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HomeMy WebLinkAbout13-14373 CITY OF ZEPHYRHILLS 5335-8TH STREET (si3)�so-oo20 14373 f � BUILDING PERMIT Permit Number: 14373 Address: 39041 PARK DR Permit Type: MECHANICAL ZEPHYRHILLS, FL. Class of Work: A/C CHANGEOUT Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 12-26-21-0030-00100-0050 Improv. Cost: 3,800.00 Date Issued: 7/18/2013 Name: BRIDGES, DAVID Total Fees: 55.00 Address: 39041 PARK DR Amount Paid: 55.00 ZEPHYRHILLS, FL. 33542 Date Paid: 7/18/2013 Phone: (813)215-1177 Work Desc: A/C CHANGE OUT 2 1/2 TON 55. / ` -, l , L DUCTS INSJ,�LA FD 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)condemned 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 commencement." Complete Plans, Specifications Must Accompany Application.All work shall be pertormed in accordance with Ci Codes and Ordinances. NO OCCUPANCY BEFO C.O. /�✓� / / f� ,�-U� C� CONT f TOR IGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER - - -�-- -.... .. .,��a ..�.�.v�r�vn�n� � t1t�6flNG C0. 4$39 ALLEN ROAD N� O�O6Q5 PH (813) 782H40f75 LSFAX (813) ,779-0100 PROPOS�4L STATE LIC, � C�C054731 E-mail� timod36309@yahoo com SUBMITTED T "�° - P ` r/ PHONE R STREET /-'-uir--J�`� � - CELL ` DAT o �, — � � � P n i j � B UMBER OR AME / / �-( f r � ^ O CITY / �� -1--_l._-_. � / CJ S / � TAT ZIP JOB LOCATION A .� �-�--�� �� 7 7 ��f�. � r , MAIN CONTACT JOB PHONE OR E-MAIL WE RESPECTFULLY SUBMITTHE FOLLOWING SPECIFICATIONS ND ESTIMATE FOR: C � G,/l �� /��/� � �� ( r:/ � � � � l I � .�� �����, �, �,��/ � �� .� Ys � � - �` �- �� � i.S �r./� �l Q� � . Y , � ��" 'f''� ��� :/-`,-� S ; - n /J / �L n �/�/ � �/ �//�� 7 .J ' � ����� , ��: �7 \ ✓ /� / / // �-'> / / � -�f �1�Mi � ,(� � � ��� -- , ,. �;.n� �, J �u �-/ _ �1�� - - � /� ,� ,� �-1 /c- � � � �/�/�,�� Ull� � ' ) ` / c%S -� e 1� �5�/i� (� �- ��W�� � f�j � � �[ � � � `�.� �/ � Cc.. / �-"C /JC� t/�� ' r� `) • /�' / ' � / '� �� � �' S , 1 D P�f ���,.,�� Y � �-� ����� w �� .�� , , , � ��y� �./ ��� /� � �� � � ��t�o����rc� � , � �'' V,�- / f� �r.ii�f� ►e����r�in,� �r��� i.r,�of3 Ar�« car<<r�i_��� ����E����v� i A .c:c�ra���arJC��vi7fi ��c�vr s� r_�Fir,�7ic�r�" f ��r��i�r= e lJ PG9 C7� /�✓1/�� )��/��;c�r� %�I���� /' � - ��� �� ���,�P� �„ , ., , 3 ��,� - � �ati r�-��n��-����� r,��r,c �;:�r�o��c�G1�.4 _ ����-� 1j��,,,_ � � � D � `�CC_`��l --r-. - - _ _ l 1 �� ' `�'� � �_/�� v�/' � � 4 ) I' inate�ial is guaiantee o be a;spECifiee.qq v,��,rk to be ccny�leted in a C ��/�./Q/ � �/� �rkmanlike manneeaccordi 5o standard practices.Any alierafice,or deriatior m above specifications in ving e�:ira costs�ti-i11 be e�:ecufed oNy upon � , , itten oide�s and will become a er.tra charge over and 2bove tlie esfin;aic agrecments contingent upon rikes acd�tenfs oi delays beyond oc� `/'� f ' '�u�� 1 �LOI.Owner to carry 9iie tc�nad �J { �t,cis a�a fully covcird bl V10 �e�o ,er reccs�a�y insurance Ou. "� I :.ompensat;on ir;� r� !.'�i'�l Ei_ Ih;'�if?r;','tI; urancc - � i� � _ '��Cn �,r r E ��- ,1, ;f��, /�f� I ' ' � �= .'-i it� , r i .i� �c;c�r „ / I , , . , �� ... , .� � ., , E � ., . f - - - ,-; - .