HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
Building Permit Application
Planning and DevelapmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 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: ��- JJt��t�� �—� _I�tt—
Legal Description�Q\I\.W�(1 3/l) "a� in g 1/a ( _ Cat k, A w\ 11__ct n
Property Tax ID tf: ?j ��- _ 4��m Lot Nol%
Site Plan Name: Block No. -('8
Project Name: 1
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Replace AC, exact change out withp`-5--ton, SEER, $ KW AC unit
C 60 C-k U V_I I
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit — check all apply:
�HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers 11 Generator � Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $���-L Utilities:cn Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name: Dennis Zacek
Address:
Company.. ARS American Residential Services
City: State:'
Address: 2800 US Hwy 1
Zip Code: 40A @ Fax:
City: Vero Beach State: FL
Phone No.
Zip Code: 32960 Fax:
E-Mail:
Phone No ��a'�g� •� 0'1
Fill in fee simple Title Holder on next page (if different
E-Mail: Cam, s -CoTM
from the Owner listed above)
State or County License: CMC1249753
it value oT construction is ycsuu or more, a REWRDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: Stater
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 ermit holder to build the subject structure
which N in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 f the granting of this requested permit, I do hereby agree that I will, i all respects, perform the work
in accordance wi h the approved plans, the Florida Building Codes and St. Lucie Countylmendments.
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
ti Je�.- •. �Qi-f s
_ Signature of 0 er/ Lessee/Agent Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF s+Lucie
he forgoing instru ent V as acknowledge before me
his day of 0,1 . 20 by
Dennis Zacek
(Name of perso cknowledging j
state
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No
COLEEN SULLIVAN
Revised 07/ i S/2d1 * EXPIRES February 09, 2021
STATE OF FLORIDA
COUNTY OF stLude
The orgaing instrument was acknowledgebefore me
- .
thi - day of 20 by
Dennis
of person acki
re
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No.C_�-aA ff�_6
S (Seal]
COLEEN SULLIVAN
My COMMISSION # GG071535
r-Miar-n no nnn4
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
(PLANS
REVIEW
VEGETATION
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
A :a•
Making It work. Makin
g it right,
Nei nstallation Work Order 5'ir- Est. Start Date s1z3
lfrQ� (772)567-3100 Est. Completion Date 6l
2800 US Highway 1, Vero Beach, FL 32960 Corporate Customer
American Residential Services of Florida, Inc. LiccmLe f CMC t249753, Relations
EC13008558 W6) 803.0879
CUSTOMER - r EMAIL
fir,ADDRESS
CALL t i JP
fi?eCITY:STA
-H
HOME PHONE
CEL
WORK PHONE
OPTION 1
OPTION 2
OPTION
E TYPE M,
SIZE -WA7, TYPE
4rZ E TYPE
EFFI CY r+ +C '
EFFICIEN"C"Y�
EFFICIENCY
�
$ Z
$
% le $ -'.5700
$ - 615&-W?Aau-
$
Sat-ic- biliSc$ — 12
$8"19 3
SUBTOTAL $
LCACA $
SUBTOTAL $
MONTH EST' $
MONTHLY EST.' $
MONTHLY EST. ` $
CUST ER INITIALS
CUSTOMER INITIALS _
CUSTOMER INITIALS
Werra ty"_.Parts Labor
Warranty:"1iParts QnrLabor
Warranty:' Parts Labor
_Compressor _ _ Heat xchanger
% compressor feat Exchanger
Compressor Heat Exchanger
'Subject to credit approval Financing Pro 'ded by Greensky. Fred interest rate of 6.99'... for 60 months. Payment example assumes one-time $7.500 purchase on
approval data?APR 719%I with
I payment of $82.69, 5 payments of $43.69. and 54 amortized payments of $162.28. Payments assume Account Activation charge of $39 applies and is due wish
final required payment Fixed interest rate of 9.99% for 84 months. Payment example assumes one-time $7,500 purchase on approval date ?APR 10,75%) with
I payment of $101.44. 5 payments -f $62 44, and 76 amorlized payments of $131.11 Payments assume Account Activation charge of $39 applies and is due with
first required paymenl. Fred merest rate 0f 9.99% for 120 inanlhe Payments asaumeaone-lime $7,500 purchase on approval date (APR 10 11 %) with
I payment of $101 44. 5 payments of $62 44, and 114 amortized payments of $102.13. Payments assume Account Activalion charge of $39 applies and is due
with first required paymenl.Fued interest role at 9.99% for 144 months. Payment example assumes one-time $7,500 purchase on approval date fAPR 1O.09%) with
1 payment of $101 44. 5 payments of $62 44. and 138 amorttzed payments of $91.62. Payments assume Account Activation charge of $39 up. plies and is due
with first required payment.
