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PERMIT DOCUMENTS UNIVERSAL COUNTY-WIDE/MUNICIPAL FOR OFFICE USE ONLY BUILDING PERMIT APPLICATION FORM FBCVersiona0 L1 Permit Type: July 2013 Edition Accepted By:ST Appj 5n Dated Approved for use throughout Palm Beach County and Municipalities Application IS: CG�nJ C]TJ KIND of PERMIT(CHECK ONE): PROPERTY OWNER: Y !� n/p/ 6- o PRIMARY PERMIT TENANT: `` tt ``,,v C o SUB-PERMIT-If Fee&Value of a Sub-Permit are ADDRESS: t L 1 k‘ N�l \ S I(- I Gout UNIT: -- covered covered under a Primary Permit,complete boxes!,3,4,5_ 6 & CITYre)oyNTc N. �&IA STATE:J—I ZIP �-j ! R3 8 only to apply.If not covered under a Primary Permit, complete the entire application to apply. PHONE: - FAX: EMAIL:k1 - A a _ - V • . AM I I TRADE (CHECK ONE): PROJECT NAME: a /� V ❑ TRUCTURAL ❑ROOFING ❑ELECTRICAL PCN: O I-it -g 5- ( b - OL- O 3 a- O O MECHANICAL o PLUMBING o FIRE o GAS — o OTHER: LEGAL DESCRIPTION: n PRIMARY PERMIT if: ADDRES% 4II NtO L l ye- •� n7� ,!/ CITY: /11n l h to TL ✓ C J FURTHER WORK DESCRIPTION: '( (_ X AC C. • Pyk ` ' It Type of Work: o New o Addition o Alteration o Repair o Demo o Temporary %Other VALUE: 35 no PERMIT FEE: NET S.F(for SFD's): (SEE FEE SCHEDULE) )AS APPLIES) (AS APPUES) r' D OWNER BUILDER PER FL.ST.489 AS NAMED- 1CK A ABOVE,FOR CONTACT INFORMATION SEE BOX 2) CONTRACTOR(CERT. HOLDER): (-10 CA NI1 rl_Ufjrk 1„t• License It 1114- Ittol(P2—L--1 DBA(COMPA YN• ): ont.ctP-rs. : -- ADDREE5f5��:� • ►• _ . � / STE: CITY: _ &bai � *2t• PHONE: 901 ''1 FAX: -7 . a •b EMAIL: b j^r • aa.L Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating and zoning. g ( itrnetur Own or gntl cludjng[on ractOrl/� ^ I— Si atur of OwneEncIuffingLr) Pr' t Name: E.�/UI Lp(\J U,L/ I}ry1"J'ltilPrint Name: + /Jr NOTARY REQUIRED IF$2,500 OR MORE,OR FOR ALL OWNER/ NOTARY REQUIRED IF$2,500 OR MORE,IOR FOR ALL OWNER/ BUILDERS R A D SOF$ STAT FLORIDA BUILDERS REQ 1' ESS OF;VALUE ST.TE OF FLORIDA •COUNTY OF COUNTY OF r • -t Sworn toilet(aft mei)aanid/subscribed before me this 0 Sworn At°(�o.^affitme_d)and subscribed before me this 1i day of (li C CJC-7 20 )-(7 ,by day •f C '�C�1Ce r- 20 2.1) ,by ise m- gsbhment l' �� 'ate � � 1 (f I �'�.i, .'INCENE rCTAVE flp7fa, j _ �1 -A� f� Il .L .�►'.Z�I►! t : „11,r1n�Aa�4mmuuen I GG 7t7t7t ) i MOND:SIR (Signature of Notary Public owri imi,hpinl 2023 ) (Signature of Notary Public-State of Florida) t (Print,Type,or Stamp Corn i esiorietatli0e1140 re11bl�a8 ' Cb ti ION/1661:2186 _ ry Nsn, I (Print,Type,or Stamp C missioned Name of It a aF r . ;February 04.2022 Personally Known_OR oB I eJ[ I Ica' w Personally Known OR Produc d Idpnti I t o - S Type of Identification Produced �{7� Type of Identification Produced a w 4,r-Z Page 1of2 iiilliiii . 11 rif- lilt " l 1 - - t L 1 /" 1102 inP1 : � /�� 11 -5. S A =f a nn QEF= - i , g� Jr A4, 7 J' 7 ..z- ,--4_ x E -fr m A, h p 7 ..1)M m .in ' 7,) 3/ v s io ,' � / z m �111101111 111 ?j1 -- n DI z r4r Part ! 