� oJ- /��%3 - - - - - � � - ---�----- � ------ - - - --- , 813-780-0020 City of Zephyrhilis Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permittin _ Owner's Name � Owner Phone Number � � — �7 Owner's Address ` /, (/ Owner Phone Number Fee Simple Titleholder Name Owner Phone Number --� Fee Simple Titleholder Address JOB ADDRESS P i O��Q LOT# �� SUBDIVISION , PARCEL ID# � ",OD3�`�� Q – �,� � � (OBTAINED F�RO�M pROPERTY T�7�CE)DEMOLISH WORK PROPOSED NEW CONSTR ADD/ALT SIGN INSTALL 8 REPAIR PROPOSED USE � SFR � COMM � OTHER TYPE OF CONSTRUCTION Q BLOCK Q FRAME � STEEL Q DESCRIPTION OF WORK - a �i ���� � � BUILDING SIZE SQ FOOTAGEC] HEIGHT QBUILDING $ VALUATION OF TOTAL CONSTRUCTION OELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W.R.E.C. �PLUMBING $ . � � �`�3� 3 �CHANICAL $ VALUATION OF MECHANICAL I 7�� NSTALLATION [�GAS ROOFING Q SPECIALTY [� OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILQER 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 I N FEE CURRE� Y/N Address License# MECHANICAL ' � COMPANY / C� /-�► SIGNATURE REGISTERED Y N FEE C RE� / � Address �Q' / / 1/S License# � OTHER COMPANY SIGNATURE REGISTERED Y! N FEE CURREA Y/N 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 FaciUties&1 dumpster;Site Work Permit for subdivisions/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&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 construcUon. ,����� �r � 7�����r����r�����rr��� Directions. '�'"" Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement Is requfred. (A/C upgrades over 57500) '* Agent(fo�the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/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 complia�ace 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 requi�ed 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 portivns 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 IMPACTIUTILITIES 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, Florlda 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'SlOWNER'S A►FFIDAVIT: 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 conskruction, 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, WaterlWastewater Treatment. - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. - Department of Health S 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"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 buifding 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 TAIN FI NCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OTICE OF M MENT. FLORIDA JURAT(F.S. 117.03) j. �' <" �' ,,/ OWNER OR AGENT CONTRACTOR '`' � �� ;� Subscribed and sworn to(or affirmed)before me this Subscribed and sworn to(or e befor me this by by Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as identlfication. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped � € / � r C�es ig n5tar �aac� Cal+�u lat�on Results are intended fc�r usev�rith Rheem heating and cooling systems ;,,r.r.���,;3-„� �°�.�,,}.. �,.� � ' r • � � , . .. . . . , . ., , „ . . :�, � , , Stre��6��dr'�ss 39�94�. P�rl� E�r'sv� �eph��il[s Far�rida. Ze�hyrh�`(�s," �� 33.�42 , ......_..�.._..M._.._..._,r .m.._..��.m. Latitude. Lc�r�gitude 27.9961°, -82.582° _ _....._._m._. _.._...,.._........_... House Square I4CltJ �q. ft. F�rotage: Name: L�avid Srie�ges .. ...... ................ ..... ....................,. .. Ph�Qne� 813-782-4075 Email� �imod363G9@aol,c�m - 4 ` ! . ! SHF� ,75 Number c�f residents _. � Ceilir�g f�eight g V11a11 U-v�lue � R-value fJ.C}9 � 11 . Fl�c�r U-vafue � R-val�� 0.2 � 5 Ceiling tJ-value I R-vaf�e 0.053 0 ].9 �r11{ir�dow lJ-vaiue 0,5 . _. . .. ,. V�lir�dc�w SHGF �,�� Moisture grait�s 56 Duct I c�ss °r'� 10 Duct g�in °I� �Q Co�lrr�g irafiilfira�tic�n {ACH) 0.6 N�ati�� it�fi(tration (ACN� 0.8 t�Vinter ven�ilatian {� � - • • • • Outdoor Heating Cooling �ry bulb (°F) 40 91 . Daily range M Refative humidity 50°f� . Moisture diff�rence 5� Indoor Heating Cooling . . _. ..... Indc�or temperature �°F) 70 75 Design tem�eratu��e c�ifference{°F} 30 16 ` . • ! . • Area Btuh °10 of load UVa I 1 3094 14�.1 Flaor 6426 �J.3 Ceiling 2226 1C�.