HomeMy WebLinkAboutBuilding Permit Application;%[C APPLICABLE IMFV ivitbi 6E CUivirEETED FUR HPPEICRi IOIv 1 O tsE HCCEt, i ED
Date: Permit Number:
Building Permit Application
Flanniny and aevelopment3ervices
oullding and Code rregulation Division
zs17D virginia avenue, Fort Tierce r -L a7frz
Phone: (772) 462-1553 Fax: (772) 462-1578 CurnR1erdal Rezi'aential
PERMIT APPLICATION FOR: To Select from drepbcx, click arrow at the end of I(e
I'KU `3 1-D IMPKUVEIVIENI GUC:AIIL)N:
Address:_ !� Sim, 50NE-- 6-C _ 37.4q(F
regal Description: - t-ky L. 1A -0 4Q7_
I-roperLy'Tax ID #i: , — b—' f — C) cc) `� EOL Mo.
5iLe Plan ;Name: Block Mo.
ProjeCL Name: A U7
Setbacks Front Back: Right Side: Left Side:
)El-?".ILED DESCRiPTION OF WORK:
L° 0jAA&A!2_ 01w -r
`8 �,� 1 U - Vn �� � to PIC_i5 i z>(,A o3 j
:U►J
11100-10 IN FOKIVIA I ION:
vkZui0an;-.—..vrk to rtorrmud an crT -ped. —cheek,l[ a 4pp,:
In
RV.'t 11.3 I.RR 1111Ps Piping _aPlaite..-s �winiav�s7Doar,
I❑ electric ❑ Plumaing ❑ --,prinRlers ❑ Generator Root Root P icll
r mai sq. Fr or ron-rrucuon: z�,Ft. of First Floor:
Cost of Construction: Utilities: Sewer Septic Building Height:
._,VVIq,_M/LES5EE ' LL)M I TKA II OR:
Name Name: iS
F��7[Eress: Company:
City: �— _ICJ stat.: AddressQ 'i
Zip Code: Fax: City: State:_E:_C
I-hone No. 1 —� D��b+ D Zip Code:,zQ %�, D Fax:
-mail: n Coti _ Phone Na, -2 721 C/---7 f
ill ;t. r4e .Imple i id- Rnieer an next page I G tIlrrerent E -Mail: — �� C,\,!n 4t,_nY Curs - CC3�-
irorn the Owner listed above] State or County License: (AQ—LALf CP I S 3%.
i�
I I vaEae of c4nstraction 6 $2500 .,r more, a RECORDED Notice or Corn enee...ent I. reyairea.
Nom co, 11 � lk)zJ
UPI 1tR1.MIA[LUNSTKuL1.lUR'[]tN L w IWOMA:I lull:
DESIGNER/ENGINEER: _ Not Applicable
MOR I GAGE COMPANY: IQot A,.Flicable
Namu:
N a r -ii z:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Jp: PRone:
FEE SIMPLE TITLE HOLDER: = Nut Applicable
BONDING COMPANY: Not Applicable
lvame:
IQame:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phol ie:
I certify Mat no v;orR or instollut'lar, R.3 comn'!C,—,cea prior tv tRu b3uanCc of a pCI'Mit.
3r. Cucie Count]( makes_no representation that is granting a permit will authorize rhe -permit holder to build the subjecr srru«ure
which Is in conflictitfl inn. appEc.51C Flame 0—.sera AS..Clation rale„ 6y10-3 or -rld �avcnant, t5 -t may reAriET or proRiSit ,a.R
structure. Please consuls witn your Home Owners Assoclation anE review your aeea ror any restrictions wRicR may apply.
in consiDeration of the granting of this requested permit, do hereby agree that I will, in all respects, perform rhe work
i..-. eeeri3_mvv : itR tRC appro:eR plans, tRe FloriRa SuilRing Cotles ant! x. [ucie County Amensments.
TRe following baildhir, permit applicarion3 ore �, erupt morn ana.re.in6 . tell eanearrerle, F'Tie .: raorn Azlitian;,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
vvARlvIR1G 113 ijvvR l!R: Your rahure to Recortl a Notice or Commencement may result In your paying twice for
impravemcntz, tu your property. A NOticE of CummEncEment must be recorded and posted on the aob5ite
before the first inspection. IT you intenta to outain financing, consuk with lender or an aitorney before
commencifik work or recordinK your Notice of Com, ilencemcnt.
