320 1ST sT 2013 SOLAR FOR POOL CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002655 Date 5/15/13
Property Address . . . . . . 320 1ST ST
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 2450
----------------------------------------------------------------------------
Application desc
SOLAR PANELS FOR POOL
----------------------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
PEAKE LINDSEY CHANTAL SOLAR-FIT
320 1ST STREET 1523 RIDGEWOOD AVE
ATLANTIC BEACH FL 32233 HOLLY HILL FL 32117
(386) 441-2299
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee 20 . 00
Issue Date . . . . Valuation . . . . 2450
Expiration Date . . 11/11/13
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
-----------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total 20 . 00 20 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 89 . 00 89 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
COMPATIBLE WITH. ENLARGED VIEWING:
ENGINEER:
HTTP://WWW.GEZELMANPE.COM/GENERIC/0223S.AS_HELICOL_FL.PDF ALLEN GEZELMAN
16502 HANNA RO.
LUTZ.FLORIDA 33549
PH.813 650 7246
VALpITY: -��,y'�, ALLEN@GEZELMANPECOI,'
" - SOLAR POOL HEATING COLLECTORS ARE REQUIRED TO BE TESTED,CERTIFIED AND LISTED BY THE
at:l V., r. VOID WITHOUT RAISED OR ELECTRONIC SEAL,MAY NOT FLORIDA SOLAR ENERGY CENTER-THE COLLECTORS LISTED ON THIS PLAN COMPLY.THEIR FSEC
aosEro BE USED FOR PLANS ON FILE,EVERY PERMIT PULLED LISTINGS AND RATINGS MAYBE VIEWED ONLINE AT:
rRrs arson w
wwea.ME REQUIRES A SEALED ELECTRONIC PLAN OR SEALED HRP;//WWW FSEC.UCEEDU/EN/INWSTRY/TESRNG/STCOLLECTORS/PWI RATINGS/INDEX.WM - _ 'ELECTR IC JEAL C
o1 1sow ORIGINAL PAPER COPY OF THIS PLAN �:rl
TSE sow
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ATOR CLA+JPS RE.NOTES 1241
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w .,... ALL AFFIDAVITS DESIGNS OPINIONS.CALCULATIONS BOTHER ENGINEERING SERVICES PROVIDED S`I ALLEN GEZELMAN PE AND HIS SSI O
_ ASSOCIATES ON ANY AND ALL PROJECTS ARE SUBJECT TO THE PROVISIONS OF EJCDC C-700(ENGINEERS JOINT CONSTRUCTION
_ DOCUMENT COMMITTEE-STANDARD GENERAL CONDITIONS OF THE CONSTRUCTION CONTRACT)CURRENT AT THE TIME.THOSE
CLAMP SYSTEM OBJECTING TO SAID EJCDC C-700 OR PROVISIONS THEREOF ARE DIRECTED NOT TO USE THE AFFIDAVIT,DESIGN.OPINION, 0 W
s CALCULATION OR OTHER ENGINEERING SERVICE OFFERED BY ALLEN GEZELMAN PE AND HIS ASSOCIATES ON THE PROJECT.EJCDC E��yIE
C-70D MAY BE
VIEWED AT:HTTP:/fGEZELIMNPECOF.VREFERENCE/AG/G700.P°F O
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DIAGRAMS cJ1
MIRROR IMAGE PLUMBING LAYOUT ALLOWED-FEED&RETURN @ OPPOSITE DIAGONAL CORNERS r
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Ir DATE:7/15/2012 2:56 PM
PZ 3 I n OB AUTOMATIC CONTROL REVISION NO./DATE:
•07 C9
I
THIS IS A SINGLE
I' +'� 0 OPTIONAL COMPONENTS SHEET PLAN
SHEET NAME:
PERMIT SET
DRAWN.SET CHECKED AG
DISCHARGE TO POOL INTAKE FROM POOL
SHEET NO:
D7 FIGURE 1 GENERAL NOTE: ` COMPONENTS ARE OPTIONAL A.2.2.PH-10
0223S.AS HELfCOL<ELCw
SCOPE OF WORK: HELICOL SOLAR POOL HEATER COLLECTOR. ROOF ANGLE: WIND LOAD TCIT1RU VUIT 200 MPH C&METHODS SPEUHEDe+n
Irlll.CNADIQUAMATERIAL
%POSURCLusAPPLICABLECODE.