� Windotn�s 3q15 13.8 Infiltratior� 5156 23.5 System Efficiency Lc�ss 1992 9.1 Tota I. 21909 Heating Loads ��. �r;�_ �=;ti-t;, !-System Efficiency Loss 1 Floor� , �Ceiling y �� ,}�;, ---Windows Infiltration -rJ ��N1all ! � i • . i �. . . ...,.., . ��u1�tt °l� t� k3a+d � „ Wall �682 9 � , ° .. ° . ; . u.. ,, . . S d• i.wL�E�id�. w7'�f�:7x'i' � ��x(3 � ' • .• . �/tC1t�UWS �.Q��� �� . ;;�. �3�`� � ' . z, � M...M• �;. - �,���' ,. .. ..... .... ......_ _, ` ,.. ,. .. ...._. .._ ...._.. ._.....__......... � � „, .. < __.._.._....._.............. ...,......... : , ,:. ,.�;. . ��.'t'15.I��E.' Ct���",��t€'3!'1- ���� r� ° . �� , , �'. .. . . .,. . .... ,. „ . ,. �: . .. : ,� >tM:�= ,., u .............:........................................................r..............,......,...,,........�,..............��..,...,......,.,.,.._........,...,..........,..._._..._...,. , , 6 ,,.. . .. , . L�tent Infiltratior� 4�62 15.1 ` , =. �;��.' :� .. �'" < r,. .. >.. .,,: y „ , �, ..,.__....,......_..-.,_. ...............q,,. ,_..... .... ,� .e-._. ..,.. ......,__._».......-.._. ...�....._., .�,......... ,_. " .p a.. c p.xM1;lu� } £...� . ,q., ��a� .. .i�i�h �r�4:�'�IA�'.: •1'i �G�� �s•� .• .n � .,h ��Fi�"�.m.?'','���y^;Y...� w��r,�in.��,i , . �lu s, , ., ?;'t��h�.f.;i:s�' s ia:.�.ii�.iu . ... .. � ._. ' ._ ... ��': &t�t. 4���✓ p �}j� s�. a�. ; '�..., 4 t�� ��C7 V .., �"&�' °.�`�": yry} y-yry m��;.�"� �1 1 L 1 1 1 � � � i�; . ,r�§s f" ,.•��.k�k�,.I::%±3q� ",'��',1;" . � i. q3�ao p.,w..iaf:.` .8,' .� ,.........�........... ......m......._ ..«.,o-... ......,.. ............ ........ ,,.m�... ,.......... ,..»..............,..,... • ,. v{% '. „3'°'7at ' S���k�[� �"`eapt� ��� �5{3 T,� . ' .��5's� ,. rt , . .. �atent Pec�ple'Lr�a.d..... .........._...4�i�}... _....1.6 � y � ,. � ' .���y^�,q,,., �`Qit�l: 2�64� � Sensible la�d �4720 Latent 1c��d 4�22 SNR p,g3 Capacity �t .`75 5NR 2.75 Tc�ns Cool i ng Loads r7�.- t1� C �Sensible People Load � �...------ Latent People Load �----Sensible Infiltration �� i-Internal � �. Windows -�4 ;� f —System Efficiency �`-Wall / � Latent Infiltration �� � Ceiling ' • ' � • � a • - i - A�o ����n �s«o� �oc�.;c� � � � �ou� Q s�n� 9<sm 10r.c°; llam i2�;m lp�n 2�?ni 3pm a��m Sprr fipm 7�m t3paz -- Houriy Laads —averaqe � i • " - � � Syskem w�uiprnPnt sf Eectior� 4�ui(! i�e macie €�sir,q l��e ioElor��;nc, c,er;ir��� valu�s. Gias� (�) 1Q2 sq. ft. Gla�s {,) _. 1� sq. ft. Glass {�I? �q. ��. ft. Glass �W� _ 71 sq. ft. Sum►�er Qutdoor �l°� Sumr�er Wet Buib 77°F Sumr��r lndc��r -��,'� �ummer Design Gra�ns 50°l� Winter �utdc�c�r _ 40°F Wir�ter Indoc�r 70°F Ser�sibl� Co�[ing _ �4,720 B�uh l..atent C€�aling _ 4�.922 E3tuh Required CQOlir�g Airflow ^ 1 124 CFM . r Sensible Heating _ 21,9�9 Btuh F�equired Heating Airf�c�w 285 CFM AI3 caicul�tians�re�ased up�an c�provec3 (�u�ac ir2ciu,cry st�r�dards anct �roced�res,and con�ply with aEI locai, st�te an�fecf�r�al c�de requirements.