HomeMy WebLinkAbout12-13478 CITY OF ZEPHYRHILLS
5335-8TH STREET
(si3)�so-oozo • 13478
BUILDING PERMIT r
Permit Number: 13478 Address: 6219 10TH ST
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: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-0080-00200-0290
Improv. Cost: 2,800.00
Date Issued: 9/21/2012 Name: BUCHANAN, LENZY Z & SHELBY A
Total Fees: 50.00 Address: 8124 DAR LN
Amount Paid: 50.00 ZEPHYRHILLS, FL. 33541
Date Paid: 9/21/2012 Phone: (813)782-9034
Work Desc: HVAC PACKAGE UNIT CHANGE OUT
�,.
( ' � /
: � �
`�
!
DUCTSINSUL D
FINAL ,.-��
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b)aondemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site� plans not at job site g)work not accessible.
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, 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 wmmenoement."
Complete Plans,Specifications Must Accompany Application.All work shall be pertormed in accordance with
Ci Codes and Ord' ances. NO OCCUPANCY BEFO C.O.
��� _
ONTRACTOR SIGNATURE � PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
� ' -
s�s-7ao-oozo ,,5��' City ot�ephyrhills Nermit App�ication rax-tsis-itsu-uuz�
Building Department ,
Date Recefved � � l-�' phone Contact for Permittin -
Owner's Name �i�-C�-7� Owner Phone Number O �����O? ��
Owner's Address 7�J�+ 1��� Owner Phone Number
Fee Slmple Titleholder Name � Owner Phone Numbar
Fee Simpte Titleholder Address
JOB ADDRESS � /D? �J � til°'��� �� �31"�- LOT# [�
SUBDIVISION S�� , PARCEL ID# a oC�' b'- ��CJ��o��+d�Sv
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONS'F ADD/ALT SIGN Q Q DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME 0 STEEL Q
DESCRIPTION OF WORK ///�-� �L �/� NZ�� NG�.
BUILDING SIZE SQ FOOTAGE� HEIGHT
QBUILDING $ VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
OPLUMBING $ , �
,. 1���
�iuIECHANICAL $ VALUATION OF MECHANICAL INSTALLA ION
QGAS Q ROOFING Q SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address ' License# �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �—
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N �
Address License# �
MECHANICAL v� COMPANY �N�� „!� ��r-v�
SIGNATURE REGISTERED N FEE CURREA Y/N
Address � � G�-�. ���,�i� f/ 3.�n"r— License# ��?- ���
OTHER � COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address Llcense# �—
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,Constructlon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster;Site Wortc Permit for subdivlsions/large proJects
COMMERCIAL Attach(3)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 8 1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet wmpliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""*PROPERTY SURVEY required for all NEW constructlon.
Directlons:
Fill out application completely.
Owner&Confractor sign back of applicaUon,notarized
If over;2500,a Notice of Commencement is required. (A!C upgrades over;7500)
" Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING , jFront of ApplicaGon Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on publlc roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The unde�signed 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 Iicensed 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 licerl�ing requirements may apply for the
intended work, they are advised to contact the Pasco Counry 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 expansfon 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 amendedj: 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 Construc.tion 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 desc�ibed 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 appiicable 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 instailation 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
ce�tify 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, Wetiand Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
- Department of Health 8 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 fiil:
- Use of fill is not allowed in Flood Zone"V"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 wiil nvt adversely affect adjacent
properties. If use of�II is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the buiiding 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 specificaliy 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 vivlations 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 o�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 O OMMENC ENT.
FLORIDA JURAT(F.S. 117.03)
CONTRACTOR �'�'"T �-!
OWNER OR AGENT Subscribed and swom r ffl ed) efor me this ' �
Subscribed and swom to(or affirmed)before me this �, ��✓��bY
Y '�
Who is/are per onally known to me or haslhave produced ho is/are personally kno to me or has ave produced
as IdenUflcatlon. �1�,,� • as identlficatfon.
� 1 �
�—�� �� �~ Public
Notary Public �f _
Commission No. Commission No.
