HomeMy WebLinkAbout14-15817 �, CITY O ZEPHYRHILLS '�
533 -8TH STREET ,��
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BUIL�ING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 15817 Address: 37120 FOXRUN PL
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: 03-26-21-0120-00000-0370
Improv. Cost: 7,557.00 OWNER INFORMATION
Date Issued: 12/03/2014 Name: FARKAS, JOHN
Total Fees: 75.00 Address: 38130 PRETTY POND RD UNIT 338
Amount Paid: 75.00 ZEPHYRHILLS, FL 33540-1442
Date Paid: 12/03/2014 Phone: 813-783-4198
Work Desc: A/C CHANGE OUT 3.5 TON
CONTRACTOR S APPLICATION FEES
AIR RESCUE AIR CONDITIO I G INC C CHANGEOUT 75.00
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Ins ec ions Re uired
DUCTS INSTALLED
DUCTSINSULATED ,
FINAL `� ° � ' «-(�
REINSPECTION FEES: Reinspection fees will com ly with Florida Statute 553.80 (2)(c)when extra inspection
trips are necessary due to any one of the followi g reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or correctio s not made when inspections called d)work not ready for
inspection when called e) permit not posted n job site f) 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 mana ement, state agencies or federal agencies.
"Warning to owner: Your failure to record a n tice of commencement may result in your paying twice for
improvements to your properly. If you intend o obtain financing,consult with your lender or an attorney
before recording y ur notice of commencement."
Complete Plans, Specifications Must Accompan Application.All work shall be pertormed in accordance with
Ci Codes and Ordina ces. NO OCCUPANCY BEFO C.O.
< 'n
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, ONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MON HS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTI N - 8 HOUR NOTICE REQUIRED
PROTECT ARD FROM WEATHER
Bull (ng Departrnent
ln'�ei N a C(�
Date Received � Phone Contact f.or Permittin �'6i3 2 4 �� �cl 6 S
Owner's Name � �- , 1'� � Owner Phone Numb r ��,3- 783- Y!`�8'
Owner's Address �-�x 2u rJ �L ,�, i 1 s Owner Phone Mumb r
Fee Simple Titleholder Name �L 3 3 Sy 1 'Owner Phone Numb r �' �
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Fee Simple Titieholder Addreas
3 7 / 2 0 ��x R��•l iJ L Ze tiR h�ll s FC. 3 3 S� � r_�
JOB ADDRESS Y LOT#
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SUBDIV.ISION PARC L ID# ; i
(OBTAINED FROM P OP�RTY TAX NOTIGE)
WORK.PROPOSED B NEW CoNSTR 8 ADD/ T Q! SIGN Q ![� DEMOLISH
INSTALL REPAI i
PROPOSED USE Q SFR Q COM Q' OTHER ' �
TYPE OF CONSTRUCTION Q BLOCK Q FRAM 0 STEEL Q ; �
DESCRIPTION OF WORK �Q u ra t- C�+A N� c� �� O A�L 3S7'p,,.J /,� e2 /`�c�2i 2o n�?�� �e.�t�
Py^1P
BUILDING SIZE 3Q FOOTA(3E HEIGHT ' ;
Q BUILDING $ VALUATIO OF TOTAL CONSTRUCTION ' I
QELECTRICAL $ AMP SER CE � Q PROG E5S ENERGY Q W.R.E.C.
