Air Conditioning Replacement Data

Transcription

1 Lauderdale By The Sea Building Department 4501 Ocean Drive Lauderdale By The Sea, FL Phone: (954) Fax: (954) Air Conditioning Replacement Data CONTRACTOR PHONE OWNER NAME: SITE ADDRESS: SUBDIVISION: LOT/BLOCK: PERMIT NUMBER DATE THIS FORM MUST ACCOMPANY ALL AIR CONDITIONG REPLACEMENT PERMIT APPLICATIONS. EACH UNIT CHANGE-OUT MUST BE ON ITS OWN DATA SHEET. MULTIPLE UNITS ON SINGLE SHEETS ARE NOT ACCEPTABLE. UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER PKG UNIT MODEL COND. UNIT MODEL AHU/COIL MODEL KW HEAT NOM TONS AHU CU PKG 1.M.C.A. AHU CU PKG AHU CU PKG 2.M.O.P AHU CU PKG AHU CU PKG 3.VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO DUCTS YES NO YES NO THERMOSTAT YES NO YES NO SMOKE DETECTOR YES NO YES NO NEW STAND/ CURB YES NO LADDER REQUIRED FOR INSPECTION YES NO CHANGE DISCONNECTING MEANS YES NO SIGNATURE: FLORIDA STATE CERTIFICATION/REGISTRATION NO. APPROVED BY DATE 1) MINIMUM CIRCUIT AMAPACITY (WIRE SIZE) 2) MAXIMUM OVERCURRENT PROTECTION (FUSE/BREAKER SIZE) 3) VOLTAGE OF CIRCUIT (208/240/480) 4) SIZE DISCONNECTING MEANS Page 1 of 1

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3 LauderdaleByTheSea BuildingDepartment 4501OceanDrive LauderdaleByTheSea,FL33308 Phone:(954) Fax:(954) PERMITNUMBER OWNER SAFFIDAVIT:Icertifythatallinformationprovidedisaccurate,andthatallworkwillbeperformedincompliancewithall applicablelawsregulatingconstructionandzoning.noworkhasbeencommencedpriortothepermitsoughtbythisapplication, andallworkwillbedoneasindicatedintheapplicationandallaccompanyingdocumentandplans. NOTICE:Inadditiontherequirementsofthispermit,theremaybeadditionalrestrictionsapplicabletothispropertythatmaybe foundinthepublicrecordsofthecounty,andtheremaybeadditionalpermitsrequiredfromothergovernmentalentitiessuchas watermanagementdistricts,county,stateorfederalagencies. DISCLAIMER:Issuanceofadevelopmentpermitbyamunicipalitydoesnotinanywaycreateanyrightonthepartoftheapplicant toobtainapermitfromastateorfederalagencyanddoesnotcreateanyliabilityonthepartofthemunicipalityforissuanceofthe permitiftheapplicantfailstoobtainrequisiteapprovalsorfulfilltheobligationsimposedbyastateorfederalagencyor undertakesactionsthatresultinaviolationofstateorfederallaw. CONDITION:Allapplicablestateandfederalpermitsmustbeobtainedbeforecommencementofthedevelopment. WARNINGTOOWNER:FAILURETORECORDANOTICEOFCOMMENCEMENTMAYRESULTINYOURPAYINGTWICEFOR IMPORVEMENTSTOYOURPROPERTY.IFYOUINTENDTOOBTAINFINANCING,CONSULTYOURLENDERORATTORNEYBEFORE RECORDINGTHENOTICEOFCOMMENCEMENT. CONTRACTOR PRINTNAMEOFCONTRACTR SINATUREOFCONTRACTOR STATEOFFLORIDA COUNTYOFBROWARD Swornto(oraffirmed)andsubscribedbefore methis dayof 20,by NOTARY: SEAL: PersonallyKnown: OrproducedIdentification TypeofIdentificationProduced OWNER PRINTNAMEOFOWNER SIGNATUREOFOWNER STATEOFFLORIDA COUNTYOFBROWARD Swornto(oraffirmed)andsubscribedbefore methis dayof 20,by NOTARY: SEAL: PersonallyKnown: OrproducedIdentification TypeofIdentificationProduced Page 3 of 6

