorizatio
n for, to
p"rck up the Mechanical Permit-for.De1-Air'Heating, Air Conditioning, & Refry erabon, Inc. for
Thank you,
Robert G.-Del.lo Russo, President
Del-Air Heating, Air Conditioning, Refrigeration, Inc.
STATI=OF f:CbRIDA
COUNTY OF, �1 (�� -
The foregoing instrument was acknouvledgecl'thi _day of,s�[� �_20 by
-Robert G. Dello Russo-who is pgfsanalty.kn�'And-appeared.before me and acknowledged that he '
signed the in trument volunta ' for the purpose expressed in it.
Signature of No ub' (Nx)tary Seal).
Print, Type;or,Stamp Name of N�atary.Public
*t*Y Notary ft tic.Si.W of FbrMa
Michelle SMOSW
My Commissaian GG 146MI
531 Codisco Way
-
Phone(4W) 333-COOS. (2665) SALES
www.de(air.com INSTALLATION
Lt Opus
DUCT CERTIFICATION FOR INSTALLATION OF NEW DUCT WORK OR MODIFICATION OF THE EXISTING
DUCT SYSTEM
FLORIDA ENERGEY CONSERVATION CODE(FBC ENERGY,SECTION 403)TO BE LEFT ONSITE AND PICKED
(�
UP BY INSPECTOR
Owner: (3�4`eC morale
Permit#:- 1,3 [
Site Address: l0 3 3 5 t 1 t!�f U0.��S 'b r, P V) L 3
Contractor: .,`
License#: ( C U.� -4 y
Final Inspection Date:
I certify that I have installed new or modified the existing duct work associated with the HVAC system
referenced by the permit listed above and found it complies with the requirements FBC Energy Code,
Section 403.3.Where modified,the existing ducts have been sealed using reinforced mastic or code-
approved equivalent. Ducts are located within conditioned space(Section 403.3)System was tested as
per FBC Energy code,section 403.3.2.1.All new duct work is to comply with FBC Energy 403.2 and FBC
Mechanical chapter 6.
A-110 let
Name of License Holder(print or type) f ►gnature of License Holder
1
� I