96-0r), r- 7 po_rpo m 1 �i �� g g (.15v �,r 3 .1 � V rn �� Z orlIf � � r � � - C ill vz (r% ( oUWiii � IHRIVi a th et ti - \I, rl IL g r4 V Z X A b b €� _„ Z fv' p p g n �P m 1) 6 x -lilt O N 2 N rV A b //VVV V I 7 0 m m x Wir [ji En › cm 0 mva .Z7 3 a m n m. Nc. n wrr r - N O al m p oOl Zit)ETcct n g N Mr 41 ,c5- -n 3 � • _1—te1 u, { p ll il Y S RQQ4 2 Sfs � 9 LL A O2 ICI +.. ma Z -y g 1 i m N m o m i 3 9 A -i o Z OP 9 O 9.1,7 0, z CITY OF BOYNTON BEACH DEVELOPMENT DEPARTMENT BUILDING DIVISION o•1 r0 N C'4c 100 East Boynton Beach Boulevard•Boynton Beach,FL 33425•(561)742-6350•Fax 742-6357 NC CHANGE-OUT The applicant is required to complete this form in order to receive a turn-around permit for an Exact A/C Change-Out. By accurately completingthis form the applicant is attesting to the fact that by installing the new unit there will not be an increase in wire size. By signature below I verify that either a representative of my company or I have inspected the existing conditions and there is no upgrade of the electrical system or service wiring changes required for the new unit(s) being Installed. The condenserlcompressor unit, air handier/heat strips, and KW size will not increase. I also affirm that there is an electrical disconnect within sight, meeting the requirements of 2011 NEC,Article 440-14. Print legibly or type and fill out form completely. Owner's Phone# 56/-5 q Owner's Cell Phone# Permit Number. New unit will be installed in what type of facility (check type of facility or fill in Other): Beingle-family, detached ❑ Single-family attached (] Multi-family, apartment 0 Multi-family, condo ❑ Commercial ❑ Public facility ❑ Industrial 0 Other Job Address: (including unit number and gate code, if applicable) SPLIT SYSTEMS PACKAGED SYSTEMS Existing Unit Information: kZ\E'=,0" Existing Unit Information BTU/HR Capacity: BTU/HR Capacity: Heat kw: Sc., Heat Kw. SEER: SEER/EER: Proposed Unit Information:(,\\Q��\r?- Proposed Unit Information: Condenser Make & Model:C r= ?,tkSk-c w1t\ps1 Make & Model: BTU/HR Capacity: r5'3� BTU/HR Capacity: SEER: \ c Heat Kw: Air Handler Make & Model: (La et caLia CSEER/EER: Heat Kw: Location of. /ni Condenser `-ip. Air Handler C \n' c= T Disconnect extcr.a., r- (Note an electric sub permit complying with code is required for the installation of a new disconnect) Any alterations to existing curbs,stands or supports will require a building sub permit. I certify that the information entered on this form accurately represents the system installed. tv Qualifier. (print) License No.RA)-S0(39(t1.4 Signature: \10- o_ Phone No.�I-6({y1-y9r3 Cell Phone 2.f ' Ske %ct "),q 100 East Boynton Beach Blvd,PO Box 310 Boynton Beach,Florida 33425-0310 Phone(561)7424350 Fat(561)7424357 S:1DevelopmennBUU D04GWFonne-Templates-SlgmtAir Conditioner Change Out Fonn a-2015.doat 01/09,04109.12109:08/15:03116 ti.1i CERTIFIED° www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number:9193892 Date: 10-03-2020 Model Status:Active AHRI Type:RCU-A-CB(Split System:Air-Cooled Condensing Unit,Coil with Blower) Series: 14 SEER AC Outdoor Unit Brand Name:CARRIER Outdoor Unit Model Number (Condenser or Single Package):CA14NA036'0^A' Indoor Unll Model Number(Evaporator and/or Air Handler):FB4CNF036L Region: Southeast and North(AL,AR,DC,DE,FL,GA,HI,KY,LA,MD,MS,NC,OK,SC,TN,TX,VA,AK,CO,CT,ID,IL, IA,IN,KS,MA,ME,MI,MN,MO,MT,ND,NE,NH,NJ,NY,OH,OR,PA,RI,SD,LIT,VT,WA,WV,WI,WY,U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1,2015 are eligible to be installed in all regions until June 30,2016.Beginning July 1,2016 central air conditioners can only be Installed in reglon(s)for • which they meet the regional efficiency requirement. The manufacturer of this CARRIER product is responsible for the rating of this system combination. • Rated as follows In accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2 Performance Rating of