INSTALLATION OF A SOLAR POOL HEATING DIMENSIONS+ IH'10'OR 12'1 COL LECTOR INSTALLATIJ'. WIINLOA.RE SITANCEOETERMINEDBY u IO FLORIDA BUILDING CODE
SYSTEM WITH A ROOF TOP COLLECTOR STANDARD FLUSH W!RO'.:- i.ATOR-HEAD[P,F LAMPS
�• SOLAR.UNIT(THERMAL OR PV)WIND FORCES
SOUR UYt'SINSTALLED PER F LW 11.- F.I. -TH,BU UNG fNVEIOPf'KEA WIrvDOW.UDC, •CH',l
€ NOTES FOR INSTALLATION OF HELIOCOL SPH(SOLAR POOL HEATER)SYSTEM ON ROOFS USING LAGS,CONCRETE SCREWS,OR ADHESIVE FOAM: UIITSSIALLBEMpU D ABODE RDOF SURIACT L,KE AN AC CDID NSEv.rHEREFaRE,spun uxrtz THus xsrA„ED Do No-
y x? THE DETAILS SPECIFIED ON THIS"PAPER”PLAN ARE CONSIDERED TO BE THE MINIMUM NEEDED BY AHI(AUTHORITY HAVING JURISDICTION)AND TMEsRORE SURFACE
AS DD ENOVEXES mMPDNEiIISwCH 1014 x)ws.THE RS,R S%YUGHrs.Spun uI—OF TH eT M TINP
E ROOF BURUCF.THIS MOMDEB PRESSURE EpUAl¢ATIDx BETWEEN THE ROpE SURFACE AND PHI BACIt a THE wUR UNR
° j INSTALLERS.USERS ARE ENCOURAGED TO ACCESS EV(ELECTRONIC VERSION)OF THIS NDZIGNNKAM CHANGE Ix THF LOADS ON THE Roof FRAMING FOa APAMufLMouIrt ANDMDDEST W..NGESNTRr Uv.HC
=Z PIANHTTP'//GE2ELMANPECOM/GENERIC/02235.A5_HEIICOI FL.PDF INETERNAI AND EATERNAL COMPON—OF WIND PRESSURE DECDUPLE,EG.THE R-FRITS THE INTERNA,YAND PRESSURE
ACTIVE HYPERLINKS ON EV PROVIDE EASY ACCESS TO INFORMATION.EV ALSO ALLOWS VIEWER TO STUDY THE PLAN AND OEM DETAILS ATn UNITS ExrERNU WIND PRESSURES,THE EXIERYAI WIND ipaCES ARE THEN iMxSFEaRfDTDTHE appi iaAMlrvGr
TTACHMENT ARDWARE H `MND—LUITIONt UN[HERE:
JM'WW.DE1FlM/JIPE.WM/6FNFRK/MIOPK WMDGI:
;Ft MAGNIFICATION OF HIS CHOICE UP TO 6400%.If A CONFLICT SHOULD OCCUR BETWEEN A DRAWING AND/OR SPECIFICATION HEREON AND AN
.2 OEM DETAIL,OEM SHALL PREVAIL.
IF
V CONTINUE EACH COLLECTOR SHALL BE CLAMPED @+
E < 1.THESE DRAWINGS AND ENGINEERING ESTABLISH THE INSTALLATION REQUIREMENTS FOR HELIOCOL SOLAR POOL HEATING EQUIPMENT IN OF CONTRACTOR CHOICE RE:NOTES p2
N ROOF PRESSURE ZONES 1&2(PZI&PZ2)ON BUILDINGS IN FLORIDA 30 FEET OR LESS IN HEIGHT AND AT ROOF ANGLES FROM FLAT UP TO 45
L:`o DEGREES.INSTALLATIONS OUTSIDE THAT PERMISSIVE"WINDOW"REQUIRE SITE SPEOFIC ENGINEERING. TOP H DE HEADER CCURLING
2.THERE ARE METHODOLOGIES EXPLAINED ON THIS PLAN AND IN THE OEM INSTALLATION MANUAL FOR ALL TYPICAL ROOF COVERINGS.