[�PLUMBING $
OMECHANICAL $ �. VALUATIO OF MECHANICAL INSTALLATION � `�
7�J``�7. (�d �
�, c�
OGAS Q ROOFING Q SPECI LTY � OTHER , ��
FINISHED FLOOR ELEVATIONS FLOO ZONE AREA QYES NO 1 `
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BUILDER C MPANY ;I
SIGNATURE 4 �' ��'� R GISTERED Y/ N FE CURRE� :i Y/N
Address Licens # �-
, �
ELECTRICIAN C MPANY � ;
31GNATURE R GISTERED Y/ N , Fe CURRE� i Y/N
Address � Licens # �
PLUMBER C MPANY �
SIGNATURE R GISTERED Y/ N FE CURRE� � � Y/N
�Address Licens #
MECHANICAL C MPANY 't� I� 1�.G��S G�� S� � (�J� S p
SIGNATURE R GISTERED � Y/ N FE CURRE� � '� Y/N
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Address 1 Z. r�ss ia.rz o /3t+�J T��- F� �3�-i'� Ucens # �G f�C 1813�b�"r�
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DTHER C INPANY ' �
SIGNATURE R OISTERED i Y/ N Fe CURRE� �; Y/N
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Address License#
RESIDENTIAL Attach(2)PIoCPlans;(2)sets of Buiiding Plans;(1)se of Energy Forms;R-O-W Permit for ew construction,
Minimum ten(10)workfng days after submittal date. equired onsite,�Constructlon Flans,S ormwate�Plans w/Silt Fence Installed,
Sanitary-FaclllUes 8�1 dumpster;Site Work Permlt for ubdlvislons/large projects '
`-°..JMRIERG9AL-- Rtt�ch(3)-com^lato se�ts of Buf!ding Plans plu;;-�l_ife- afety_Page;(1.)set of Enerc�y Forms.R-O-W Permit for new constructlon. _. __
Mlnimum ten(10)workfng days after submittal date. equired onsite,;Construction Plans,S ormwafer Plans w/Sllt Fence instailed;�' -��
Sanitary Facilities&1 dumpster.Site Work Permit for II new proJects:All commerclal requi ments must meet'compi(ance
51GN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW constrwctlon. '
lirections: ''
Fill out applicatlon completely. �
Oumer&Contractor sign back of applicatlon,notarized
If over S2500,a Notice of Commencement is required. (A/C upg ades over 57500)
' Agent(for the contractor)or Power of Attomey(for the owner)would e someone with notarized letter from owmer authorizing same
)VER THE COUNTER PERMITTING (Front of Applicatlon Only)
�eroofs if shingles Sewers Service Upgrades A/C Fence (Plot/Suroey/Footage) ,
Driveways-Not over Counter if on public roadways..needs RO.W
NOTICE OF DEED RESTRlCTlON�; he undersigned understands that this permlt may be subJect to"deed"restrictions"
which rnay be more•restrictivejthan �o nty regulatlans. The undersfgned assumes responsib(lity for compliance with any
appllcable deed restricflons,
UNLtCENSED CONTRACTORS AN CCiNTRAC70R�RESP�NSlBILITiES: If the owner has hired a contractar ar
contractors to undertake work;ifhey m y be required to �e Ifcensed in accardance with state and local regulatlons. If the
contractor (s not licensed as reqtalred y law, both the owner and contractor may be cited for a mfsdemeanor vlolatlon
under state law. If the owner or lnten ed contractor are uncerkain as to wha# Ilcensing requirements may apply for the
intended wark, they are advlsed to con act fFie Pasco County Building Inspection Division—Licensing Sect(an at 727-847-
8009, Furthermore, if the owner ha h(red a contracfor or confractors, he is advised ta have the contracfor(s) s(gn
portions of the "cantractor Blo,ck" of th s application for which they wiii be responsibie. If you, as fhe owner sign..as the
contractor, thaf may be an in�ication t at he is not properly licensed and is not entltled to permifting privileges in Pasco
Caunty. •
TRANSPQRTATIC?N IMPACT/UTlLIT! S lIVIPACT AND IRESQURGE REGOVERY FEES: The underslgned understands
