HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit MumBer:
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•
Building Permit Application
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PRo .e://L] SEL-i�53 Fon: i//L) �6L t5/S Commercial Residential
PERMIT APPLIC.A I lulu FUR: Mechank;al
PROP05ED IIVIPK_UvEMEMI [UCAIIUlq:
/1O�ress: '3 i az - 2� orf tst
Legal Description:
Property i a;z 113;;: Ll 7 Y S Lot No.--
5;te Plan Mum"C: Block No.
Protect ivame:
�etGacRs Front 6acR: RigRt oiae: left nice:
DEIAIIED DESLRIPIIUIIq 0FFww0RK:
J
i'
R GC.- z, l - L.al u7-r
IL:U-M51 KUL.I lUld IIQFUKRIAI IUIQ:
Addhio-n-al work to be a rtormedunder this permit-check a app y:
HVAC _Gas Tank ❑Gas Piping rs vvindows/Doors
]%huup
Ele-ric Plumbing ❑Sprinklers Generator Roof Roo. pikcn
Total Sq. FL of Cons►ruCdon: S F�. of First Floor:
Cost of Construction: $ 3-5 dlides:113ewer ELeptic Suilaing ReigRt:
OWNERAESSEE:
" CONTRACTOR:
Name
Name:
Address: - vltcal
Company: S _
mddress:
City: ` J!& Mate: �,'
Jp CoOe: 3LtqFT9 Fax:
City: ____ _1CA Mate 1__(1
PRone No. r n _5--
Zip Code: b Fax:
E-Mail: rC. ';,.
Phone No. ' - `7
Fill in fee simple Title Molder on neA, page (if different
P-Mlail:..
from tRe owner IlsteB abovel
Mate or Coanty Ciccm3c: Ji iY ;
IT value or construction Is or more, a RECORDED notice or COR fflcHzeffl=nt 1. PeYQiraH.
sUNPCtIVIER IAL LuNS I RUCTION LIEN QCW INFURIDIAI IUN:
DESIGNER/ENGINEER:
WE rtpplicable MORTGAGE COMPARY; � MOE mpplicable
Namz:
Name:
Address:
AddrEss:
City:
State' City:Ztate:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ MOI Hppiicable
BONDING COMPANY: Not ApplicaQle
Dame:
ivame:
mddresb:
Haaress:
City:
City:
tip: Phone'
_
JP: Phone'
OWNER/ CONTRACTOR AFFIDW i: A,.plicotian is neresy maEe to outain a permit to do the work and in.tallatiern i.3 ;naicztca_
I certify tRat na :orR or installation Ras commenced prior to the issuance or a perrmit.
at. Cucie Countymakes no r.Frejent-ties LRot is granting a permit will authorize the ermit holder to build tRe aaF3;ect �tre-terc
wR;cn i. in eonTliet ,itM any applica0le home Owners Ftssociation rule, 6yla.., err anTea:ernants Mat may restrict or prollibit such
structure. Please consult with your Home OYYncr. A.9aeiatiaR _M review your Deeo for any restrictions which may apply.
In consideration of the granting of tni, rcyaa.,Lea permit, i so nere5y agree that I will, in all respects, perTorm tR. -orrc
in oecortlance witR tRe approved plans, the Florida 8eileins Call -3 was 5t. [ucie County Nmenaments.
Inc taller: ins Be -riding permit applications are exempt from und.rgoing a tell eanee:rcncy review: room atlaitions,
accessory structures, swimming ,avb, tcnee;, --II., signs, screen rooms and accessory uses to another non-re.iacntial aac
vvmRMING TO OWNER: Your failure to Recartla IVacice or CommencemenE may result in your paying: twice for
improvemcrits to your property. H Notice of Commencement must be recorder ant] posteC on the jobsite
Berate the first in-speCdon. If you intend to obtain financing, consult with lender or an atturney before
commencing work or rl—ucording your wotice of Commencement.
t AA -
Signature of Owner essee/Contractor as Agent for Owner
STATE OF FLOR
t�;
COUNTY OF
The fo PPi�ing instrum cknowledged before me
this -LNay of 2017by
Name of person making statement
Personally Knov OR Produced identification
Tyfe,ef ldentif t r1 n A
L
( isnatarc at {Gala. ; ru -Mate or Florida J _I . _. �,� �,
Can7n71'31vn IGa. io-
REVIEWS IFRONT ZONING
COUNTER REVIEW
FC
HiE
E.7-EIVED
ATE
OMPLETED
Rev. 8/2/17
Signature of Contr.&Wr/Ciecrnae Fleiler
STATE OF FLOR '
COOM i y OF
The forgoing iretran+ env -leo rare me
tni.. day or z'u�by
Iia..c at peran rn,.R;Fig statement
Pyr. -anally Rn vR rroduced Identification
i ype of ide ificadon
Proaaccr
a
kV natu or Iaotary Pu4liC-- jMate of Florida
QTn11��larl IGO f 1 (Seal!
