HomeMy WebLinkAboutCHANGE OUT FORM - GRUMSTRUPALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
P 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
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69.cto IL
Address.- 101-0 -1 <7-
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Legal Description,, WJN-;TtXl_'��' ( o
Lot No.
Prop erty'rax ID 4611, 'Z40
Site Plan Name: Block No.
Pro'j ect Name:
Setbacks Front Back-. Right Side: Left Side:
. OFW0R'K*
Additional work to be P rtormed under this pe_rm_it__—___ct__ec____k --- all tha apply:
"-
14LJHVAC Gas lank ❑Gas Piping Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof E: Roof pitch
Total Sq. Ft of Construction: S . Ft. of F'Irst Floor.-
q Cn
Cost of Construction: $ Utilities: Sewer Sufic
ic elf in Height-,
USSE E ,OWN E R/ COINTRACTOR�.,
Name Name-, DCW'<L
Address: 0 L,), Company: LLC
city-. State: Y'L_ Address:53*1 �J (D fl QJ- C on+l* I e,
Zip Code:. City: J ji c ke, Stites
Phone No.0"? Pad6qcj_,6)�6_3 Zip Code: 3qU..6_Fax.7?Q Sq _31S 11
17 - M a i 1: Phone No..
v4'0
Fill Iin fee simple Title Holder on next page (if different E-Mafl-
from the Owner listed above) State or County License: OVC, I %i '16 a3
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ETR IONVEN LAW I N FORMAT 0,
'W 'AL "PLE�:� s MEN15 CONN
ON
DESIGNER/ENGINEER.
Not App�kcable
MORTGAGE COMPANY:
Not Applicable
Name:
4
Name.
Address..--.
Address:
City :
State:
City:
—State: --
Zip: Phone
Zi po Phone,:
FEE SIMPLE TITLE HOLDER.
Not Applicabie
BONDING COMPANY:
—Not Applicable
Name:
Name:
Address.
Address:
City:
City:-
zip: Phone :
Zip-, Phone:—
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the workand installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County akes 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-resident' use
WARNING TO OWNER-D'Four 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
01
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing w-Qrkor recordinr Notice ofCommenceme
Signalture of Owner/ Lessee/Contractor as Agent for, wner
STATE OF FLORIDA
COUNTY OF pof+ ,s" a —
The forgoing instrument was acknowledged before me
this I h day of 2019 by
, lav
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
,(Signature of e0_tary_PubIjc- State of Florida
R I -M
Daniel
A, � oicn.ff 90(A96
- FRONT I'ZO'NING
COUNTER REVIEW
DATE
RECEIVED
LCOMPLETER
Rev. 8/2/17
Signaturi/of Contractor/License Holder
STATE OF FLORIDA
COUNTY of
Theforgoing 'instrument was acknowledged before me
this day of``o by
(IV
Name of person making statement
Personally Known _X OR Produced Identification
Type of Identification
Produced
(signatureof Notary PubN6 State of Florida )
-T--W -W W
Comm sl Noto awtoof Rxids
Micheile Daniel
My Co mission FF 906496
SUPERVISOR I PLANT TVCGE'rATiON, SEA TURTLE MANGROVE
REVIEW REVIEW I REVIEW I REVIEW REViEW
This combination qualifies for a Federal Energy Efficiency tax Credit when
placed in service between Feb 17,2009 and Dec 31, 2016.
AHRI Certified Reference Number: 200945843 Date: 06-17-2019 Model Status: Active
Old AHRI Reference Number: 6892357
AHRI Type: SP-A
Series: GPC14
Outdoor Unit Brand Name: GOODMAN
Outdoor Unit Model Number (Condenser or Single Package): GPC1 4361-141 D*
Region All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS,
MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, 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 GOODMAN product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda I 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), btuh : 35600
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 12.00
t"Active" Model Status are those that an 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." Prod uctio n 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 accom-paniedby-WAS indicate an involuntary re -rate. The new i)ublished ratinct isshownalona with the previous (i.e. WAS) ratina.
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.ahrid!rectory.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 user's individual,
personal and confidential reference.
AIR-CONDITIONING, HEATING,
CERTIFICATE VERIFICATION
& REFRIGERATION INSTITUTE
The information for the model cited on this certificate can he verified at 9 , click on "VQwify Cortiflento" link
we mke life betterm
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.
@2019Air-Conditioning, Heating, and Refrigeration Institute
CERTIFICATE NO.:
132052494686111888