that Transportation lmpact Fees and ecourse Recovery Fees may apply to the construction of new bufldings, change of
use in existing buildings, or expansla of existing buildings, as speclfled in Pasco County Ordinance number 89-07�and
90-07, as amended. The undersigne also understands, that such fees, as may be due, wilt be (dentifled at the time of
permitting. If is further unders#ood th f Transportation It'rrpact Fees and Resource Recovary Fees musf be paid p�ior to
receiving a "certificate of occupancy" r final power reiease. If the project does not involve a certifrcafe of accupancy or
finai pawer release, #he fees mttst be pafd prior to perr�ft issuance. Furtherrnore, If Pasco County Water/Sewer impact
fees are due, khey must be pald prlar t permit issuance!n aecordance wlth appllcable Fasco County ardinances,
CUNSTRUCTION LlEN LAW(Cha�pt �713, Florida Statutes� as amended): If valuation of work!s $2,500A0 or more, I
certify that I, the applicant, ,t�ave be n provided with�a copy of the "Florida Construcfion Lien Law�Flomeowner's
Protection Gu(de" prepared by:the �lo ida Departmenf of Agriculture and Cansumer Affairs. If the applicanf Is someone
other than the"owner", i certify;that i h ve�obtained a copy af fhe abave described documen#and promise in gaod faifh_to
deiiver it to#he"owner"-prior tflicomm ncement. '
CClNTRACTOR'&/OWNER'S!AF�iiG IT: I certify that ai!the infarmatlon In this applicatlon is accurate and thak a!! wotk
wiN be done In compliance with al) ap licable laws regulating construction, zoning and land development. Appllcation is
hereby made to obtaln a pe�mit to o work and installation as Ind(cated. I certify that no work or installation has
commenced prior to issuance of a p rmit and that all work will be perfarmed fo mset sfandards of afl laws regulating
construction, Counfy and City codes, zoning ragulations, and iand deveiopment regulatians in the jurisdicfion. i aiso
certify that I understand tha#the regul tions af otiier government agencies rnay apply #a the #nterfded rrvork, and that it is
my responsibiiity fo identi#y what actio s i must take to be in compiiance. Such agencies (nciude but ace nat fimited to:
- D�parkment of Envlramm �tal Protectlon-C�press Bayheads, Wetland Areas and EnvEronmentally Sensit�ve
Lands, Water/Wastewater Trea#ment.
- Southwest Flvrida Wat r Management �District-Weils, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers- eawails, Dacks, hlavigabie Waterways.
- Depa�tmenf of �Health & Rehabilitative SeNiceslEnvironmental Nea}th Unit-Weiis� Wastewater Treatment,
8eptic Tanks. �
- US EnvUanmental;Prot�ct on Agency-Asbestos abatement.
- Federa!Avlatlon Authority Runways.
I understand that the follawing:restricti ns apply to the use of fill:�
- Use of ffii(s not apowecl (n Fiood Zone`°V"unless expressiy permitted.
- If the fill ma#erial' is #u e used in Flood;Zone "A", it is understood that a drainage pian address3ng a
"compensating volume" ill be submitted at #fine af permitting whlch is prepared by a professional engineec
Ifcensed�y the State o�Ff rida.
- !f the flll materla! Is to b USEl� E!1 FIOOCI ZOl18 "A" in connection with a permitted building using stem wall
construction, ! cer�ify thaf II wlll be used only ta fill the area within fhe stem wa(I.
- If fill material is,to be u ed in any area, ;I certify that use of such fiil wiii not adversely affect adjacent
prope�kies. (f use�of fill is faund to adversely affect adjacent properties, the owner may be cited for vioiating.