y € 3.THERE SHALL BE NO TILT-UP.THE SPH COLLECTORS SHALL REST DIRECTLY UPON AND SHALL BE MOUNTED PARALLEL WITH THE ROOF
r SURFACE. g N1
d ° 4.HE000OL SPH COLLECTORS ARE UNIQUE.UNLIKE OTHER SPH COLLECTORS,HELIOCOL DOES NOT"FIGHT THE WIND".HEUOCOLSPH
4 COLLECTORS ARE COMPOSED OF NUMEROUS PARALLEL INDIVIDUAL SOLAR COLLECTION WATER TUBES WHICH ARE OVER-MOLDED INTO AN
UPPER AND LOWER HEADER.THE INDIVUAL TUBES ARE HELD IN ALIGNMENT BY SNAP-GN RIBS WHICH ARE SPACED ABOUT 184NCH
o ES APART ee C k
E 3 fki : c C 3fE
p PARALLEL WITH THE HEADERS AND PROVIDE AN AIR-GAP FOR PRESSURE EQUALIZATION BETWEEN THE ROOF COVERING AND THE SOLAR fC'n t 1kg
o� COLLECTOR.AIR FLOWS AROUND THE INDIVIDUAL TUBES WITHOUT GREAT WIND RESISTANCE.THIS PERFORMANCE CAN BE COMPARED TO
~ B THE RELATIVELY HIGHER SURVIVABILITY OF PALM TREES WHICH BEND WITH HIGH WINDS AND SURVIVE HURRICANES WHILE NEIGHBORING F 1
LIVE OAK AND OTHER MASSIVE TREES WHICH RESIST THE WIND ARE UPROOTED.
o:R S.HEUOCOL COLLECTORS ARE CLAMPED TO THE RESPECTIVE ROOF WITH OEM"GATOR CLAMPS".AS SHOWN IN THE DRAWING FIGURES.REFER
= TO OEM INSTALLATION MANUAL FOR SPECIFICATIONS AND HAVE AN OEM INSTALLATION AVAILABLE ON JOBSITE FOR AMI INSPECTOR
r % 5 REFERENCE.THE UPLIFT RESISTANCE OF THE STANDARD METHOD OEM-RECOMMENDATION OF 4-GATOR CLAMPS PER HEUCCL COLLECTOR 7iyt
G W TWO EACHFOR UPPER&LOWER HEADERS IS ADEQUATE FOR WINDCONDITIONS THRU VULT 160-MPH,EXPOSURE_D,RISK CATEGORY II. i F4L e
i 0 6.GREATER WIND FORCES REQUIRE THE USE OF A THIRD GATOR CLAMP EACH ON THE UPPER AN LOWER HEADERS. S 3999 3 1 $ C C FIF
7.GATOR CLAMPS ARE LAGGED THRU THE ROOF INTO STRUCTURAL FRAMING(MINIMUM 5/16-INCH DIAMETER,MINIMUM 3-MCH THREAD
U EMBEDMENT)ON SHINGLE&MEMBRANE ROOFS. EE R33
S.TILEROOFS REQUIRE THE USE OF A CONTINUOUS Z-BAR UNDER EACH HEADER.THE Z-BARS ARE ATTACHED BY CONCRETESCREWTOEACM •-=Rp € 333 jtCi3• f
TILE CONTACTED.THE GATOR CLAMPS SCREW THRU THE Z-BARS.REFER TO OEM MANUAL.THE TILES AT EACH ANCHOR POINT SHALL BE
BONDED TO ROOF COVERING WRH A SOLID FSM(FOAM SET METHOD)BED OF DOW TILE BOND •? ° s
HRP://BUIl01NG.DOW.COM/NA/EN/PRODUCTS/AOHESIVES/nLEBOND.HTM
9.ENGINEER HAS EVALUATED THE INSTALLATION COMPONENTS AND HARDWARE CURRENTLY PROVIDED AS HELICOL OEM INSTALLATION KITS
AND FOUND THEM TO MEET THE REQUIREMENTS OF THE FLORIDA BUILDING CODE.THERE SHALL BE NO SUBSTITUTION OF OTHER VENDOR 888 .REE 3 �I j F�
MATERIALS WRHOUT PRIOR APPROVAL OF ENGINEER THRU OEM,
p ;
10.PLUMBING SHALL BE PER FIGURE 1(WITH OR WITHOUT THE DESIGNATED OPTIONAL HEMS).FLORIDA PLUMBING CODE SHALL BE ADHERED
TO WITH PARTICULAR ATTENTION TO PIPE SUPPORT,PER FPC TABLE 308.5,THE ABS VALUE OF 44T SHALL BE TAKEN AS THE MAXIMUM FOR
HORIZONTAL AND 10-R FOR VERTICAL SOLAR PIPING.CONTRACTOR SHALL INSTALL THE SYSTEM ACCORDING TO THE MANUFACTURER'S
WRITTEN INSTALLATION MANUAL. Z COLLEARS CTOR
BOTTOM HEADER
11.INSTALL TAPCONS PER MANUFACTURER INSTRUCTIONS HTTP://WWW CONCRETESCREWS.COM/CONCRETE-SCREW-INSTALLATIONASPX. BOTTOM HEADER COLLECTOR AND ROOF TILE
12.FOAM SET METHOD AVOIDS ANY PENETRATION OF THE ROOF COVERING BENEATH THE TILE.WATERPROOFING OF OTHER ROOFS SHALL
RELY UPON A GENEROUS PUDDLE OF FLORIDA NOA/PCA APPROVED ROOFING SEALANT BETWEEN GATOR CLAMP AND ROOF COVERING.AS AN ALTERNATE,WITH APPROVAL OF AH),CONTRACTOR MAY SUBSTITUTE A FLASHING DETAIL OF HIS PREFERENCE FROM NRCA ROOFING&
WATERPROOFING MANUAL OR OTHER RECOGNIZED PROFESSIONAL PUBLICATION. c
13.CONTRACTORS.INSPECTORS,AHJS AND OTHERS HAVING QUESTIONS MAY CONTACT ENGINEER DIRECTLY-OFFICE!8139091956,E-MAIL
ALLEN@GEZELMANPE.COKE c
os ENGINEERING NOTES o2 FIGURE 2 S E
IL
10 ASCE 7 COMPONENT AND CLADDING LOADING
TS
1DB<t��
@ Gator Feet '� \
11DBT5
Gator Feet )g'6 Flet Roof HipA0of T
HELICOL GATOR CLAMP ASSEMBLY
Collector Header(Top) 110 Short Gator Clamp
113T Collector Clamp Top :>f' h( h
t
113L Latch
a n
a a
113G Gasket
Fig.2 1138 Collector
Clamp Bottom Gable Root(8 5 7°) Gable._Roof_I
110 Long Gator Clamp I - End Zones
Interior Zones
HELICOL COLLECTOR HEAD ASSEMBLY PZ 1 PZ 2
`loxr
I*
u
ZMR HLLICOL COLLECTOR ON Z BAR '-A";iR tCLAE11 a XSL i T M.>st P u'R>LwtBl:l s-ii x,>+w_:rz.d.c
H A,:1.-.•I L4xve N v.4...Ha N. 1 .i,,:,ces.
USE OEM ATTACHMENT PARTS ONLY
E � os �.,�
T'^11•�61/•rt•��-•en•.Mr•N'wrr twa�MMu6Y4•i�tMfira47YM!
/SIow TO CONNECT THE SOL fir?
COLLECTORS TO EX/ST/NG FFIkLE G
POOL F/LTi?OT/ON SYSTEM •.p.�.. �� '
Vacuum Breaker -& i,
TO SOLAR RETURN
COLLECTOR FROM SOLAR
(COOL) COLLECTOR
CDC (WARM)
ROOFSENSOR
AUTO
CONTROL
0
Check Valve
1 (OptionaQ
VALVE CONTROLLER
i
Three Way Valve.7 �— POOL SENSOR
(STR-JV3)
0 -NEW PLUMBING Check Valve
EXISTING PLUMBING (STR CV) t
Install after
thisoint:
:o?:
X.
