HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 )_DJ Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 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
PROPOSED IMPROVEMENT LOCATION:
Address: 9�-,5m nu "&6 IIrr
Legal Description:
Property axT lD #: _ 3Q.,,.- {Q vb3 L% O` "t' T Lot No.,_�
Site Pian Name: Block No.41_
Project Name: & � h
Setbacks Front Back: Right Side: Left Side:
itiona wor to e e orme under t is permit — c
r
HVAC 0 Gas Tank [:]Gas Piping
nElectric Q Plumbing Sprinklers
UShutters LLWindows/Doors
OGenerator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `tit 1 Utilities: 0 Sewer ®Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name
Name•
Address: ui nL
Company:
Address:
�"
-T C,
City: fop-+ l -e- State: F1
Zip Code:. Fax: N
2T,-
Phone No 11Z)4-90-Le.](�?1
City: �-
Zip Code:
Phone No. L U -
State:
Fax..-
ax..- X1-1. J 5
-
_
E -Mail: IOr
r
Fill in fee simple Title Haber on next page ( if different
from the Owner listed above)
E -Mail:
State or County License:
A'( -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
WPM MENTAL CONSTRUCTIONLIEN LAW-I'Nt OkRMATION
DESIGNER/ENGINEER. _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name_
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
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 instaflation 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 tender or an attorney before
commencine work or recordine vour Notice of Commencement.
Rev. 8/2/17
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA -
COUNTY OF �s. C' ,. Y�
STATE OF FLQQA
COUNTY OF _ U_X i _ 02 ,,f a
The for Ding instrument w s acknowledge before me
thisday of 20LI by
The for ging instrument was acknowledged before me
this2S day of r rl�tn z0 l by
.
Name of person making statement
Personally Known 'X OR Produced identification
Name of person making statement
Personally Known _2 OR Produced identification
Type of Identification
Type of identification
Produced
Produced
{Signature of Notary l4
yak,*.. °- NLM.ILLVERS.
(Signature of Notary Pubii DONNAM. NtLI
Commission N COGG 099038
My SiDN # GG 099038
Commission NFJ(PfiiES:U.2621
Bonded ihru Notae Werwrlfets
',oApn130 2029
���.., •' Bonded Thru t4*ry Public Underwitws
REVIEWS
FRONT
ZONING
SUPERVISOR
PIANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Certificate of Product Ratings
AHRI Certified Reference Number: 201176299 Date: 03-23-2018 Model Status: Active
Old AHRI Reference Number: 7493646
AHRI Type: RCU-A-CB
Outdoor Unit Brand Name: RHEEM
Outdoor Unit. Model Number (Condenser or Single Package) : RA1436AJ1
Indoor Unit Model Number (Evaporator andfor Air Handler) : RBHP-21
Region: Southeast and North (AAL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, AK, CO, CT, ID, IL,
IA, IN, KS, MA, ME, MI, MN, MO, MT, NO, 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.
The manufacturer of this RHEEM product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSIIAHRI 2101240 with Addenda 1 and 2, Performance Rating of Unitary
Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btu In : 36000
SEER: 15.50
EER (A2) - Single or High Stage (95F) : 13.00
t"Active" Model Status are those that art AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being
marketed but are not yet being produced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
Ratings that are accompanied bar WAS indicate an involuntary re -rate. The new published rafing is shown aloha with tfie previous (i e. WAS) Wggg-
DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibilityfor,
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.ahridirectory.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;
entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the users individual,
AM
AIR-CONDITIONING, HEATING,
personal and confidential reference. -
& REFRIGERATION INSTITUTE
CERTIFICATE VERIFICATION
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better"'
and 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.
02018Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1��6628s344o82os72