,,•;:�::�i%&-.; BOBBIE S.SWETLAND
Name of Notary typed,printed or stamped Name of � ;;� xpires ebruary ,2016
��R����.�`�� Bend�!Thru 7roy Faut Insurance A00-385-7019
Pasco County Parcel: 02-26-21-0080-00200-0290 001 Page 1 of 1
Data Current as Of: Weekly Archive - Saturday, September 15, 2012
Parcel ID 02-26-21-0080-00200-0290 (Card: 001 of 001)
Classification O1 - Single Family
Mailing Address Property Value
BUCHANAN LENZY Z&SHELBY A Ag Land ��
8124 DAR LN ��d $15,120
ZEPHYRHILLS FL 33541-7526
Physical Address Building $59,590
Extra Features $678
6219 lOTH ST
ZEPHYRHILLS FL 33542-3547 ]ust Value $75,388
L@aal DeSCrlDtion (First 4 Lines) Assessed (Non-School Amendment 1) $75,388
See Plat for this Subdivision
Taxable Value #75,388
TYSON SUB
PB 4 PG 109 LOT 29 BLOCK 2
OR 8737 PG 602
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price Condition Value
1 0100 SFR OOR3 9,450.00 SF $1.60 1.00 15120
� $ �
Additional Land Information
Acres 0.22 Tax Area OZH FEMA Code X Reside�ial Code TY B pl
Buildina Information - Use O1 - Single Family Residential (Card: 001 of 001)
Year Built 1973 Stories 1.0
Exterior Wall i Concrete Block Stucco Exterior Wall 2 Concrete or Cinder Block
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring i Carpet Flooring 2 None
Fuel Electric Neat Forced Air- Duded
A/C Central Baths 1.0
Line Descriptlon Sq. Feet Repl. Cost New
1 BAS 1,479 $68,330
z Q 55 r- $647
3 � 624 $11,550
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 �WS 1988 432 $583
2 F N E 1996 192 $95
Sales History
Prevfous Owner SUNTRUST BANK
Month/Year Book/Page Type DOR Condition Amount
Code
07/2012 8737/0602 Warranty 12 Improved $57,300
Deed
05/2012 8706/ 1244 Certificate���
of Title 12 Improved $0
05/2004 5836/ 1003 WDeedty C] Improved $0
http://www.appraiser.pascogov.com/search/parcel.aspx?sec=02&twn=26&rng=21&sbb=0... 9/21/2012
�' i i De s i n Sta r �.�a � � • � � �
,c� ad Cal �u lat� on
Resufts ane irrtended far use with Rheern h�ating an�i aooling systems only
T`3C9�G`W LPNT�IP(A"�39 ywl�B��E��'V
s>i „�°n�ew'�,". ,«..e�: ���«.��.he':k.a,w '^K,�R7o�' s.�, a��. >. , ��. � .
• • ! �
... � • , .�� , ` .� , . , � . . ' ' " � � r, > � .. , . . . . - ,
' �ii��i
Street Address 6219 lath street, Zephyrhills, F� 33542
LC�L�I���� ��n��i.�i.l� ��,����41 ��G.����
.. .,. ... .................... .._..........,..........,..,................,.........,. ......_...... .........._.._............ .,............. ................................... ... ... ... ... .. ,...
House Square Footage: 1479 sq. ft.
... .................. ............... ... ... ....,........ ............. .............._. ._. ....... _... ..... ... .,..,. ,. .......,.
hJame: SHELBY BUCHANAN
Ph on e: 813-782-9034
Email:
• ' • . �
SHR 75
Number a�F residents 4
Ceiling height g
Wail U-value � R-value O.Og f 11
Floor U-value J R-value 0.2 � 5
Ceiling U-value � R-value C?.05 � 19
Windaw U-vafue p,�
Window SN�F p,g5
Maisture grains �6
ouct �c�ss al� �a
Duct gain °/a �Q
Cooling infiltractian {ACN} Q.6
Heating infiltration (ACH} p,g
Winter ventilation p
� • • • � • � .
Outdoor Heating Cooling • .
Qry bulb (°F) 4U 91
Daily range M
. ........ ................ ........ ....... ................. ... .......... . _.. .. . . .
Relative humidity �pn�p
Maisture difference s�
Indoor Heating Cooling
Indaor temperature {°F) 7n 75
Design temperature difference{°F) 30 16
' . • • • • � .
Area Btuh % of load � ,
W�I# 232a 11.2
Floor 5592 26.9
.. .. ............. .............. ........ .. .......... ._........... ... _. .
