HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPEETED FOR APPEICA 11019 10 BE ACCtr i ED
Daze: Permit Number:
11OWL01210dam
Building Permit Application
ri....... u .,A7 w.r i pmenr services
vo7d: ,s —V C tre Reguiarion uivision
4100 Avenue, Forr Pierce FL _i4vuz
PRone: v f/_) u6z-i»3 Fax: (r 1z) 4iiz-i3ra LUMmercial ReAemtial
PERMIT APPLICATION FOR: Mechanical
PRurOSED IMPROVEMENT LOCATION:
m0gress: '� G b 7 e_ Z i ea -;v
Legal Description:.'O Zi �b 0 5S OA S G
Prop�P[r I z;- ID IT: C U --L1dU ' ` i� U EOLNo.
Sit= Plan Mame: Block No.
Project Mame:
ziettlacks From. Back: Right Side: Left Side:
DETAIEED 13E5C,RIP I lulu OF wuRR:
CA,zR� '5_L�L 4- vL.� 4G 1711 E-�-
315m�Col1 -s
u KI C u t Z) _3 LS 5� �
F -05I RUC ION W—URMATION:
Aildhional worR ro rtormed under Lhis permit- checR a apply:
❑HVAC 7_ Gas Tank ❑Gas Piping tiShutters ❑ vvi�.aoY.swoor�
�ectric ❑ Plumbing ❑Sprinklers 11 Generator U Root u Raor pitch
Total Sq. Ft of Constructs n: S Ft. at Fist Floor:
to 0Septic
Cost of Consi,rucuon: $ Udlides:llSewer Building Height:
OWNER71E55EE:
CUIV I RALI UR:
Name
Rame: ES -
Address: ib�'.CJ� i–Nvi
Cornton": VA
City:rlr�ar�, I�C-I� State:
_
Address;
�
Zip Code:3((� 5`7 Fax:
City: State:_
Phone No. b)G ;k 36
zip Cone: ` c Pax:
E -Mail: C::�j /`5 j (` Cft,+l
PRone MCI. 7L --
Fill in fee simple Title Holder on next page ( If different
_
E -Mail: C -
from the Owner listed above)
Stare or County Licensed
Ir value or constructlon is $z300 or more, a RECURDeD NOLIce of Commencement is required.
5uPPLEMEN 1AC f;VIa51 RULI IUI9 EIEM EAw I19FUKMAI11CM
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: Rpplication is hereby made to obtain a permit to do the work and installation a. inatcatea.
I certify tRut no �..v.-RC or ir13tallati0n no- COMMIcncea P76F LO Lie l3,eoFlEe yr .. permit.
at. Eucie County makes no representation that is srantins a permit will authorize the4ermit hoiden to build the 30b;cct �traCtarc
�,fiicR i; in contiirt.itm �nx pli.aSic Flom. O.�cP. A7.0alatiaR geld, d,laws or and covenants that may restrict or proMisit sucR
structure. Please consult Ory'our Home owners Rssociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, PeFfor,�.. tfic work
in accordance witll tfle approves plans, tMe rlorida Building C.00es ant! at. Cucie County mmendments.
liic following natidiRg permit applications are exempt from undergoing a rull concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residential use
WmRNING TO OWNER: Tour failure to Record a Ifiotice of Commencement may result in your payine twice for
improvements to your prupurty. A Notice of Commencement must Be recortieti anti posted an the jobsite
Before the first inspetTion. If you intend to obtain financing_ consult with lender or an attorney before
commencing work or recordin. ,your Notice of Commiincement.