4 LauderdaleByTheSea BuildingDepartment 4501OceanDrive LauderdaleByTheSea,FL33308 Phone:(954) Fax:(954) PERMITNUMBER PERMIT AFFIDAVIT FOR ACKNOWLEDGEMENT OF COMPLIANCE WITH RESTRICTIVE DEEDS AND COVENANTS STATE OF FLORIDA BROWARD COUNTY On this day personally appeared before me, the undersigned officer duly authorized to administer oaths and take acknowledgments, who being by me first duly sworn, deposes and says. (HOMEOWNER) By my signature below, I acknowledge that the legal description for the property for which I am applying for a permit is (Lot/block) a/k/a (Street address & subdivision) 1. That I am the legal owner of the property 2. I acknowledge that approval may be required from the following (Homeowners Association) Which entities or associations regulate or otherwise govern the community, neighborhood, or development my property is located. 3. I further acknowledge that I am responsible for any additional cost that may be assessed by the Town of Lauderdale by the Sea and/or the entity regulating or governing the subject property as a result of my not having obtained the necessary approvals from any entity or association that may regulate or otherwise govern the community neighborhood, development in which my property is located. FURTHER AFFIANT SAYETH NAUGHT Witness Signature Witness Printed Name Witness Signature Witness Printed Name STATE OF FLORIDA COUNTY OF BROWARD Affirmed and signed before me, on the foregoing document was acknowledged before me affiant,, who personally appeared before me at the time of notarization, who signed and acknowledged signing the foregoing document, who did take an oath, and: [ ] Who is personally known to me or [ ] Who produced the following identification Commission Expiration date: Notary Public (Seal) (Printed or typed name) Page 4 of 6

5 LauderdaleByTheSea BuildingDepartment 4501OceanDrive LauderdaleByTheSea,FL33308 Phone:(954) Fax:(954) PERMITNUMBER TimeLimitsforConstructionNOTICETOOWNER Section612oftheTown scodeofordinancesrequires: 1. The construction of any new structure or new addition to an existing structure to be completedandallconstructionmaterial,equipmentanddebrisremovedfromtheproperty within18monthsofthedateoftheissuanceofthefirstbuildingpermit. 2. Theexteriorelementsofanyrepairorrenovationtoanexistingstructurewhichrequiresa building permit shall be completed and all construction material, equipment and debris removedfromthepropertywithinsixmonthsoftheissuanceofthefirstbuildingpermit. Thisnoticeistheminimum60daysnoticerequiredin612.9(g). The Failure to complete the construction at, by the constructiondeadlinemayresultinafineorlegalactionbythetown. Ifthereareextenuatingcircumstancesthatprohibitthepropertyownerfromcompletingtheconstruction withinthedeadline,theownermayseekanextensionoftimefromthetowncommission.anapplicationfor extensionoftimemaybeobtainedfromthedevelopmentservicesdepartmentortownclerk. Owner sacknowledgement I acknowledge receipt and understanding of the Town s code provisions regarding the time period to completeaconstructionprojects. Signature: Date: PrintName: AddressofProperty: Page 5 of 6

6 LauderdaleByTheSea BuildingDepartment 4501OceanDrive LauderdaleByTheSea,FL33308 Phone:(954) Fax:(954) PERMITNUMBER BUILDING DEPARTMENT DURING A HURRICANE WATCH & BEFORE THE ONSET OF HURRICANE VELOCITY WINDS YOU ARE REQUIRED TO SECURE THIS SITE IN ACCORDANCE WITH THE BROWARD COUNTY ADMINISTRATIVE PROVISIONS OF THE FLORIDA BUILDING CODE SECTION All loose objects in exposed outdoor locations shall be lashed to rigid construction or shall be stored inside an enclosed structure. Florida Building Code Broward County Administrative Provisions Section NOTICES ISSUED BY THE NATIONAL WEATHER SERVICE OF A HURRICANE WATCH ARE DEEMED SUFFICIENT NOTICE TO THE OWNER OF REAL PROPERTY UPON WHICH CONSTRUCTION IS OCCURRING, OR ANY CONTRACTOR RESPONSIBLE FOR SAID CONSTRUCTION, TO SECURE LOOSE CONSTRUCTION DEBRIS AND LOOSE CONSTRUCTION MATERIALS AGAINST EFFECTS OF HURRICANE FORCE WINDS This includes but not limited to: Road Right-of-Way shall remain clear of construction waste and trash Waste and Trash Enclosures Temporary Toilets Loose Construction Debris Forms and Construction Materials Roofing Tile and Materials Construction Shacks (1) Loading of Roof Tile (4) Store the construction materials inside an enclosed structure Building materials shall be loaded on a roof no earlier than (200 working days prior to permanent installation. Temporary Electric Service Poles AND PROTECT ALL GLASS AREAS Page 6 of 6