_ signature or u er/ lessee/Agent SignatarC ar Co.-.tre r/[i[�.,C Rold�r
STATE OF FLORIDA
COUNTY OF �:e—
The forgoing instrument was cknowledred before me
tRi., t<,., at A0/ 2DY
Ev..nt7 wcaR
(Namg'o�f person acknowledgin
(3ig azure of Motary Pubic- state of Florida J
Personally Known ;� OR FroMuce[I Isendrlcadon
Type of Identification Produced
lime ti
FC.vAj Fi. yr s� .. U
Commission 110.FF220930 o. �_.,,vZ:r'`
yt''SJAI cvi-rLsJiut�
STATE OF FLORIDA
COOR! i r OF Sit=�
The forgoing lnstrument was acknowledged before me
tnis oay or cu d_�L my
Dennie Zeeek
(N.m or peF�an a[Rna,.le86ins j
{5ignata, [ of IVota� rr Pa61i�- 5tat� o o� iaa
Personally Known X OR Produced Identification
I y"e of Identifieotian PFvMaecll
Commission No. FF220930 (Sea�j
rHf VA :_,. i-ZEr.Ku
v'T. = ., 'r J Er!l,u SB , 4p 's}AI E vF! iOq,DA
Revised 07/15/2014
REvIEwS
FROM i
cOMIMIS
bOPERvIOK
P1709S
vEG TAI I0111
bEA I UK ICE
RIARlGROVE
COUNTER
RI'_v,t'.vv
REVIEvv
REVIEW
REVIEW
REVIEW
REVIEW
DATE
C0FnPLC I E
INITIALS
ptprebin
H=■ting '
�+' - •(~ NV +,---7,,N b>Esl. 51ort Dote i. j
�X`-mmoranar;on work Order Eal. Co pl.tlen Data v
{772) 567-3100 Corporate Custo.... r
2800 05 Plighway 1, Vero Beach, FL 32960 Ralati.n.,
aaigrvey�oa,:scv;s-®tFkalncLcclUe+CMC2w9753CaC0r5_',,:;' (866)803.0879
enertpRleR
EMA:_
CALL51I1"
HOMEPHONE
cR'¢ ores-ORRPReR11
YOUR DESIGN
OPTION 1
OPTION 2
OPTION
r TYP n4P
SIZE TYPE
SIZE TYp
SIZE
EFFIIENCY
ErFICIENCY
EFFICIENCY
r7= $
�;?y `7 $_
a?oi7 $
SUB16fAL�
SUBTOTAL $_�'�, `/CP
SUBTOTAL S
MUIaTHLY E $
MONTHL 5T • $
MONTHLY EST' �
CUSTOME NITIALS _
.. _ ._ CUS ER INITIALS
CUSTOMER INITIALS
W manly' �_ Parte _
T_. Labw■
Wa anty: K1__ Parts Labor
..f m�a]nly' _ Partes Labor
! Q erlr; resso�eal Exchanger
1% Comprtissor ,- --:Hoa aEx.hangcr
�l on+preccer r scot Exwh..11g�1
;ngeanl ravavcrtiaa and diapeza8 of w . e aird by 1..-. l.omp,etc c can up includ'ng use
of floor savers t., protcul yea. ho„re and
removal oT uxi36,,g cqo pm.n;. All :a; k completed in dwno in a--awdanwu -ith existing coBes
and permits, as required.
■M
SELECTED OPTION M1 02 Er3
❑ Weatflorproof
Connect to Eil=tlrrg El-tre�iw Air Cleans
SUBTOTAL
Disconnect
Eleotncal ❑ Medi.. Filter
+ �/�, E12
�Lifetim-a EgciprneRl Slab
New Plywocd Drr.k. [3 PCO
' e�--4--$ "1
Vsound Isol.,non Pads
gRaconnact Droiri In€r gfU Ligh; 5}4�
O Liquid Tit■ Conduit
o Coiling Saver Ki G Humidifier -
Man & Float!
TOTAL
❑ 51art Ki;
D Dehumidifier.
--r-^
Refrigerant LL Dry+ /�M`in D pin Safaiy 5 -itch 0 veld -r Unit Pad
�Q�geranl Pip.
Xseal New Connections ❑ Fla. Voarng
N.- ❑ Rec.nneet
u Seppert Attie Equipmw�t ❑ DuGl�rk ConnccG.na
❑ CASR ❑ CHECK#
jilfRefrigerant Pipe Cover
idSepply Plc m ❑ Fuel Esping
,
Jpr k�po-�i�R Vat -e
❑ New RuconneG; G E-eclncal Wiring
0 CREDIT CARD ZLAST 4#st
fif-stat - Ty.. S t
yp
I3 R■lum Pl=num �1�Iome Service Pian -
❑ Ne- 0 R.runnect �' 1 Term 1364 iia st
Y
EXP APPROVAL.
OUR GUARANTEES
1 111/1
.ETComfort Guarantee
,21Home Prole.lton Goar.nl.o
FINANCING'
��P.Ylntupimnauvaim;iumtmappmv
4 -Hoo. Semite GearoRlew
100r4b Unr„onditrona, Money Back Guarantee
cradd
A. Je'�^,,0 L',? e- 52- kw -!5 Vic C]Oaa.
Gr z _•;su
t7!�}'n
At;a/—
O
• Written cealanrer satha. lie : -ill oe ebtainnla Be'o-e Beg nn:ng any unforeseen auu lional or extended -R
• „NY CLAIMS FOR CONSTRUCTION DEFECTS ARE SUBJECT TO THE NOTICE AND %URE PROVISIvNS OF CHAPTER 555;,
FLORIDA STATUTLS,
• BUYER19 RIGHT TO CANCEL- Thio I-- home =ell■ilati_n =ale, and If you do not want the goods or services, you may cancel
this agreement By providf.-.g .rittwn notice to the =alter in pe -=n, b; t_legram, or by mail. This notice must Indicate that you
Do not want 111119 goods or serei. and -eat be d.li:ered ar peotrnarked before midnight of the third business day after you
sign this agreement. If you cancel this agreement, the sellar may not keep ail ar p -rt of omy cash down payment. See the
rwl_i res _fdo nereof for an explanation of this right.