SUPERVISOR IPLANS I VEGETATION I SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW I REVIEvv
li0.ling • r.rwbin
Eal burr D.;u1.7
Wo 4e�T Installation Work Order Est. Cumplution Date 711
(I !;d) DB /-3 1 UO CDrpo"v,tu C-wtemep
W aJ , dAs 2800 US High .ay 1, Vera Beach, FL �Zaao R.lal ons
Amen= Ro,—:® v.,ntics or P1Elicq Inc mom a cimi7.9PmC ti•.5= CRC.+taro= (066) 003.0879
CUSTOMER / CR1rv[ c7<:'..:..S_P
/
ADDRES
"OMC Rrvr
";LC rR0re or
YOUR DESIGN
WORK PHONE
OPTION 1
SIZE 57 TYPE
OPTI■
51ZE TYPE rye.
514E_/_,�TYPE
EFFIZAENCY
EFFICIENCY
EFFIL.iEN�))� 1
ZZ7,
41.1
r AlnY
may$
$
p�
$
$
SUBTOTAL 3 S,��oo
SUBTGT t_ 5 (AOS
5UB/jujTAL$___4'zk O
MONTHLY T.' $
MvNTHLY Eoi ` $
MONCUSIU
ER INITIALS
CUSTOMER tNITiAL5
CUS;71!,LS
vvr nty. Parte Labor
W rprnty: P..rtg Labe.
W runty 10 P„ng =Labor
0 Compressor _Heal Exchanger
f O C -.F _poor _ He..1 Ezehengep
Cen+pp-_ccer Meat Exch WRger
Refngerepit reee:e.ad a..d dicpo..ed of ..e required by I.:. Complelo Jour up rn.lodi .g Csu
of floor o.vera to p.ol.c; your hums .rid
re.o-.I of w iating egaipmant. All irk completed 'ia do..e in .ocard.nee with cria;ing cod.g
and permits, as required,
UXIJ ■
SELECTEDuPTIZ-,N: 01 M2 03
SUBTOTAL a»
❑ Wa.lh.rproof 'gConneet 1., Exisi ng ❑ Electronic.,ir Cleaner
Dlsconna..t Electrical u Media F her
'
E7 Lif-l;me Equ p.-.e.,I SI..b ,) Ne- Plyweed Deck u PCO
Saeed Isodioa Pads Drum Lira L UV Light
1,4Reconnec;
EJ Liquid Tito Con3uit Lr Coil'ng Saver Kit LJ Hamid:fier
$
❑ Stunt Kit W.n & Fl. -I) p Dahom'd'ficr
TOTAL i
fd Refngerant GL Dry Mai.. Drain S.ta;y 5wr r 0 Oot..00r Unit Pad
Refrigerant Pipw , Sea' New Connections 15 Flue Venting
'
❑ Ne.. 01919vat E3 Support Att;. Ega;pm.nt p Ductwork Connections
O CASH ❑ CHECK#
R.fr goiant Pipe CoverSupply Ple m p F-cl PiFi-v
I�Ex'a-eiepi Le CJ New oconnect ❑ Ele�_Iria�l Wirin
/ g
Twat - Iyp.�,� �Re1em Pl.-em Home Sarvica PI'n -
❑ CREDIT MRD 4LAST 4#sr
�5 fix.' ❑ Ne O`R., vn,.g _i Tem, ('oo, days)
EXP APPROVAL
OUR GUARANTEES
iffComfort Guarantee JiffHome Prolechon Guarantee
U FINANCING"
)a 2a -Hear So..iao Go-rento. jt10m Un.ondilian.l Moray -Beek Ga..rantee
•rlyrnud upzions availalffle with approved credit
• Written eoutc,"o. autRign...tior -ill be oblai.-icd 6ofarc b:g'nning any anf.,rour.ri additional or c:;ended Wurk.
