Fillable COUNTY FL Mechanical System Change Outs Permit: Date (Lake County Board of County Commissioners)

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COUNTY FL Mechanical System Change Outs Permit: Date (Lake County Board of County Commissioners)

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The COUNTY FL Mechanical System Change Outs Permit: Date (Lake County Board of County Commissioners) form is 2 pages long and contains:

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BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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COUNTY
,
FL
REAL
fl0RI0A
· REAL CLOSE
Office of Building Services
Mechanical System Change Outs
315 West Main St., Tavares, FL 32778 · PO Box 7800
Phone (352)343-9653 · Website www.lakecountyfl.gov
Permit: Date
Job Address:
Detailed scope of work:
Structure Type ☐ Single-Family Residence ☐ Other
Energy Source ☐ Gas ☐ Electric ☐ Solar ☐ Other
Note: Electrical work other than unit to disconnect will require a Licensed Electrical Contractor. The breaker and electrical
wire size shall be determined in accordance with the National Electrical Code 2017 (NFPA 70)
Duct System ☐ Relocate/Replacement only – no square footage increase
(no additional information is required)
Full System Change Out System Size Additions
☐ Condenser and air handler/furnace ☐ Unit size(s) remains the same ☐ New mini-split system
☐ Single-package unit ☐ Change in unit size(s) ☐ New additional system
☐ Using existing system, sq. ft
Required information for all work
Partial System Change Page 2 must also be filled-out only on Partial system change outs but must be signed.
Condenser Information
Manufacturer Model #
Voltage/Phase __________ MCA__________ MOD__________ HSPF__________ IEER/SEER
Air Handler/Packaged/Gas Furnace System
Manufacturer Model #
Wire size required ☐ Existing or ☐ Upgraded
Voltage/Phase MCA MOD AFUE %
Heat strip size (kw) Wire size required ☐ Existing or ☐ Upgraded
Gas Furnace output in (BTU’s) ☐ Heat pump or ☐ Straight cool
Additional information
Note: If gas heat, pipe size and shut-off valves shall be to current requirements: ☐ Existing or ☐ Upgraded
Legend
HSPF
Heating Seasonal Performance Factor
IEER
Integrated Energy Efficiency Ratio
MCA
Minimum Circuity Ampacity
SEER
Seasonal Energy Efficiency Ratio
(per manufacturer specification)
MOD
Maximum Overload Protection Device
AFUE%
Annual Fuel Utilization Efficiency
(per manufacturer specification)
(Gas Furnace per manufacturer specification)
Office of Building Services Page 1 of 2
BF65 Mechanical System Change Outs
Updated January 15, 2021
Partial Mechanical System Change Outs
This page is only required for partial systems change outs in addition to the required first page.
Florida Statutes, Section 553.912, Air Conditioners. It is the intent of the legislature that all replacement air-
conditioning systems be installed using energy-saving, quality installation procedures; including, but not limited
to, equipment sizing analysis and duct inspection.
Per FBC-EC C501.7 and R501.7 exceptions, outdoor and indoor units that are not designed to operate
together must meet U. S. Department of Energy Certification requirements contained in section
R303.1.2. Matched systems are required and must be verified by one of the following means: AHRI data,
accredited labs, manufacture's letter, letter from a Florida Registered Professional Engineer.
☐ Installing either the air handler or condenser (provide documentation)
The replacement unit you are installing is certified for capacity and efficiency by (check one):
☐ ARI Rating
☐ ARL or Other recognized testing laboratory
☐ Professional Engineer, Florida registration number
☐ Manufacturer's letter
Please complete HVAC Matching Equipment Certification and provide all the required support data proving this
is a matched system. This information must be provided with the permit application. Note a copy of all informati
on submitted must be on site for a final inspection. Missing forms or information will result in a failed
inspection. This form is a required part of all mechanical permit applications for system replacement, addition or
repair. Permits may not be processed without all supporting documents.
Note: This completed form is required on site at time of inspection. The form will be taken to office for record
keeping after inspection. The A/C System shall comply with the FBC Energy Conservation Code (2020) 7
th
Edition
Section C403 and Section R403.
Prepared by (Print Name) License #
License Holder’s Signature Date
Office of Building Services Page 2 of 2
BF65 Mechanical System Change Outs
Updated January 15, 2021
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COUNTY FL Mechanical System Change Outs Permit: Date (Lake County Board of County Commissioners)

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Completed 21 January 2021

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