Unitary. Air-Conditioning 8 Air-Source Heat Pump Equipment and subject to rating accuracy by.AHRl-sponsored,independent;third party testing:j Cooling Capacity(A2)-Single or High Stage(95F),btuh:33000 _ - ) SEER:14.00 - - - -- . EER(A2)-Single or High Stage(95F) : 12.00 " - - - - - - - • Motive'Model Status are those that an AHRI Certification Program Participant Is currently producing AND selling or offering for sale;OR new models that are being marketed but are not yet being produced'Production Stopped'Model Status are those that an AHRI Certification Program Participant Is no longer producing BUT Is still selling or offering for sale. Ratings thalare accompanied by WAS Indicate en involuntary re-rate. The new Published rating Is shown along with Me previous(I.e.WAS)rating. DISCLAIMER AHRI does riot endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for. the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed In the. directory at www.ahtldlrectory.org, TERMS AND CONDITIONS ARPJ This Certificate and Its contents are proprietary products of AHRL This Certtilcate than only be used for indMdual,personal and confidential reference purposes.The contents e11h15 Certificate may not.In whole or In part,be reproduced;copied:disseminated; entered into a computer database;or otherwise utilized,in arty form or manner or by any means,except for the user's Individual, personal and confidential reference. AIRCONDmONINO.HEATING, CERTIFICATE VERIFICATION a REFRIGERATION IN5TNUTE The Information for the model cited on this certificate can be verified at www.ohrldlroctory.org,click on'Verify Certificate'link we mate ticc better and enter the MW!Certified Reference Number and the date on which the certificate was Issued, which Is listed above;and the Certificate No.,which Is listed at bottom right. ©2020Air Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: +324e2osscs2osesos Florida Building Code Online Page I of 2 I Fan& az (i.S1) -^+ :1 .`6 Business & Professional Regulation , c4, 14.( 4 r .ae fl"1P=CCM= BCIS Home I Log In I user Registration I Hot Topics I Submit Surcharge I Stats S Facts I Publications I FOC Staff I BUS Site Map I links I Search I dFI5r 3 product Approval �o5[II:Pubihc pser ,c. ., bw Product Approval Meng>Product or application Search>Application 1st>Application Datall DD1flCCCFTMC FL x. FL14239-R4 .6Eg6TARi Application Type Revision Code Version 2017 Application Status Approved Comments Archived - 0 • Product Manufacturer BMP International Inc. Address/Phone/Email 4710 28th Street N St.Petersburg,FL 33714 (727)458-0544 benmengs@yahoo.com Authorized Signature Xianbin Meng benmeng8@yahoo.com Technical Representative Address/Phone/Email Quality Assurance Representative Address/Phone/Email Category Structural Components Subcategory Anchors Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer 0 Evaluation Report-Hardcopy Received Florida Engineer or Architect Name who developed Frank L.Bennardo,P.E. the Evaluation Report Florida license PE-0046549 Quality Assurance Entity National Accreditation&Management Institute Quality Assurance Contract Expiration Date 12/31/2018 Validated By Troy Bishop,P.E. f, Validation Checklist-Hardcopy Received Certificate of Independence FL14239 R4 COI Indeo od( Referenced Standard and Year(of Standard) Standard Thar ASTM D1761-88 2000 Equivalence of Product Standards Certified By Florida Licensed Professional Engineer