'-Unless olherwrse noted, all warranties are from the manufacturer
SPECIFICS OF • •
SELECTED OPTION: ❑ 1 2 ❑3
Weatherproof $econnect Drain Line ❑ Detlumidifior _
Disconnect 11�s` Ceiling Saver Kit ❑Outdoor d Pad
SUBTOTAL $ .
❑ Llfevme Equipment Slab (Pan & Float) ❑ Flu sting
Wound Isolation Pads Amain Drain Safety Switch ❑ Ductwork Connections'
iht�S
❑ Liquid Tile Conduit eal New Connections Connect to existing plenum
$
S
CStart Kit Support Attic Equipment ❑ Duct Modifications
ofrigerant LL Dryer — Supply Plenum lase Notes for scope of work)
TOTAL $ � Y
efr gar t Pipe ❑ New 1] Reconnect ❑ Now Duct System
❑ New pweconnect Welurn Plenum ❑ No Duct Work
Refrigerant Pipe Cover El New X.Reconnect ❑ Fuel Piping
rExpansion Valve ❑ Electronic Air Cleaner _ ❑ Electrical Wiring
❑ CASH CHECK# 13_
5 (
stat Type ❑ Media Filler ❑ Home Service Plan —
pip
onnett to ExisYling ❑ PCO 1 Term (364 days)
❑ CREDIT CARD %LAST 4#s)
Electrical ❑ UV L'
Plywood Deck
ew 13 idifier
EXP _._ APPROVAL
OUR GUARANTEES
❑FINANCING'
Comfort Guarantee Home Protection Guarantee
4-Hour Service Guarantee 5-100% Unconditional Money -Back Guarantee
NOTES
L •�
'ARS is not responsible for preexisting ductwork. See Terms and Conditions on the back of this document for details_
• Wniten cuslomer authorization will be obtained before beginning any unforeseen additional or extended wcrk.
• ANY CLAIMS FOR CONSTRUCTION DEFECTS ARE SUBIECTTO THE NOTICE AND CURE PROVISIONS OF CHAPTER 558, FLORIDA STATES
• BUYER'S RIGHT TO CANCEL: This is a home solicitation sale, and If you do not want the goods or services, you may cancel this agree-
ment by providing written notice to the seller in person, by telegram, or by mail. 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 after you sign this ogteemenL If you cancel
this agreement, the seller may not keep all or part of any cash down payment. See the reverse side hereof for an explanation of this right.
- I acknowledge that my right to cancel has been explained to me orally and in writing, and without waiving my Tght to cancel, I authorize the performant,u o'
the work, a-bject to all terms and conditions set forth on the reverse side hereof, plus any taxes upon compMicn.
Notice To Owner - Do not sign this home Improvement contract in blank. You are entitled to a copy of the contract at the time you sign.
Keep It to protect your legal rights. This home improvement contract may contain a mortgage or otherwise create a lien on your property
that could be foreclosed on if you do not pay. Be sure you understand all rovisions of the contract before you sign.
roi%TO R 1 DATE CD ANY R RESENTATNE
CUSTOMER SIGNATURE DATE DATE
0 2019 Amenean Roaidenlixl Services LLC. All nghts reserved. ARS 1078-FL 190i.4 L190124 0256
Certificate of Product Ratinas
AHRI Certified Reference Number: 9489533 Date: 05-25-2019 Model Status: Active
AHRI Type: RCU-A-CB
Series :14 SEER AC
Outdoor Unit Brand Name: PAYNE HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : PAII4NC030'0"A'
Indoor Unit Model Number (Evaporator and/or Air Handier): FB4CNF030L
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,
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.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 PAYNE HEATING AND COOLING 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 Heal Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third patty testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 28200
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 12.00
t'Active' Model Status are those that an AHAI Certlffeatlon 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.
Rating5 that are accompanied ov WAS Indicale an involuntary re -race. Tha new published ralinq is 5nown alo-)q wih the r.rgUir)US fl g. WAS ratino
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 alteratlon 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 arc 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 user's Individual,
personal and confidential referenc e. AIR-CONDITIONING, HEATING,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The Information for the model cited on this certificate can be verified at www.shrldirectory.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.
02019Air-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: t32032596352960582