�tl ccag-���ute� restrl+,s are Estimat�s.Product�ravided by Eneegy Design Systems and Idea 7ree Load Calculator Page 1 of 3 HOUSE INFORMATION HOUSE LOADS Cooling Load: 29,467 �W� Heating Load:�21,823 ADEQUATE EXPOSURE DIVERSITY (AED) 12 C�U � ���''�� s coo „.r:nn .:(�.'JL What direction of the house has the most glass? Click the corresponding arrow next to the photo. � 3 3am 10am Opm 2pm 4;,m 6am Ep^; uar 'tam 1pm 3pm 5am 7pr, �Hourlv�oa0s vera9e Adjust square footage of window area on this home. � Adjust square footage of window area: % Shading LOADS GRAPH E 101 N �14 S 14 W 7�1����� � 3�p '� ae eon I � HOUSE INFORMATION ���,�� �.�.��...�..._ ..�.�. What is the conditioned square footage of your house?: ��7 � � �� �� . _'�" ,� �..,.g.,. . Square feet: 1390 _. _ _ � �---'-------��-�-----."---�---------�----�------� 1CCn�� I When was�our house built? � _...—...._.__.— ... __. . ..__ .._"'"'__"_"'""____...._� Jan FeG Mai Apf SAaY ��r�, JUT Aug Sep Ccl Nuv Der Before 1990 1� 1990- 2000 Aft2�2000 � �HFaT'NC �:^c;:Na lHeATiN�,r,P�an„g ■�co,in���A.ae�, � �li--------- � i i How do you want insulation values displayed? � � --R- --_�.__l Caoling loads >��.�:;;;r�: f.� Winter Electricity Rate �,1 r Sensible People Load I �""—"—��-Latent People Lo � � �'�", Summer Electricity Rate �0.1 :_ �, Sensiblelnl �-- Internal Windows -�.,,,` � Natural Gas Rate 1,2 � � --sv, Propane Rate �2,5 Oil Rate 2.3 `"—wall Summer indoor design i75�� temperature ' , �� ti`Ceiling Latent Infiltration=� Summer outdoor design ,9� 1�������� � temperature http://yourvirtualhvac.com/contractor/loads/?user hash=3fc9dacadc620b1ddb24ec7fl402b... 7/18/2013 Load Calculator Page 2 of 3 � Winter indoor design �7�� p����� � Heating Loads ' 8�?t�ti, E temperature �-System Effiaency Loss Winter outdoor desi n i 9 40 �� e ,��� temperature Floor�� y;.r ,�Ceiling �, < � SHR ;,�� 5 '�>, �� ; Number of Residents �2 �� —w� Average Ceiling Height �9 � � Wall R-Value �11.11 � � � i ``- Floor R-Value � Q� � � �nfi�tration-' wall Ceiling R-Value ;18,87 � � Window U-Value �0:5_�e �� Single Pane = 1 Double Pane = .5 Triple Pane = .3 Window SHGF �0.85 � � Clear = 1-.85 Low-E _ .6-.4 Grains of moisture �56 � � difference . Duct Loss % �10 � � Duct Gain % pl�p� �� Cooling Infiltration Rate �0.6 � � , (ACH) Heating Infiltration Rate ��8�__. � � (ACH) Winter Ventilation �p --����- �� Summer Ventilation �p �����-�� � FLOORS CUSTOMER INFORMATION Fill in the customer information http://yourvirtualhvac.com/contractor/loads/?user_hash=3fc9dacadc620b1ddb24ec7fl402b... 7/18/2013 � Load Calculator Page 3 of 3 , Name David Bridges Email j �mod36309C�aol.com Phone g13-782-4075 Get Proposal http://yourvirtualhvac.com/contractor/loads/?user hash=3fc9dacadc620b1ddb24ec7fl402b... 7/18/2013 .t *""�P E! t:i,; . >4� ,i ` /'# Duct Seal Affidavit . � n � , � � / y 3 Company (✓ �� � ��i� S ���Cn�d r��0/�l J� License�t v� �� � / l � ; � � �39 � I �� R��� C� Address z ����' � �l�' � � 3sL� f 3 9� � Permit# I � � �� � / � 6 � � � � P � � ,�r� U� Z- � �� � �� I ( �� 335� � , I��M°��i� —� 0/I �l4 affiant,hereby affirm that I am the duly licensed contractor of record for the above reference permit,that all of the forgoing information is true and accurate,and that the duct sealing at the above referenced address has been completed in accordance with all appiicable codes and standards. Cont�actors Name(priMed) M � ` 0 n ��� Date � � �� —� 3 ► Signature`�� r � ��Y��'�' � State of ���O rt��,, $ �� County ot ►.ul ' ��; t, On this day of �n I • � b e perso�ally,app ared t', to me known to e the person who executed the � foregoing instru ent,and acknowledged that he : ° execute he s e as his free act a deed. SEAL(sig d) - � aLIC c .. . Q e.,I., nl,t•if: ,_ .L„w ..