P
4 Ef .N.:z,, s' • Chlorinator
r ::.:' r .y; • Heater
3 s' Other pool
accessories
optional
/ .�/i,��/'/f.Y"j', h l'; //,,.✓,4�' .i /,. �' b y/%C' �ioz: .!"i. -, ala' p e:v� >���F.v
E3SO10417 COLLECTOR LOrOCIT FILEO
Shown below are the THREE most common Solar Collector installations.
d--END CAP
~END CAP
RETURN 1 t FEED
FIG 5.1 -SINGLE ROW
--END CAP
SEND CAP
END CAP
RETURN 1 END CAP t FEED
FIG 5.2-DOUBLE ROW
t
END CAPS
END CAP t FEED END CAPS 1 RETURN
FIG 5.3-SINGLE ROW SPLIT FEED
FLORIDA SCALAR ENERGY CENTER
1679 CLEARLAKE ROAD, COCOA, FLORIDA 32922-5703 (321) 638-1000
Approved Solar Energy System
FSEC # S9004 Approval Date: NOV 1989
Revision Date: SEP 2006
DISTRIBUTOR SYSTEM
United Marketing Associates, Inc. Helio -
13620 49`" Street North TILE P
Clearwater, Florida 34622 I
This system was evaluated by the Florida Solar Energy Center (FSEC) in accordance with the Florida
Standards Program For Solar Domestic Water and Pool Heating Systems (FSEC-GP-7-80) and was found
to meet the minimum standards established by FSEC.
Description
Collector Manufacturer Model Number Units Total Rating
1. Heiiocol U.S.A. Inc. Heliocol-50 As required 46,100 Btu per unit
2. United Marketing Sun Star 50 As required 46,100 Btu per unit
Tank Manufacturer Model Number Capacfty (gat) Type:
1. Not Applicable
Pump Manufacturer Model Number Power Draw (Watts) Rated Power
1. Existing Pool Pump
Controller Manufacturer Model Number Type: Differential temperature
1. Independent Energy C-35-15-3T
2. Heliotrope General HM4000A
3. Solar Metrics SP10
Freeze Protection
1. Collectors drain automatically when pump is shut-off.
Other Major Components
1. Jandy Industries JVA1200 valve
2. Hydrotech Chemical Corp. G65208 valve
3. Heliotrope General FV-2, O-P valve
If further information is required you may contact the Florida Solar Energy Center at the above
address.
var�Y+Mr+,r,.•sn+•°Fwsew �aFi
R
FLORIDA SOLAR ENERGY CENTER& HLE P
�eRwYt
SUMMARY INFORMATION SH
June 2000
FSEC#98002 _
MANUFACTURER Revised February 2009
Collector Model
Heliocol USA,Inc. Helioco150
927 Fern Street, Suite 1500
Altamonte Springs,Florida 32701
This solar collector was tested by the Florida Solar Energy Center(FSEC)in accordance with the prescribed method and was found
to meet the minimum standards established by FSEC. The purpose of the tests is to verify initial performance conditions and quality
of construction only. The resulting certification is not a guarantee of long term performance or durability.
DESCRIPTION
Gross Length! 3.835 meters 12.58 feet
Gross Width 1.168 meters 3.83 feet
Gross Depth 0.051 meters 0.17 feet
Gross Area 4.481 square meters 48.23 square feet
Transparent Frontal Area 4.481 square meters 48.23 square feet
Volumetric Capacity 14.4 liters 3.8 gallons
Weight(empty) 10.7 kilograms 23.5 pounds
Recommended Flow Rate 314 mI/s 5.0 gpm
Test Pressure 1103 kPag 160 prig
Number of Cover Plate None
Flow Pattern Parallel Forced circulation
Number of Tubes Multitube mat
MATERIALS
Enclosure None
Glazing None
Absorber Polypropylene with UV stabilization
Absorber Coating None
Insulation None
THERMAL PERFORMANCE
Testing per ASHRAE 96-1980 (RA 1989)
Test Flow Rate 314 ml/s 4.97 gpm
Incident Angle Modifier Kia = 1.0 - 0.11 ([1/cos 01— 1)
Efficiency Equations
SI Units °C/Watt/m2 English Units OF/Btu/hr•ft2
= 82.8 - 1852 (T;-'r,)/I Tl= 82.8 - 326 (T;-T„)/l
0= 83.7 - 1844 (T,T.)/I - 5069 [(T;T,)j]Z t)= 83.7 - 325 ('I Tj/1 - 157 [(T;T,)/1]'
RATING _
This collector has been rated for energy output on measured performance and an assumed standard day. Total solar
energy available for the standard day is 5045 Watt-hour/m2(1600 Btu/ft2)distributed over a 10 hour period.