• ANY CLAIMS FOR CONSTRUCTION DEFECTS ARE SUBJECT TO THE NOTICE r,111119 CERT! FROwISIONS OF CHARER 558,
FLORIDA STATUTES.
• BUYER'S RIGHT TO CANCEL: Thi. I... hum. zoll,11.1d..n sale, and If you do not want the goods or services, you may cancel
;hi..greamun. By p, aviding written notice to the seller in person, by telegram, or by mail. This notice must indicate that you
oo lot w.ni the goods or services and must be delivered or postmarked before midnight of the third business day after you
sign this agreement. If you cancel this agreement, the seller may not keep all or part of any cash down p-ym..-.L See th--
reverse side hereof for an explanation of this right
• 1 acknowledge that my right to cancel has been o-pIRirrwd to me ■■411, .rd in -riling, and-:Iheet a.::.rg my .right tw aamvr4,1 aethoriec the
performance of the :ark, =alijeot to all tern= .nd audition-_ =1 forth en the rar e...o aid. h.reef, plug -my I-%. apo., completion.
Notice To Owner - Do not sign this home improvement contract in blank. You are entitled to a c■p; of the euritmet .t the time ywe =ig-.
Keep it to protect your legal rights. This home ,mprovement contract may contain _ m. eRwias spe-to o lien an your paeperty
that c f on if you do not pay. Be su_ , on underst_rd .Il ppe-iaie of the aunt"¢ =fen: yea c;gr.
r., lemur•= e. .. ri•rc nn,,.a v ccnneeeuranvr
u
M;7 Am ice Rnr, I nii. Se vi— LLC. All r.61e re■ervou. .1, r0'; 4 050817
11256
AHRI Curtifiad R.-faranuu Narnbar: 9156904 Data: 11/5/2017
Produel: *plli *ysWm: Real frump wER Rernme Out000r unk-mmource
Outdoor Unit Model Number: 25HCC51 BA7030'
Indoor Unit Widal Number: FB4CNP025L
Manafacturar: CARRIER AIR CONDITIONING
Trade/Brand name: CARRIER AIR CONDITIONING
Series name: PERFORMANCE 15 HP
Manuramurer responsillle for ille razing or z111s system cvmilinazlon Is CNRRIER NIR COiv'uIT1OAlAz'a
Razes as follows in accordance w,9R KRRI Standard z-1 W e>ra ,e'v0a far UnRaryNlr-Conaaloning anti mr;5ource
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent, third
parry zeszing:
Cooling Capacity (Btuh):
18000
EER Rating (Cooling):
12.00
SEER Rating (Cooling):
14.50
Heating Capacity(Btuh) @ 47 F:
17300
Region IV HSPF Rating (Heating):
8.20
Heating Capacity(Btuh) @ 17 F:
10500
ita fts fdiowed by .. ao eriislc (');ndkm1a a volen=ry role of p.m. --'—sly published daz, unless accompanied WAS, which indkra-ma an inmvnmry reraM.
DISCLAIMER
AHRI doa* rmt endv,av the product(*) listed uw this mrunuar v, -.d mekes..o represen.atla.,s, trarranua or guarana— as to, and assumes no respensibillly for,
The product(r) listed an this Certificate. AHRI e„pressly dlscl..l a ..II liability for darrrglow of any kind ..rWns vat of the use or performance of .hu product(s), or .ho
saauthorized _lteratt_e of data listed on this Cartifl.ete. Certified rail :gs ora -lid only f.r models and ounflguratiee, listed In the
direaM at www.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its vu-ete..ts are preprietarr pp --ducts of AHRI. This l.ertlfi.ete shall only 4e used i r Indhddaal, personal and
con identiat reference purposes. The contents of this Certificate may noG In whole or in part; be reproduced; coplEM dissentin.td;
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 wnf1d.ntI.I m.mnrtc ROME,
CERTIFICATE VERIFICATION e, REFRIGERATION INSTITUTE
The information for the model cited on this certificate can be verified at www.shridirectory.org, click on'Vedry Certificate' link _ ldF bert_r"
ono v„ tar the AHRI cartifled Refereme Numeer anu the date on wn.ch the certificate was issued,
whish Is IL --d ..bu o. -,d the Co. t►flCeto No., which Is Hsi— — bo—m rlan-c___
42014 Air-Conditlonine, Heatine, and Refrigeration Institute CERTIFIM E N—U.: r�rD uw��►ar�uia