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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: l��Jl L Permit Number: ij CIVED Building Permit Application OCT 3 12017 Planning and Development Services PEMAI1TINGSt. Lucie County,Building and Code Regulation Division FL 2300 Virginia Avenue, Fort Pierce Ft 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line J� PROPOSED IMPROVEMENT LOCATION: Address: SL ' Legal Description: Property Tax ID# � ` -�� a� �'�- Lot No. Site Plan Name: r r Block No. Project Name: T-In-w � Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: A work to a er orme under this permit-c ec a app y: b=HVAC 11 Gas Tank []Gas Piping Shutters ❑Windows/Doors 11 Electric 1:1 _Plumbing OSprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: Ft.of First Floor: Cost of Construction: $3°180— Utilities: _Sewer Septic Building Height: OWNERAESSEE: CONTRACTOR: Name 4%,. Name: Address. Company:P Y= S City: t lam' .+ State:R Addr s: S.v'/ Zip CodeL&qlT Fax: N City: State:f(" Phone NG!$\ Zip Code:'N)53 Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page( if different E-Mail: from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 1 30 3W5 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures,swimming pools,fences, walls,signs, screen rooms and accessory uses to another non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording our Notice of Commencement. i Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA COUNTY OF COUNTY OF LAI 0, The f going instru nt acknowledged before me The f oing inst t was acknowledged pefore me this day of_ 20n by this Yi1day of 20 by NarAe of person making statement / Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced l (Signat re f Notary Public-State of Florida) (Si nature of Notary Public-State of Florida ) Self REN S. NIELSE KAREN S. NIE� Commission No ( o mission o;`'F R, Commission FF 1156 1' _ ion N FF 7 - �•` My Commission ExPir s '� My Commission Expires June 12, 2018 ;'u,°, June 12, 2018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17 This combination qualifies for a Federal Energy anal CERTIFIED` Efficiency Tax Credit when placed in service www.ahridirectory.org between Feb 17, 2009 and Dec 31, 2016. Certificate of Product Ratings AHRI Certified Reference Number: 7942207 Date: 10/31/2017 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1636AJ1 Indoor Unit Model Number: RH1T3617STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT,VA, 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 region(s)for which they meet the regional efficiency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (Btuh): 35400 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating (Cooling): `Ratings followed by an asterisk(`)indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not 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:+ww.ahridirectnry.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; AML entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verity Certificate"link „e make life better— and etterand enter the AHRI 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. ©2014 Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131539333143923605 I�Isr, nows