Output energy rating for this collector based on the second-order efficiency curve are:
Collector Temperature ENERGY OUTPUT
Low 35 -C (95°F) 48,600 Kilojoules/day 46,100 Btu/day
Intermediate 50°C (122°F) 17,400 Kilojoules/day 16,500 Btu/day
High 100°C (212°F) 0 Kilojoules/day 0 Btu/day
1.679 CLEA]kLAKE R(c Au,C:ocxaA.Fu>tuDA 3292'2-5703•TFi.321-638-1000 ■ FAx321-63£1.1010 ■ www.fsec.ucf edu
LJN vFasrry yrs ran DF FLowA•AN Eo uv_0PPomNrry/AFFI WX WF Ac noN Emm oYER•A RESEARCH INSTITUTE of THE UNPARSaY of CEWML FLoRCA
� I
City of Atlantic Beach x"' z
MBS. {
Building Department o asst t�g�Depaitment)
800 Seminole Road ' •ti `" ¢ °zti "
r. Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(9044)247-584
E-mail: building-dept@coab.us eaolec�'
• • - City web-site: httpJlwvw✓.coab.us
i
APPLICATION REVI W AND TRACKING. FORM
Property Address: szo /�� D2pAgiMent review required Yes,,'No
Building,)
Applicant: �1r'f Fl� Planning&Zoning
Tree Administrator
Project: 5 0 Public Works
Public Utilities j
Public Safety !
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept of Environmental Protection
Florida Dept.of Transportation
St Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: BApproved. []Denied.
(Circle one.) Comments:
QBUILDINGD
PLANNING&ZONING
Reviewed by: Date: .57%Y
TREE ADMIN. Second Review: [Approved as revised. ❑Deni -
PUBLIC WORKS Comments:
j PUBLIC UTILITIES
f
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
F
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
2233 /17
800 Seminole Road, Atlantic Beach, FOffice (904) 247-5826 Fax(904) 247-5845PR 1 .9
Job Address:
20 Permit
Legal Description J �� 2 -�`�' -2`l A++a/n±",G gg"4` Parcel# 1 7 3
g p P1.11"IT ea o q. t. q. t
Valuation of Work$ o�y 5�• Proposed Work heated/cooled non-heated/cooled 3�_
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)((circle one):• Commercial dentia
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval# CA 9q 0-0`f
For multiple products use pro uct approval form h /
Describe in detail the e of work to be performed: d� ��'
)cs �?
Property Owner Information:
Name: SP +a��S�tate
Address: Sk She
Cit}, t �t� ec>`clti -Zip 123 Phone �uN— a2�14 8652
E-Mail or Fax#(Optional)
Contractor Information: kPr
Ott�-��l� Qualifying Agent: W
Zip
Company Name: State
Address: ( c e).0 or etv kR City
Office Phone a Job Site/Contact Number �%4,—9 9
State Certification/Registration# C
Architect Name&Phone#_N
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
hat no work or
llation has
rior
isthe
Puaneelonis a perm and t allmade to bwork well belperformed tot to do the omeet the stanrk and dards of allations as l laws regulatinicated I g nstruction in this jurisdiction.( This permit beeomesonull
ction or work is s
workvoid If
f commenced of 1 understand within six that separate permitsomust be conssecured for Electric ua!Work,Plumbing,Sigfns,or a�Ris,Poeriod ols xFurnaces,Bmonths oilerrs t Heal rs,
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR OBTAIN FINANCING, CONSPAYING LT WITH
MENTS
TO YOUR PROPERTY. IF YOU INTEND
YOUR LENDER OR AN ATTORNEY
BE OR ERECORDING YOUR NOTICE OF
CO
1 hereobywork y t hat I have read complied an examinewhetherd this.
led Vrtein or not.o The granting of a per ame to be true and doescnot prAll esumetto gions ve autholaws rity tot olatenances gor can
cel tthe
tYP 1, p
provisions of any other federal,state, or local law regulating construction or the performance of construction.
'5111 ltollli
Signature of Owner
Signature of Contractor W1
(,U► ((i a rr` 0 , Ca l(� �r.................................
PrintName G—%��t,t' Print Name ........................................................................................
Swo and bscr' me SwoLrDaysof
d ubsc 'bed efore me 20
th' Dao ., 0 this >r
- KIM K.BROOKS
COMMISSION14.2014
Feoruary MY COMMISSION•EE174226
Notary Pub is I
�xP ,2014
No ub is � "'
t,,,Revi