or Architect FL14239 R4 Eauiv Eauiv DO Sections from the Code Product Approval Method Method 1 Option D https://floridabu i lding.org/pr/pr_app_dtl.aspx?param—wG EV XQwtDquDEJ ErtOSCei RuPj... 3/28/2018 Florida Building Code Online Page 2 of 2 Date Submitted 08/09/2017 Date Validated 08/16/2017 Date Pending FBC Approval 08/20/2017 Date Approved 10/10/2017 Summary of Products FL Model,Number or Name Description 14239.1 Slotted Steel Tie-Down Clips, 1" Steel Tie-Down Clip System(For Use with Mechanical Units and Y Models at Roof or Grade) Limits of Use Installation Instructions Approved for use in HVHZ:Yes 1L14239 R4 II Dwq,&p! ---1 Approved for use outside HVHZ:Yes Verified By: Frank L.Bennardo,P.E.0046549 Impact Resistant:N/A Created by Independent Third Party:Yes Design Pressure:N/A Evaluation Reports ,L Other:This design provides allowable capacities for the FL14239 R4 AE Fval.od(��/r system.The required site-specific design pressure(demand) Created by Independent Third Party:Yes shall be calculated by others for use with this design. Contan=::2601 Blair stone Road Tallahassee FL 37398 phone'650-167.1624 The State of Florida H an WEED employer.fnovdobt 2007-2011 State of Fb'M4::pdvary Stateme02::Aan1slal0 m=m::Refund Statemey Under Florida law,email eddrmses are public records.I1 you do not want your e-mail address released In response to a public-records reauest,do not send electronic meal to this entity.Instead,contact the office by phone or by traditional mall.II you have any questions,please contact 850.487.1395.'Pursuant to Section 155.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455.F.S.must provide the Department with an email address If they have one.The emalls provided may be used for official communication with the licensee.However email addresses are public retard.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.To determine If you ere a licensee under Chapter 455.F.5.,pkase click here. Product Approval Acceptor FM F-1 Credit Card . Safe.. A�.c U it it VMI:1 RICl.i Xe 4 C`rte".1> S r C // Gk CIS C /�0..k5 Ct iitej so )i-A-.. a� �$�h eata)6A— https://floridabuilding.org/pr/pr app dtl.aspx?param-=wGEVXQwtDquDEJErtOSCeiRuPj... 3/28/2018 1 • ENGINEERING EXPRESS® r--:7 '>.? P . E` • O„ • • PRODUCT EVALUATION REPORT ENGINEERING EXPRESS® EXPERT PRODUCT EVALUATION REPORT August'', 2017 Application Number: FL#14239.1-R4 FLB Project Number: 15-2378 Product Manufacturer: BMP International Manufacturer Address: 4710 28th Street North St. Petersburg, FL 33714 Product Name: Slotted Steel Tie-Down Clips, 1'and 2'Models Product Description: Steel Tie-Down Clip System(For Use with Mechanical Units at Roof or Grade) Scope of Evaluation: This Product Evaluation Report is being issued in accordance with the requirements of the Florida Department of Community Affairs(Florida Building Commission)Rule Chapter 61G20-3.005, F.A.C., for statewide acceptance per Method 1(d).The product noted above has been tested and/or evaluated as summarized herein to show compliance with the Florida Building Code Sixth Edition(2017)and is,for the purpose intended,at least equivalent to that required by the Code. Re-evaluation of this product shall be required following pertinent Florida Building Code modifications or revisions. Substantiating Data: • PRODUCT EVALUATION DOCUMENTS FLB drawing#15-2378 titled'Mechanical Unit Steel Tie-Down Clip:At-Grade and Roof-Top Mounted