the condfitions of':the buil ing permit fssued�under the attached permit applEca�ion, for lats less than one (1}
acre whlch are elevated b ffil, an engineere'd dralnage plan Is requ4red. �
if i am the AGENi'FOR"fHE OWNE , I promfse in good falth to lnform the owner of the perm(tting conditions set forth in
this affidavit prlar to commencing co struction. I understand that a separate permit may be required for elecfrical work, ,
plumbing, signs, wells, pools,� air co ditioning, gas, or iother installations not specificai(y included in the applicafion. A �
permi# issued shall be canstrued to b a license to proceed with the work and not as authority to.vlolate, canael, alter, or
set aside any provisions of the techni a! codes, nor shaif issuance af a permit prevenf fhe Buildirig Official from thereafter
requiring a correctian af�rror;s in plan , constructian ar vlolatlans of any codes. Every petmit lss�ed shall become irivalld
unless the work authorized by such ermit is cammenced within six months of permit Issuance, or if work authorized by
#he permit ts suspended or abandone for a.period of six(8).months after the time the work!s commenced. An extension
may be requested, In writing;�from th Buflding Official!for a perlod not ta exceed ninety (90) days and wiil demonstrate
Justifiabls cause for the exten'sion. tf ork aeases for niriety(90)consecutive days, th�job is considered abandoned.
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WARNING TO OWNER: YO.UR FA LURE TO RECORD A NL?TICE O� GQMMENGEMENT MAY RESUl.7` IN YOUR = I
S�,�Y1NG'�IdV10E EOR.IMPRQVEME TS Tt?�YOUR PRQPERTY: !F YOU INTEND TC?08TAIN FlNANC1NG, GONSULT
WITH Y�UR LE DE: QR AN AT O P�EYt BEFORE RECORDI G Y � ` OTIC OF COMMENCEMENT: �
FLORIDA JURAT'(F:S.11 .03) ' (
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OWNER OR At3ENT � � � CONTRACTOR � 4..�P.�
Subscribed and swor o(or affirmed be ore e s Subscribed and swom fo(or affirme j efore me s
by by
Who 1s(are personaliy known to me iar has/hav produced VYho Islare-personally knsiwn'to me or haslhave produced
as IdentlBcati n. as(denUBcation.
Notary Publ)c � � Nataty Public
Commisslon No. Commissfan No.
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Name of Nokary typed,printed or stamped IVame of Notary ryped,printed or sfamped
� Flo�e Im�rove en�Agr�e¢renfi
' •f3'i 3-fi7�-5fi0Q ,� ,� �' . �"_ "'�',�, Corporate �ffice
, (BS8) 638-3792 �'� ��'',^""°'"=" ; �•;°� 1429 Massaro Blvd.
5tatt� Lic# CAC��13365 �A � .�����'��' � Tam a, FL 33619
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F'rr,E�os��al C���te � �t"j r Install Date
Customer Name " � ' J� � k A".5
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�±ddr�ss '
.rrC'-- 'l/ f" ''� ��
City � /� � Stat�" 'Lip Code ��' Email
Phbne Number(horne) �(„������ I � (cell) •��� � �`��� ����
4 ' Q
f�tJMiNAL S��R ��5�� ���uxe Premiu t3ptimust� Size 1Nar�anties
73 SEER 1 S SE�R 16 SEER 18 SEEf� � S
� �ir Conditioner ❑ ❑ ❑ ❑ p 4
1-ieat P�Sm� , ❑ � ❑ D � � �� �.sk yo�ir
L7 C.on enser/CoilOnly O
O f=��rn�ce System ❑ ❑ ❑ ertica! � 3 S�'�3p�4`S�b3
❑ Packagc Air Conditianer C] ❑ D 'l.5 ��i'W3B"Y�ti��(
❑ Package I-If�at Purnp ❑ � �Hori`onta O �
certificafie.
� Lifetime � 5 year ❑ �.5
Air Delivery System Green Silver
❑ 2.,00� ❑ 1,600 ❑ 1,4Q0 ❑ 1,2�0 ❑ 1,Oq0 ❑ 800 ❑ 600 D Replace Boots � Grilles Mastic Seal
e ` �°
/��'!'+�7.'� %t`r'r.r�t9 t'`.a' ..S i���"' / � �a�U...� ttx �-. 4. � `(
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To abtnln maxirrrum rated effrciency.from any NVACsys�em,the equlp arTd the air dlstributlon system must comply with the rnanufaccurers
speri(rcatians and requtrements.Afr•Rescue Alr Conditianing can only be responslble tvr components lnstalted by Alr Rescue Alr Condlcianfng.
