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Office of Building Services (Lake County Board of County Commissioners)

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BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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Office of Building Services Page 1 of 2 BF65 Mechanical Scope of Work 1 -2
Updated September 29, 2017
Permit: Date:
Job Address:
Detailed scope of work:
Structure Type : ( ) Single-Family Residence/Townhouse/Condo ( ) Manufactured home ( ) Other______________________
Energy source: ( ) Gas ( ) Electric ( ) Solar ( ) other _________________________
Duct
( ) Relocate/Replacement only – no square footage increase (no additional information is required)
Full System Change Out
( ) Condenser and air handler/furnace ( ) Unit size(s) remains the same
( ) Single-package unit ( ) Change in unit size(s)
Additions
( ) New mini-split system
( ) New additional system
( ) Using existing system, square footage increase
Partial System Change Page 2 must ALSO be filled-out only on Partial system change outs.
Required information for all work
Condenser information: Manufacturer: ______________________________________ Model Number: ____________________________
Circuit breaker size required: ______________________ Wire size required: _____________________ ( ) Existing or ( ) Upgraded
Air Handler/Packaged System: Manufacturer: _________________________________ Model number: ___________________________
Circuit breaker size required: _____________________ Wire size required: ______________________ ( ) Existing or ( ) Upgraded
Heat strip size: ________________________________________ Additional info: _____________________________________________
Note : If gas heat, pipe size and shut-off valves shall be to current requirements: ( ) Existing or ( ) Upgraded
Electrical work other than unit to disconnect will require a Licensed Electrical Contractor.
Prepared by (Print Name): ___________________________________________________ License #: _____________________
License Holder’s Signature: _______________________________________________Date: _________________________
*** Note: This completed form is required on site at time of inspection. The form will be taken to office for record keeping after inspection ***
Office of Building Services
Mechanical System Change Outs
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Office of Building Services Page 1 of 2 BF65 Mechanical Scope of Work 1 -2
Updated September 29, 2017
Office of Building Services
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 101.4.7 exceptions Outdoor and indoor units that are not designed to operate together must meet U. S. Department of
Energy Section C403.2.3 (commercial) or R303.1.2 (residential) requirements. Matched systems are required and must be verified by
one of the following means: ARI (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 information 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.
Prepared by (Print Name): ___________________________________________________ License #: _____________________
License Holder’s Signature: _______________________________________________Date: _________________________
*** Note: This completed form is required on site at time of inspection. The form will be taken to office for record keeping after inspection ***
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Office of Building Services (Lake County Board of County Commissioners)

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Completed 18 July 2020

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