Applications', sheets 1-5, prepared by Engineering Express,signed&sealed by Frank L.Bennardo, P.E. Is an integral part of this Evaluation Report. • TEST REPORTS Ultimate test loading structural performance has been tested in accordance with ASTM D1761-88 test standards per test report(s)#TEL 01970387A and#TEL 01970387B by Testing Evaluation La Inc. Signed and Sealed by Lyndon F.Schmidt, P.E ```\ 4 rr r�, I ji&m, • STRUCTURAL ENGINEERING CALCULATIONS Raised Engineer- alidtditse •.1'T( P: , :,: _ Structural engineering calculations have been prepared which J pE0046"�9 '•:0 evaluate the product based on comparative and/or rational AUG I 1 analysis to qualify the following design criteria: _ 2 1. Minimum Allowable Unit Width _ -p Lu 2. Maximum Allowable Unit Height Frank L. Benna?d61' O 3. Minimum Unit Weight #PE0L. 549 & t0Rlol .•' Gam` 4. Maximum Allowable Unit Surface Area 5. Clip Configuration and Anchor Spacing /'s f'GN/�' ,ti 6. Anchor Capacity for Various Substrates �� 7. Maximum allowable roof-top heights for various installation wind speeds 160 SW 12TH AVENUE SUITE 106, DEERFIELD BEACH, FLORIDA 33442 PHONE: (954) 354-0660 - FAx: (954) 354-0443 EN GINEE RING Ex P RESS.COM ntw..a.,a,.an,m..uw.w.,wn am,wa,., ba e.oecnrm„suamea,•ewam,aa ISENGINEERING EXPRESS® 8/01/2017 BMP International—Steel Tie Down Clips Page 2 of 2 No 33%increase in allowable stress has been used in the design of this product. Impact Resistance: Not applicable to this product. Wind Load Resistance This product has been designed to resist wind loads as indicated in the design schedule(s)on the Product Evaluation Document(i.e.engineering drawing). Installation The product listed above shall be installed in strict compliance with the Product Evaluation Document(i.e. engineering drawing),along with all components noted therein. The product components shall be of the material specified in the Product Evaluation Document(i.e. engineering drawing). Limitations & Conditions of Use: Use of this product shall be in strict accordance with the Product Evaluation Document(i.e.engineering drawing)as noted herein. All supporting host structures shall be designed to resist ell superimposed loads and Shall be of a material listed in this products respective anchor schedule. Host structure conditions which are not accounted for In this product's respective anchor schedule shall be designed for on a site-specific basis by a registered professional engineer. All components which are permanently installed shall be protected,against corrosion, contamination,and other such damage at all times. This product has been designed for use within and outside of the High Velocity Hurricane Zone(HVHZ). • 160 Sw 12" AVENUE SUITE 106, DEERFIELD BEACH, FLORIDA 33442 PHONE: (954),354-0660 - FAX: (954) 354-0443 ENGINEERINGEXPRESS.COM VSMSCR14LI,MK Th I(LT,IIpfl.,Y.IW,i Ria,, 11PL A�mp.,�p.CIVINpI,i V*w.a(VIaais plg'gp11-11' • IY. VY.}y1CT M IOW 11V i ViA-Up R10 Y A41Y1Yrj CIw}1.1ORaa IC aiMi LU.O .Nlam1 .FMI�i1R.0YL1T FCti D . ..g; Nzi y; c 4 9 5 M m 1-; 12 �Orli E a<1 op. 1 a a 5 i o ega_ ceo = 24 ' £ 001 a a 5 i I €C Sin : mx 2.ic ggcF �I1 1 $ a / i I P°:-%9 lip OD { 7 ilii g_ _m a g * z \ ' NUONUN NE GM m q S 5 c g "Zg / citlip n m «, (SEE DESIGN 5601,11) /I I i E PI m g ,' Cil n 9 5 Iao€m ° r 6mL rn — 4 co r 6g t $ R �$ 01 rn ��i AR , 1--1 yi G F0 0 di Al il6 eo '. 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