Ceiling 2352 11.3
windows 3180 15.3
Infiltra�ion 5447 26,2
System Effieiency Loss 1889 9.1
Totai: 20779
H eati ng Loads
20,7/9 f3TUfhr
�System Efficiency Loss
Floor �
�Wall
Ceiling
Infiltration � `-Windows
• • • ! . • .
, �. . . ���� . . ..., . . . .
� y HP-r"J�, i. . �"'3i` ; r�„'� i
@ � . �. � � i
Wall 1237 3.7
!�+�i��hg . �. .R -„�� ...; �.�' . : . .
:���6�. �., ,���:,.
.....,�....�,...��...............................�...n,�..�:�..:..a:�........�.;�`»',���^�;SP».».:.:.u{F�;R`n�«Y�, "4..<+nna.,.�,......................,.,....,. ........,.. � '
Windows 18352 54.7 � � . , °�.
�,�.,.�..M,... _..,_.....�...._.�� ,..���:-��_�u�--�-y-�- ., ,�-���-.�._,.�...� ,
. , .. .. . :: .:_ , ,
., . ..� . . . . .
r��,. � .'C�'. ":��` ��.;�, ��-. _.� � � � . ,
.,, ��,,,.�..�;.>x. •� , , . -: a � >.,.�. . �;�„. �� � � " , , ,
.,,..<...^- k.�:.. . 5 : '. "�5' . ��f�,i,: ,iiR �
n
....��........i.....,.....�..�........n.A..i�+47Xf�M::A.......AA'h.td.....«...�.��..�...d:.N.iM.DYr:..r.i:r....»R............r.....�..M:«.. .......'....�..:i...�..�....... .... . '
Ldtetlt Itlft�trattQtl 471� 14,1 ' �
,r�. , ,
.. ...........�....._..,.....»......wi...�%r� ; c"%�,�'Y' ."'�'.d::� .�iz'�""" h�N'2"v.�.�,w r HY^:.;."';%:y ..qq�`,5. y�•
,� a a� � t ., ',;A'R �'�:�ie,'.W � �W Sz ; ,. � e� . � i, w
I .. �• p,�{}$,jE,s���'�"�rok q�f t' � ;:
' i;° ��`, , � .�����:"ye� dwm�`�` . °a�"P'w+/k„y�;1j,.rf9 `� .�. �L,y y, �a h�r'+ _� ,
p3�.,�f . � `' �° �, y � '
...�,....na.r�..�.�..��.�........,...�.4..e..�n,.�,.n�tfR&�w�.SH...w�4.,..,. n �.. .'„'wd..d«: . ....«...w%..,. ��� �"",t. {�'f���-'"i,',l'�fi. Y�;4,�q.»,b�' ;� �.. � . �
i n te r'n a l �z g,.� �,�:��E i�.#k»r,;r1���;��. P�Ys .:��:, .�kc t, �>;�=A; , ,
1659 A�.9 •��� _,��.� ,,:
�.� �
.............w...w......�..d6,�„,�qa.a.__....�...,,.�».;..�.;"'���, ;fr^^c. — :-;�,�.—�..:.._..:.,,,..««,.-�._.�..._r:, `` .".G , ♦ ' � - , .
,q v a ........,..�� �
$� ;?� nii°�[�Y�.`,' .,.�r. �,
�- ,. I� �:, d'"... • fqP�Yx>.: �"°�ni.,;-: µ, .,.. y. � , .
...�..»n..n.n«.,...,.,...r.n...�....e..uM.nro�rWF..,Ir�.F..,...�..M1..n.�.r`�'.�J:....�..�.i..n.r..� w 3 �, ,•�. t N "��' , .. .
� . +.-. . . . � .� �':..=4 ..
..,s. ,F.� . r�v , . .. „. ,
. .� ...,..d�, ...f.i'.�.:fMd�..;�.x.:....... ..............�:.,...,.,......d.s.�::.s......+.... ,
Latent Peaple Load fi$0 2 �
.. ...._�._�....,._..,.....w,..w...�.......,..__�.._._.,�.._.____....,..�..�.�.�.�....�...,.�._..�,�_..m...........__.,.._.�..
„ . .,,,. .
T+���: . .. .� ' � .3353{�
Sensibfe �aad 2�31,35
Lat�nt load 5394
SH R p,g4
Capacifiy ,at .75 SHR 3.I3 Tons
Cool i ng Loads
33,534i t31 t1J�jr
Sensible People Load
Latent People Load
(��----- WaII
��--•- Ceiling
�Internal
!„�---Sensible Infiltratioi
Windows --""' "--System Efficienc�
`Latent Infiltration
� � ' � . ' • ! ' � ' .