Rev. is/z/1/
5ignatarc of Own kY[=cc/CvF'.tr.cTor a3 Agent Tor ❑.Rc,
STATE OF FLORID!,:, � _ �4 r
COON IT OF !rV tr��
aigmzierc of Cantrz r/EieeRsc Holder
STAT E OF FEUKID I �` �_t e—
COUNTY OF
i fie forgoing instrument was acknowledged before me
this day of_.. Zi3j by
i nc Tars.iRg iR3trerneRl-,.. oelf.-..e.:lcasea perore me
tRls may oft , zs_D by
19.Mc oT pcP.eR malting statement
Personally Known OR Produced Identification
laame of Rrson making statement
Pero. -tall, RRo .ROR PrQ%..d 1M.PidFic, dw,
type entificauon
Pr c
Type of Identiticatio„
Produces
(sisneterc at nota.—, Pv5lic- st.tc of Florid.. ]
(Sign ure o otary Public- State of Florida )
COR1R11.,3:an ��1 (3eal)
Commission IdoN 4 c'1 [ (Seal)
R!lvlrvva
rRrjm i
I-0MIMG
SUPERviSOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REvIEw
REv1Ew
REvIEvv
REvIEvv
DAZE
RECEIVED
DATE
COIQIPCETED
Rev. is/z/1/
PERMIT# ISSUE DATE
mA14mmy X LLvLLLPriv N 1 SL+ Kvi%_v,5
liuildiug & C vaC c:Dn,�lia>t><%c llivisi�u
BUILVINKi I'LKMI I
sUts-Cun I KAU 113K ACRELIVILI-4 t
-It°G�li d!�u f �� have agreed to be
(NmipM, Na e) r -C_�
the _ c'_ Sub-contractur fur 7 9
(T,Nc of l.aac) (rfltll�, l vllL mate!)
ror the project located at
(r. g cat street AiIa ess or rroperty t ax iu #)
It is understood mat, ii mere is any change of status regarding our participatiun with the above mentioned
project, the tsuilding and Code Regulation Divisiun of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACTOR SI ATURE tQuallitert
PRINT NAME
LU•t,Q, ( a Iq- g?S___�
COUNTY CERTIFICATION NUMBER _ 7�
State.rFl.rida,CamAyof �fla��V1 �Gt,�x_
Th. reregei: g InAmment -gym ;lg • I bdn �_�mu this � � d..; or
20L7, b,- Y
who is ersonally know or It produc a
a id [location.
f� h
Signal" ..f NutVy N01c
g -
Print Namc of Newry Public
04
i
R.Jsed 11/16/2016�" Eli^rc3 63
�I
ZUIPCCTOR SIGNATURE (Qnalinrr)
KVf u itl�
PRINT NAME
COUNTY CERTIFICATION NUMBER (] n
stat. �r Fl -ride, Czent, .f �t1, ( i/(� P4 Via I—
The foregoing Instrument was sig [ fore me this 13- day or
,20rby IFy1
who is ersonally known _or has prod) a
as d t cation.
�1
STAMP
Sig re.f N.e..ry Pa lir
L4
Pri.m N -m. of N.t..ry Pablle
fir+. `—'TAT= Ci" rt vKi�A
i
Carmrr* ;7 i. -M24
=,veli -9 • f'1=mQ�ir
' "' Ice' : ���� Est. Start Date T
All.7�`dtti��liUll WD! IffeI Eat. Camplatio: Doiw /
(772) 567-3100 Corporate Customer
280D 05 Highway 1, Vara Beach, FL 32960 Rel-liam.
A■ri■. Rwidwt al Se --t FlwiU Inc Lice■■■ # CMCt249753, tAC045878, CFC1.28283 (866) 803.0879
CUSTO..R EMAIL
CISUTE
O
S/
HOME PHON
YOUR HVAC SYSTEM DESIGN
—RR R1onG
SIZE _TYPE Y.c.+-rte' r SIZE_TYPE
$I=E TYPE
EFFICIENCY /C-� X—i— EFFICIENCY
EFFICIENCY
17
Gv
�
LL
41 If
$
$� -
$
SUBIvTAL 4i$
SUBTOTAL $
MvNTHLY E5T.• $ �TL 5 S /�1�
MONTHLY EST • 4i
CUSTOMER INITIALS LS
/LY
CUzTv@IER INITIALS
W-rr-..ty: ,-� P-nz / �!� Labor
Pa�s Labor
Warranty: Parts Labor
-1—Compressor Heat Exch..ngor
Exch..ngar
—Ca ... prassa. _ _Haat Exchanger
Refegvmnt baa. red ..,,d disposed of .a . agei-d by lo-. Cv-picau clown op in.lud;ng use of floor savers to protect your home and
removal of o..;-ing ageipma❑t. All -ark complesad is dans in a..cordance with existing codes and permits, as required.
