HomeMy WebLinkAboutGARY CAMPBELLALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential 1,�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: V
Property Tax ID #: — Lot No.
Site Plan Name:
Block. No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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l, ermi —check aappy: �n�
VAC
Gas Tank Gas Piping Shutters Q Windows/Doors
Electric ® Plumbing Sprinklers 12Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $
Utilities: DSeptic Building height:
OWNER/LESSEE: TONTRACTOR:
NameQ - \-
Address:
City: State:
Zip Coder L�Ck Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
1
CC)U
F
1-00
N T Y—
Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential 1,�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: V
Property Tax ID #: — Lot No.
Site Plan Name:
Block. No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
rt�ona wor to be e97OrmeI
l, ermi —check aappy: �n�
VAC
Gas Tank Gas Piping Shutters Q Windows/Doors
Electric ® Plumbing Sprinklers 12Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $
Utilities: DSeptic Building height:
OWNER/LESSEE: TONTRACTOR:
NameQ - \-
Address:
City: State:
Zip Coder L�Ck Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: `�
z
city: �`
1 Stater
Zip Cod
Fax:
Phone No�
E -Mail: L
c
State or County License:
(�(�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEIIR: Not Applicable
Name:_
Address:
City:
Zip:
Pho
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City.
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
iNot Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I 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.
- r
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �`�I, \ ~.r. COUNTY OF
The for oing instrument was acknowledged before me
t is day of \ :��':� Xi) r 201�— by
T" i
-' (k\ r
Name of person making statement --
Personally Knownr� OR Produced Identification
Type of Identification
Produced
otic State of Faida
E Merr�dp
Y CMMn&ubn GG 138118
(Signature of NotarR&L5ffl"Mal8=1JN
teo on a
Commission No.L " \� (Seal)
REVIEWS FRONTZONING SUPERVISOR
COUNTER REVIEW REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
th` day of, - 20 -by
Name of persen mal�ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
Notary PutNic $tate of Florida
. Wanda E Mercado
(Signature of Notary b e 21
Commission No. (Seal)
PLANS VEGETATION SEA TURTLEI MANGROVE
REVIEW REVIEW REVIEW REVIEW
•+•iCERTIFIEDU
www.ahridirectory.orgCertificate of Product Rati
AHRI Certified Reference Number: 9117236 Date: 12/13/2017
Product: Split System: Air -Cooled Condensing Unit, Coil Alone
Outdoor Unit Model Number: GSX140301L*
Indoor Unit Model Number: CSCF3642N6D-+EEP
Manufacturer: GOODMAN MANUFACTURING CO., LP.
S
Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR
CONDITIONING AND HEATING; ENERGI AIR; FRANKLIN
Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA
AK, CO, CT, ID, IL, 1A, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ,
NY, OH, OR, PA, RI, SD, UT, 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: GSX14
Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP,
Rated as follows in accordance with AHRI Standard 2101240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing:
Coofirg Capacity (Btuh): 28600
EER Rating (Cooling): 11.50
SEER Rating (Cooling): 14.00
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 www.ahridlrectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This not.
in who! shall only be used for individual. personal and
confidential reference purposes, The contents of this Certificate rmay nvt. in whole or in pari. be reproduced: copied; disseminated:
aim
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.
CERTIFICATE VERIFICATION AIR-CONDMONING.HEATING,
The information for the model cited on this certificate can be verified at www.ahrid lrectory,org, click on 'verify Certificate' link & REFRIGERATION INSTITUTE
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, we make fife better -
which is fisted above, and the Certificate N0., which is listed at bottom right.
@2014 Air -Conditioning, Heating, and Refrigeration Institute ' CERTIFICATE NO.: 131576498134040652