AED Graph ' °
30000
�",�.,_...�.�,�\
�
Z()000
'�
m
J '�"'^`�..
10000 �''"'�–."""-'"'.,+.,..,,,,"�`'�^��,,,,_�
_"'.,^..,,.
0
8ani 9�n'i l0aria llarn 12prrr lprn 2pni 3K�rt� 4pni 5prn fi���r� 7�>Mn Fip�n
� — Hourly Loads _ —Average ,�
� �
� �
System equipment selection will be made using the follawing Manuai 5 derived values.
Summer Outdoor g�°F
Summer W+�t Bu�b ?7°F
Summer Indoor 75�F
Summer O�sign Gr�ins 5p°/Q
Winter Outdoor 4paF
Winter It�du�r 70°F
Sensible Cooling 28,135 Btuh
Latent C�o1in9 5,394 Btuh
Required Coaling Airflow 1,279 CFM
Sensible �ie��in9 . _ 2Q,779 Btuh
Required Heaing Airflaw 270 CFM
All calculations are based upon approved hvac industry st.andards and procedures,and comply with all local,
state and federal code requirements All camputed results are Estimates.Product provided by Energy C�es�g��
Systems and idea Tree
. i ' . , • ,:�t'i�l�d'�iw: y ..�"4�w. ., _.. r. .ra . ..+ ' �
�l '10651 tiwy. 301
S , Dade City, FL 33525
(3g2) 567,-6224
Fax. (352) 521-5980
Appliances Since 1959 sonappl@tampabay.rr.com
www.sonnysappliances.net
s S
O H
L �
� . P
T T ,
� HOME CELL
Q HOME CELL
DATE OF ORDER CALL FIRST C.O.D CREDIT CARD COMMERCIAL CHG. FINANCE CO. NEXT PURCHASE SALESPERSON
QTY. INT. MODEL NUMBERAND DESCRIPTION SERIAL NUMBER AMOUNT
O �O � ��..J �.�
ALL SALES ARE FINAL.DEPOSITS NON REFUNDABLE. NOteS
TERMS AND CONDITIONS HEREBY ACCEPTED. TERMS A FINANCE CHARGE OF INSTALL
0.0493%PER DAY WILL BE ASSESSED ON ALL UNPAID ACCOUNTS AND ARREARS,
ANNUAL PERCENTAGE RATE OF 18%. ALL MECHANDISE REMAINS PROPERTY OF DELIVERY
SONNY'S DISCOUNTAPPLIANCES,INC.UNTIL PAID IN FULLAND STANDAS SECURITY
FOR THE OUTSTANDING BALANCE SHOULD IT BECOME NECESSARYTO PFOCESS
SAMEFORCOLLECTION IAGREETOPAYREASONABLEATTORNEY'SFEEANDCOST SUBTOTAL
OFTHIS COILECTION FOR SONNY'S DISCOUNTAPPLIANCES,INC
a��reaby — TAX
AIIclaimsandreturnedgoodsMUSTbeaccompaniedbythisbill. CT TOTAL �
TERMS AND CONDITIONS ACCEPTED.MERCHANDISE RECEIVED IN GOOD
CONDITION AND ALL PROPERTY LEFT IN GOOD CONDITION. CT DEPOSIT
Received by: CT BALANCE DUE
WHITE-ORIGINAL YELLOW-CUSTOMER PINK-DELIVERY GOLD-SALES g��1 � ,�, '
Y�r + 4 . �Me �
10/05/2012 FRI 14:11 FA%
�001/001
Fron: 09/27/2012 12:�0 �029 P.001l001
.
.y����h r,:i
��.
Duct Se�! Affidavit
Company ��� lS �?lDur� /�/�j /�j ��/
_ � License# 4"'-'� ` ' �
,�d� U�S'/ �� ��� . �����
� � Per
r
�
� '��� ����� afnan�hereby affirm that I am the du Iice
hr nsed contractoc of reoord fcr the above
referenced permit,that all of the forgoing Information Is true and aca,rate,and that the duct sealing at the above
referenced address has been cornpleted i�accordana with aU applicable eodes and standards.
Contractors Name �inted� ��/ �/o��/d���r'r"
— Date � �
Stgnature