SPECIFICS OF ■ •
SELECTED OPTIONJGI ❑2 ❑3
Woaiharpm.f ❑ Connect to Existing C Electronic Air Cleaner
SUBTOTAL $
Cis..onnact Electrical In Media Fi ler
/dLifetime Equipment Slab 13 N=- Plywood Dawk 0 PCO
$
,offSaw-d Isalalia.. Pada U R.conri.c, Drain Li,.a 0 UV Light
$
iquid Tite von'uit o Ceiling Saver Kit ❑ Hermdifier
8 Float!
CI 51art Kit Wan
❑ Dohaadifiar
TOTAL ;
❑ Rafrigeran, L.L. Dryer_ ❑ Main D, -in Sufa.X S-kch ❑ Ovidao. Univ Pdd
J2' Refrigerant Rpm G zeal New Connections ❑ Flue Venting
- 0 Reeennent CI 5epport Attie Eqz;iprRa ,t % o Ductwork Connections ry
D CASH D c::HECK#
Refrign. ar.0 Papa Cover ❑ Supply Planum p Fuel Piping
G Expansion Valve ❑ New ❑ Reconnect Muntriva Wiling
❑ CREDIT CARD (LAST 4#si
T st .l -Typo ^Q ❑ Ratern Planewi ,t:TH.FmV S-iLv PI -n -
E3 Na.. ❑ Reeanncet 1 Tenn (364 dayo)
EXP APPROVAL
OUR .•.
C.,mfort Guarantee j2mome Protection Guarantee
❑ FINANvINu'
�24-Hour 5er•ice uc..ra-tee / 00% QRee�ditienal Money -Back Gem lea
'Payne,.- .p—.a •..;Ma wim pprovcu a ;t
• Wiitt■R syEfemer--the..lion -ill be ebt :mad before beim ng -my eritorecaa , -ddit o-1 ar ar..andnd vra&
• ANY CQ{IMs FOR CONSTRUCTION DEFEt.15 ARE SUBJECT IU THE NOTICE AND CURE PROVISIONS OF CHAPTER 558,
FLORIDA STATUTES.
• BUYER'S RIGHTTO CANCEL: Thio b a home mwilci.adon olala, a•.d if you do not want the goods or services, you may cancel
thi. agf.amara by prorading ryrivien notice zo the seller in person, by telegram, or by mall. This notice must Indicate that you
do not want the goods or services and must be delivered or postmarked before midnight of the third business day atte. .in
sign this agreement. If you cancel this agreemem, the seller may not keep all or part of any cash down pay. -m. -.L See thw
reverse side nereaf for an explanation of this right
• I acknowle that m; ,:ght to cancel has been ■-pl-imed to me orally -nd In -. icing, and-itheet--ming my right to eonael, I -atha. Ka the
perform- oaf a -ark, cabinet I� all lama oad eeriditians set forth writhe P.-,-wmv eider ha zaf, plus -.y to -a apart ea ... platian.
Notf o Ow er - Mo not sAl this home improvement contract in blank. You are entitled to a copy of the comlro--t at the time y■= ::Gm.
Keep to pro cl ur leg ts. This home improvement contract may contain a mortgao, er wri o °reale a lien ■� yea. property
that ould b f e ed n' yo o not pay. Be su.e you underst-nd all pa -;s ■Rs .t th- beet bef re yes s gr.
