HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 X
PERMIT TYPE: PLUMBING
PROPOSED IMPROVEMENT LOCATION:
Address: 5924 ALEXANDRIA CIR
Property Tax ID #: 3410-503-0256-000-1
Site Plan Name:
Project Name: WATER HEATER
I DETAILED DESCRIPTION OF WORK: dw
50- GALLON ELECTRIC WATER HEATER REPLACEMENT
Lot No.
Block No.
OWNER/LESSEE:
CONTRACTOR:
Name Joseph A Gotsens Carol S Gotsens
Name: RICHARD BASSOFF
Address: 5924 Alexandria CIR
Company: ADMIRAL PLUMBING SERVICES, LLC
City: FORT PIERCE FL State: _
Zip Code: 34982 Fax:
Phone No. 772-468-2102
Address: 2895 JUPITER PARK DR STE 700
CONSTRUCTION INFORMATION:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail PERTMITTING@THEADMIRALPLUMBER.COM
Additional work to be performed under this permit —check all
that apply:
_Mechanical _ Gas Tank
_ Gas Piping
_ Shutters
_ Windows/Doors
_ Electric Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Sq.
Ft. of First Floor:
Cost of Construction: $ 1260.00
Utilities:
_ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Joseph A Gotsens Carol S Gotsens
Name: RICHARD BASSOFF
Address: 5924 Alexandria CIR
Company: ADMIRAL PLUMBING SERVICES, LLC
City: FORT PIERCE FL State: _
Zip Code: 34982 Fax:
Phone No. 772-468-2102
Address: 2895 JUPITER PARK DR STE 700
City: JUPITER State: FL
Zip Code: 33458 Fax:
Phone No 561-746-1180
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail PERTMITTING@THEADMIRALPLUMBER.COM
State or County License CFC1426115
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
STATE OF FLORIDA
Address:
COUNTY OF PALM BEACH
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
`/OR
Address:
Personally Known Produced Identification
City:
Type of Identification
City:
Produced
Zip: Phone:
n 9
lk ULLIVAN
Zip: Phone:
(Signature of Nota ; u = 45ta)le Q�ItitM1981bN p GG043125
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OW)LN ATTORNEY BEFORE RECORDING Y NO E OF COMMENCEMENT."
Kev. L/ // iy
W69re f5f Owner/ Lessee/ntr/a�c a gent for Owner
SikratTrKof Contractor/License der
STATE OF FLORIDA l/
STATE OF FLORIDA
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The for oing instr� e �t wAa,s acknowledge before me
this�day of 20� by
The fnor� oing instrU w s acknowledBf efore me
this day Vf 2d / by
bG of ,
RICHARD BASSOFF
RICHARD BASSOFF
Name of person making statement.
Name of person making statement.
`/OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
n 9
lk ULLIVAN
(Signature of Notary e o
f'Cr L MSULLIVAN
(Signature of Nota ; u = 45ta)le Q�ItitM1981bN p GG043125
;yf.•�.
Commission No. `- MY COIO4 p GGG43125
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1,
-. ,.� EXPIRES October 30, 2020
Commission No. (Seal)
,,, ,,. EXPI EMS 30, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. L/ // iy
Admiral Plumbing Services, LLC Invoice 24272219
2895 Jupiter Park DR #700 Invoice Date 5/22/2019
-' t = - Jupiter, FL 33458 Terms COD
A Service Experts ContpanyJ 561-746-1180 Completed Date 5/22/2019
License: CFC 1426115
Customer PO
Billing Address Job Address
JOE GOTSENS JOE GOTSENS
5924 Alexandria Circle 5924 Alexandria Circle
Fort Pierce, FL 34982 USA Fort Pierce, FL 34982 USA
Description of Work
Furnished and installed 50 gallon standard electric Rheem water heater with expansion tank valve and plumbing permit.
Tested, no leaks.
Unit comes with a one year parts and labor warranty through Admiral Plumbing and a 6 year warranty through Rheem, see
paperwork attached to the side of the heater.
remember to flush your heater once a year to help minimize scale build up inside the unit.
Task # Description Quantity Your Price Your Total
T42610 STANDARD 50 GALLON ELECTRIC WATER HEATER - PLUS PERMIT AND UPGRADES 1.00 $925.00 $925.00
A14860 WATER EXPANSION TANK (TANK ONLY) 1.00 $230.00 $230.00
A99536 WATER HEATER PERMIT 1.00 $225.00 $225.00
D70657 COURTESY DISCOUNT 1.00 $-120.00 $-120.00
Paid On Type Memo Amount
5/22/2019 Check $1,260.00
Sub -Total $1,260.00
Tax $0.00
Total Due $1,260.00
Payment $1,260.00
Balance Due $0.00
Terms: ALL ESTIMATES ARE GOOD FOR 30 DAYS. All material is guaranteed to be as specified. All work is to be completed in a professional manner
according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and
will become an extra charge over and above the estimate. All agreements contingent upon delays, beyond our control. All payments are due upon
completion of installation. All payments not received upon completion are subject to 1 1/2% service charge per month, or the maximum rate permitted by
law, whichever is less. In the event of non-payment, all costs incidental to collection, including without limitation reasonable attorney's fees shall be added
to the unpaid balance. "CANCELLATION OF WORK AFTER DEPOSIT IS PAID: In the event ajob is cancelled after the deposit is paid, a refund will be given
minus any permit (if applicable) and administrative fees that were paid by Admiral Plumbing.
PLEASE MAIL ALL PAYMENTS TO:
2895 JUPITER PARK DR #700
JUPITER FL 33458
(561)746-1180
I hereby agree to have Admiral Plumbing complete the work described for the proposed price regardless of the time it takes to complete
the work.
5/22/2019
1 hereby acknowledge the satisfactory completion of the above described work.
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