• I ackna,.ledge that R,y right to w-ricul has been explained to me ara ly and in writing, .,no ,hidroa,-..l.tng my ngh; ;o conal, I aatharico th.
per6rmar-a of Ih. work aebjaat to all leRlr=and cwnditions set forth on the reverso side hereof, plus any Wes upon uu mplu;ion.
Nwtiw To Owner -Do not sign this home improvemcr t cuntm. in blank. Y o aro aninlad :v ...,My I the eontioal M the Erne you Zion,
Keep it to prat =1,cn. legal rights. This home improvement conaract m..y wnlwn a mo�ago or e; rwiav pre—tea lien en you. property
th-t avoid be fo;-.JCoed an if ;ou d�t,not pay. Be sure youu(/understand all provisiuns.oi Iha cun;ra bef_m yoe srgn.
ee .lee . rr. rvRE if��MJ
CUM A7k:R s1.alWrnL'
0-.17A—.nn Rm ienlinl S.,m O LLG nn n -Res ros■r
e..:e
nn3l o:c v�tr..�:
za
6256
Certificate of Product Ratinas
AHRI Cbrtifled RefelCnce Number: 10359716 Dale: 10/ 1 r/c011
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
OULdoor Unit Model Number: czFAC3fa6A'u3l
Indoor Unit Model number: Pvz-,NF9UAC
Manufacturer: UmRRIEm AiR L�JiaDl 1 iriniNG
I raoelerane name: CARRIER KIR CONDI I 10AING
region: AEI jAK_ AC- AR. AL: C.A. Cis. C I . DC_ BE. PC. GA. 111, ID. 1C. IA, I. KS; KY; E.A, MA, MD, ME,
MI, MN, MO, MS, MT, NC, ND, NE, NH, Ni, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX,
0 1. VA. v i. vvA_ YYv. YYI. YY ir u.a. 1 errizories)
Region Note: Central air conaldoners manuracmreia prior to Janua,—y 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 region(sj for wRIcR tRey meet the regional efficiency re4airement.
Series name: Pr_RrVRIi mwCE .I r AC c-3 I AGE
Marmfacturer responsible for the, atir rg of this system combination is CARRIER AIR CONDITIONING
Rated so farii%ws in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning ane Alr-�bource
neat ramp cgaipment ane subject to veRfication of rating accuracy by AHRI-sponsored, hrdependent, third
party testi,,—ug:
Cooling Capacity Il6iurly '15'u00
EBR Rating (caaling): 12.50
;zsEErc Rating kCooling ): 15.00
IeErc mating (Cooling):
' Ratings followed by an asterisk (') indicate a volenlary nsa_ of Feb'r_hed dale, zrleaa-wvvmF_ ,ivd with w WAS, .h,e.H indk:alea a....—one;ry rem�-
DISCLAIMER
AHRI does not endorse the product(m) listed a.. this Certificate -Rd M-hou na ., present -tion„ w-rr-Rllva -r ga-1'anivva as b, no assumes no responsibility for,
the produclis� listed on this Certificate. AHRI expressly disclaims all IiabIIlt fe. d-Rragee of any kind rising vat of the age e, perfo
.... arce of .flu proaoaas), or the
onucnnuruua alteration of data listed on this Certificate. Certified ratings are valid only for models and configemilona 11 --ted In the
direorory wt =.w -hridlrvo:ery,org.
TERMS AND CONDITIONS
This Cunramate and Its contents are proprietary products of AHRI, This Certificate shall only be used fur indi.1daaE, per -R -I ..nd
confidvrtl-I refer -rico porposex ...a,..,nronw vi tn.s Certificate may not, In whole or In part, be reproduced; copied; disseminated;
entered Into - eermpater d..taba—; or othcrwtav uAl"d, L. -r y form -r m-nncr or wy -ny mo -ns, ox. apt for the user's Individual,
personal and confidential referent.
.IR•ue.,el :en;Mo. new. Imo.
CERTIFICATE VERIFICATION
& REFRIaERATIaN INSTITUTE
Th- Infumutlon for the yodel died an this conlfl—to can be sarlffoa ui www...Ildeirec:ury.org, click on -Verify Certificate' link
and enter the AHRI Certified Ref.ren.v Number - .d the d-tv v.. :high the cerrlflc :e w. � Issued.
_! r.: rs i; i i , r,
which Is listed above, and the Certificate No., whl■h Is Ikt■d ..t llotteRr rignl.
�c'vi>� mif-Conahfoning, Pleating, ani] Refrigeration institute CERTIFICATE NO.: IJ Iaz13 r05o''Zo3o'