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Syste:rr�Price �� Customer Si�nature ��`
y�i � U( �,7" .
Total Aclditi�n5- rt'�m'�tYr mizec?prrcin�works�eet �� Customer(Pr'int}
SUB70TAL �''� � D�te �� �
��...v t�.,--C �
'('CLC),•'E�F'�i.Hc h�ete ARAC Re��{prir�t) � � —
Mfc�Rcb��te/%RAC Discounl i���� r CC# --- CVV _._.
Total �rice 7�-'� � Check#_
� Minus�c,a�m Payment '" �������� Financing Type Amt Financed
�
Eal D�.ie llpon StarC-l1p �� Ilwe own the real property in which the equipment is to be fnstailed and havc
Iauthority to ord�r the work as oudined above.Terms:Balance due upon starwp,
or in ac<ordance witti Crnanciny agreernent.See reversE side fur adctiti�ma!ten,is.
f3uyers Righ[to Cancel:SO7.U3% This rs n f�ome svlidtati�n sale,and i(you do nof vnf fhe goods a services,you rnay cuncel tfiis ugreement by providing wri�ten notrt:e to th:°
aetfa�r�n petr;on,by[eie4rc�rn,ar by aic�i!.T/trs notica�must incGcute lhaf yUU do not w�nr the goads or services ur�d,n�ut be delivPred erpasrrnarked before rnidnight�f rhe tit�rd
b�t�rncssdr..ynlleryor.rsi�nthisa?r�e�r�ent.;lVOU«1nr.elti�rsngrcemenGihesefler� nynotkeepnllorrorto(anycashdownpu}�ruent.
The install tecl7nician has re:viewed this Home lmproverrient�1 rEement for instaliation af HVAC systems hy Air Rescue Air Conditianing.
I, t:ustomer Name(print) agree th�t the agree ent r��flects my understanding of the scope of the job and the eqUip:7�eni
to bc�installed. C:usYomer Signature
�ee a��ached fs�a� �'�r a $350 a��s�orta�raityr
Wi,ite Offic� Canary-ir�stail�r Pink�Custome�r Goldenrod-Accountirtiy
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Latilcjd�, Longitud� �7.9961°, `82,582°
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Pl�ar�e: 8I3-783-41 �
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Sur�t+�er ver�ti(�E:ia�� ' 0 -
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Wir�dc�ws 6�8� 2�.3
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Gi�ss (S) 15 sq, ft.
Glass ([�} 1.5 sc�, fi.
G(ass (W) 77 sq ft,
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Su�rtira�er Irlcfc�t�r '13°F
Summer Design Gf°ain� 50°�o
1�i�ttlt�C Qi,ll`C140I" 4�J°�
Winter Iricloor 70°F
I - 5�nsibl� �c�aliE�� - - .. ,. �2,495 Btul�
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�#` ' �� ° ` c� This combination ualifies for a Federal Energy
«' ' � .� q �:_
� ��� - , .. � �,;; Efficiency Tax Credit when placed in service i�a
�� '�;:�� � �' ��,� '� , ,�iz', between Feb 17, 2009 and Dec 31, 2013. f�
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AH Certified Reference Number; 5796520 ~�M��2d�� �'�"'�R`'��-� �
�
Date; 11/20/2014 '�
� Pruduct: Split System: Heat Pump with Remote utdoor Unit-Air-Source �
�� i i
;
� Ou4door Unit Model Number: SSZ140421A* #y
j Indoor Unit Model Number:ASPT48D14A* �s
��
1� Manufacturer: GOODMAN MANUFACTURING CO., LP, �j
�_
t�i
f�k Trade/Brand name: GOODMAN; JANITROL; AM INA DISTINCYIONS; EVEiZREST; ONE HOUR AIR �•
: CQNDITIONING AND HEATING; ENERGI AIR �-;�
Series name: SSZ14 t�
I; i�
� Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP, ��
�x{ Rated as fol�ows in accordance with AHRI Stand rd 210/240-2U08 for Unitary Air-Conditioning and Air-Source ��
Heat Pump Equipment and subjecf to verification of ratin accurac
�. party testing: 9 y by AHRI-sponsored, independent,third 'F
�� �
`s �i
Cooling Capacity(Btuh): 41500 i�
� �,i
� EER Rating (Cooling): 12.50 ���
� �SEER Rating(Cooling): , 15.00
�:
;� Heating;Capacity(BtuH) @�47 F: 40000 �'�
�j Region IV HSPF R'ating (hieating): 9:00'` �
�8 �(
Heating Capacity(Btuh) @ 17 F; 23000 �a
�
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'Ratings followed by an aslerisk(•)Indlcate a voluntary rerele of prevlously publish d d21s,unless atcortlpanled with a WAS.which indiwles an InvoluNary rerole. �h
�-d,.�.�..�
�� DISCLAIMER ��
�'z AHRI does nol endorse the product(s)Iisted on thfs Certiflcate and makes no epresentations,warrantles or guarantees as to,and assumes no responsiblllly for,�y ��
�; the product(s)Iisted on thls Certificate.AHRI ezpressly discla(ms all liablli[y f4r damages of any kind arising out of the usa or perfonnance of the product(s},or the
��t� unauthorized alteretion of data listed on this Certificate.Certi(ied ratings are 4alid only for models and configurations Ilsted In the
directoryatwww,ahridlrectory.org. ?
TERMS AND CONDI710N5 •
�� This Certiftcate and ifs contents are ro dela <
confidentlal referance purposes,The co�tent ofthisuCertifl ate may not rt'f�aole orin partbbe reprodu(cedY�opled ed ssenli nated; ��i� s t;,, ��;` f
Y P �n�;_,�'�..,-��.�, ��� �
�� entered into a cmnpuler database;or otherwise utlllzed,in any form or mann r or by any means,except for lhe user's individual, �'+l� 'F '+' �,:.,,�
!� personal and canfldenUal reference, �'e�'� �si��.;i,�� f q
�g� CERTIFICATE VERIFICATION AIPo-CONCi171UMNG,FlEATIMfl. 5a
The Informatlon for the model clted on thls certlflcate can be verified at www ahridlrectory.org,clfck on"Verlfy Certlficate"����k �'ttEFHIGERhT1pN IvSTiiLI7E
'� antl enter the AHRI Certified Reference Number and the date on which the ce fficate was issued, (
whlch is Iisted above,nnd the Certlflcate No.,which is Ilsted at bollom right. ��L'�1�"��'�'�i•i�����L��,� �t
��; 02014 Air-Conditioning, Heating,and Refrigeration Instit te CE �
`� �� RTIFICATE NO, �3060977102765032Q �� �
`��=:a�:r�^��.� ^----- _ � � �
""° 3'M-"".w��»..::sv.`.'f"`'g"`�->.;�'",�=.:,e.s.^'^^,.,.;•�*-: ..-r,�,,,,..x.m��}�__""." --- -- --- �---� —- � ........ �
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- Permit Nu�'iber ���1 ! -• tl�cpt:1560229 Rec: 10.00 ,.
_ParcellDNumber � .� ' ..— — '"'�;'�Q !02/12/2015 L. KT' pp00 Clerk ,
NOTICE aF COMMENCEMENT -
- .
�tate of Flor' a TI;I;'-,F:EA li9 RESI:RJLC FC�f:IILFR OF (!:E CGURT CE!;1l�IGkil("�!•!
Gounty of- ;�
TNE UNDERSI ND he eby gives notice that improvements ill be made to certain real property, and in accordance with Section 713.13 of the
Flo�ida Statutes,the following informaUon is provi in this NO ICE OF C MENCE T. �p 7gc
4.Description of propert}r{lega/descripfiori):� t3� � �� ������J��� �� ��� 3�
a)Street(job)Address � �, , �,,� `�, � �
2.Generat description of improvements: � ,� ' � .y
1/)�'1/ .