OU S1G ATU E DATE COMPANY REP A
ae,..,,inen,,.PMrrRe e., ti ,.7
0 2017 rvnem--^ —i enft 3ennce, =rn1 ngft mw.reo. ACTS1078 050817 a lr
CE RTIFIEW
Certificate of Product Ratings
AHRI Certified Reference Number: 7173463 bate: 11/20/2017
Product: var1a61e 5peetl ivilnl-op11t Hlr-Cone hloner, witR rtemote Outdoor Onlz pu�soara., Frte ljcli.a.,
Dattivar Unit Mosel IQI mBur: s3mFCUtiz—s
Inavar unit Model Num6ar: 4UI0IFCU-iz---s
Manuracturer: CARR1ER CORPORR11uA
I raDererantf name: Cj%RRIER
aeries name:
Region: sa,.tile..�t ant! l9wRIl (AE, AR, DC; DE; FE; t: A, RI, RT, EA, IRO, MS, NC, OK, SC, TN, TX, VA
AK, CO, CT, ID, IL, IA, 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.a. i erritories)
Region Note: Central air conditioners manufactured prior to January 1, 2015, are ellgl6le to Be
Instaileaa in all regions until rune 3'v_ zll-i6. .�
Beginning duly , z9-16, central air con0liloncra
a�.n amy 6a installed in ragionte) tar wfliah th.y meet the regional efficiency requirement.
Manufacturer responsible for the rating or this system comQlnadon Is CmRRiI!m CORPOrw 1 IOI4
Rotas as tollana in avcordance 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, intlepen'aent, tlllru'
paRy testing:
Cooling Capacity (Btuh): 12000
EER Rating tCooiing): a.00
SEER Rating (Cooling): 15.00
CER I IFIED RR I INGz FUR VARIABLE-SPEED, MINI- AND MOE i i-SPEI I SYS I EM5 ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS
(BASED ON COMBINATION TYPES) WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED
EQUIPMENT. VISIT WWW.AHRIDIRc;CTOR T ZRs r v VzRIFY THAT THIS COMBINATION IS AN AC i IVE E15 A INv AND THE DATA CIS I ED ON
TRIS CERTIFICATE IS ACCURATE. SERR4A OIQ I HE AHRI REFERENCE # TO QUICKLY LOCA I E I HI5 COMBINATION IN THE DIRECTORY.
' R.lings Tolluaw Uy .n .sleria r) inoi—ta a vulantdry rc' nta cr pruv, osly pu5115MO udM ontuas au rnpaniuu wiin a rrnS which indicates an involuntary rerale.
wI. CMIRIER
AHRI d___ not ...dome the prade.l(a) Ilat.d on thl; C.rtlfle.la -rid m.kea me reprasent-Jan„ :.r...ntiez or ge.r..e;ee: a7 ;v, apd .aswm_ na r—ponalbillty Tor,
the prouuctssr listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performan_- of the ppcd■■t(_), =r the
aFv�e:hori.od..ltcr,.tion -1 d..:.. 113-..d an ¢hid C.rdf ..to. Ceryl;,.. r..angs .ra vali.. only for moo.ls.no conagora:.oris llat.o in
directory at-ww.ahrldi;act■.--.=rg,
TERMS AND CONDITIONS
This Certificate and Its contents are proprietary products of AHRI This Certificate shall ont, be used for Indl-ld■.1, perp■Ir-1-Rd
_*
wnffocntlal r.;crtncu purposes. a conte.-,e ..r eels eartrrr,,oiv rnoy nut, in wflulu ur in pars, DE r.prouoc.u; cuplau; uisseminateo;��
-nl.red Irrl...empal_r d.t.b..=.; ., ether-leo stllLed in o ni fe�m er m-nnar.r b,-.n,- mane, e�eept f.r th. a,..-'a Indlvida.l
pers.nai and cunfl..ntial reference. AIR-....NDITI.NIN.., HEAT rRo,
CERTIFICATE VERIFICATION M RerR:.eR .-vR I..STRIITE
;r.. inbrm. d.n ror dle mumcl cites ur, slt,s certrncate can be verified at www.ahridirectory.org, click on 'Verify Certificate' link
.nd ■nt.r the AHRI Certified Reference N;rnb.r.,-,d th. d.;. an :hich :h...rdflc— a..-j lsea.d,
which Is listed above, and the Certificate No., which.s listed at bottom right.-
Ozi,14 mi-Conaltloning, Reating, anti Rerrlgeratlon Institute CERTIFICATE NO.: X315065 85zU1z4341