3.Own�r 6nfcr�natian or l,essee infarrnatEo -i�fihe Lessee co teacted far fhe jmproveme #: � � 5� �[
a)Name and address:� � �`�V�'� �� ��,(� �, �, �, ' � ( � '���(S
b)Name and address offee simpEe�trtlehalder(if different tha Owner lisfed above)
c)Interest in properry: (' �j �
4.Contractar lnformatian
a)Name antl address: Y � � � r�^ � ; � ��
b)Tefephone No.: '��-- �., — � Fax No.:{opfional}
5.Surety(if applicable,a copy of the payment bontl is attached) 1
a}Name and address:
b}Te(ephone No.: � Pau�a s o'NEIL,Ph D PRSCO CLERK & COMP7ROLLER
c)Amount of Band: $ 02�R��015��2�54pm �� �f�,,,�1��
6.Lender ' r'��.'"1'� �:iC!
i
a)Name and address: �
b}Telephone No.:
'7.Persons within the State of Florida designa e y ner pon whom notices or other documenfs may be served as provided by Section '
' 713.13(1)(a}7.,Flarida Stafufes: '
a)Name and address:
b)Telephone Na.: Fax No.:{opfiana3)
8.a.ln addition#o himself or herself,Owner designat s � of
to receive a copy of the Lienor's Notice as provided in Secti n 713.33{1)(b),Florida Sta s. /,
b)Phone Number of Person or entity designated by Owner. [,�-�'"�
' 9.Expiration date of notice of commencement{the expiratia date may noi be before the cam etian of•canstruction and ftns! payment to the
contrector,but wiii be 1 ear from the daie o(recordin uNes a differenf date is s ecified: ,20
WARNING TO OWNER:ANY PAYMEN'f5 MADE BY THE 0 NER AFTER TH�EXPIt2ATI0N OF THE NOTICE OF COMMENCEMENT ARE
CONSItiERED IMPFtOPER PAYMENTS IJNDER CHAPTER 7'i ,PAR31,SEC'FIOM 713.13,FLORIDA STATUTES,AFiD CAN RESUtT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER .A NOTICE OF COMMEIUCEMENT MUST BE RECORDED AND POS'I�D ON
THE J4B 5lTE BEFORE THE �IRST tNSPECTIQN. !F YQ INTEND TQ OB7AIN FINANCENG>.CONSULT W1TH YqUEt LENDER QR AN
ATTORNEY BEFORE COMMENC(NG WORK OR RECORDIN YOUR NOfiICE QF COMMENCEMENT.
. Under penalty of perjury,,l declare that I have read �e foregoing otice of commencement and that the facts stated therein are true to the best of my
! knawledge and belief.
', c�.G � ��7-P�1Y���� �a� C�..�-
{Signature oi Owner or essee,or ONOets o essee's(Authorized Qflicerf irectorlPartnerP ,r) {P'ni Name ar�d Provi�e Sigr�tor}�s TitlalOffice)
, The forego'ng insfrument was acknow(ed ed before me this �_. �ay of i��jf�y'�(���j't.� ,20��� •
by -;1.��..��.�;��� aS �? �^'� . - (type oi authority,e.g.oRcer,trustee,attomey in fact)
for ,as
(Name of Person) (type of authority,..s.g.oflicer,Wstee,aHomey in fact) ,
fot �-� {name of party on beh ft of whom instru eni s exeeuted). '
�� Pe .
� Typ bS�iC�a"°!%e�,�,5 .(,�lME L VEN! " Notary Sgnature ,
. n
. �. ,.�Y COMMISSION#FF049338 Pri f name J
, '`�'N�F�„�; � E\PIFES June 19,2016
(40?)348-0183 AoridaNata:y5erviae.Cpm _
I