HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
e � -
- 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 I
PROPOSED IMPROVEMENT LOCATION: i
Address:
Legal Description:
Property Tax ID #: Lot No. {
Site Plan Name: Block No.
Project Name;
Setbacks Front Back: Right Side: Left Side.
DETAILED DESCRIPTION OF WORK:
Replace AC, exact change out with --) -5ton, SEER, KW AC unit
Aaoit+onal work to be ertormea under this permit —check all apply:
0HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Roof Hoof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction: $ _ nI ! 1q Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Dennis Zacek
Address:
Company: AIRS American Residential Services
City: ���QkpfCL State:
Address: 2800 US Hwy 1
Zip Code: Fax:
City: Vero Beach State: FL.
Phone No. �—
Zip Code: 32960 Fax:
E-Mail:
Phone No. •-I a(b3
Fill in fee simple Title Holder on next page { if different
E-Mail: CM,Q S •CJ3TXN
from the Owner listed above)
State or County License: CMC1249753
If value of construction is $2500 or more, a RECORDED 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: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Nat 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 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 lender or an attorney before
commencins work or recordine vour Notice of Commencement.
_ Signature of 0 er/ Lessee/Agent Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF situue
The for oing instr ment was acknowledge efore me
this day of 20 aby
Dennis Zacek
( me of persona owl
� V46 4
+g re a f IN o r Pu i - ate of Florida }
SPATE OF FLORIDA
COUNTY OF sriucm
The forgoing instrument was acknowledge before me
this day of 20 by
Dennis Zacek
(N M
e person ackn wled Ing )
h t
n ubli- Florida )
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Produced I Type of Identification Produced
Commission No (Seal)
Commission Nor (Seal)
COL.EEN
C ____ __ MY COMMISSION # GG071535
Revised 07/ 15/2 ) �k "? MY COMMISSION # 00071535 = z ' EXPIRES February 09, 2021
EXPIRES February 09, 2021 " ..,.54. ry
REVIEWS
FR i
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
4001FI•
orkMakin.
Making it w.
Installation Work Order
(772)567-3100
2800 US Highway 1, Vero Beach, FL 32960
American Residential Services of Florida Inc. License M CMC124975c
EC13DO8558
Est. Start Date
Est, Completion Date
Corporate Customer
Relations
(866) BO&OB79
CU ER
EMAIL
CALL SLIP
ADORES
O
C.TY-SrATEZIP ,
HOME PT4014F
ELL PHON
D (L — 2
WO K?NONE
OPTION 1
OPTION
SIZEZ•-'TYPE �KJL
SIZE TYPE _ ".
SIZE TYPE
EFFICIENCY
EFFICIENCY
EFFICIENCY
14.1CLA $ ram! tom'
$ -
$
64 4r m $ cee= e E )._
$
_
$
$
$
$
SUBTOTAL $ {fir I9'•f
SUBTOTAL $
SUBTOTAL $
MONTHLY EST.* $
MONTHLY EST.' $._
MONTHLY EST.` $
/�
CUSTOMER INITIALS `V di
CUSTOMER INITIALS _
CUSTOMER INITIALS
Warranty:" O Parts Labor
Warranty:' Parts -Labor
Warranty:" Parts Labor
1-0-Compressor Heat Exchanger I
Compressor Heat Exchanger
Compressor Heat Exchanger
'Subject to credit approval, Financing Providod by Groeneky. Fred interest rate at 6.99% for 60 months. Payment example assumes one-time $7,500 purchase an
approval data (APR 7194b) with
1 payment of $82.69, 5 payments of $43.69, and 54 amortized payments of $162.2a, Payments assume Account Activation charge of $39 applies and is due with
first required paymont.Fred interest rate of 9.999b for 84 months. Payment example assumes one -lima $7.500 purchase on approval data (APR 10.15%) with
1 payment of $101.44, 5 payments of $62.44, and 78 amortized payments of $1a 1.11. Payments assume Account Activation charge of $39 applies and is due with
firs, required payment. Fired interest rate of 9.99% for 120 months. Payment example assumes one-time $7,500 purchase on approval dale (APR 10.11%) with
1 payment of $T01.44, 5 payments of $62.44, and 114 amortized payments of $102.13. Payments assume Account Activation charge of $39 applies and is duo
with first required paymanI.Ried interest rate of 9.99% for 144 months. Payment erampte assumes onetime $7,500 purchase an approval date (APR 10.09%) with
1 payment of $101.44, 5 payments of $62.44, and 138 amortized payments of $91.62. Payments assume Account Activation charge of $30 applies and is due
with first required payment.
"Unless otherwise noted, all warranties are from the manufacturer.
' • ' SELECTED OPTION: ❑ 1 ❑ 2 ❑ 3
❑ Weatherproof '�2econnect Drain Lire ❑ Dehumidifier SUBTOTAL $ ��BZ
C❑Ceiling
Disconnect Saver Kit ❑ Outdoor Unit Pad --
lxifetime Equipment Slab (Pan $ Float) ❑ Flue Venting �f S_L, -
$
*PSound Isolation Pads ❑ Main Drain Safety Switch UDuclwork Connections'
❑ Liquid Tile Conduit Pseal New Connections ❑ Connect to existing plenum _
-$
❑ Start Kit ❑ Support Allic Equipment ❑ Duct Modifications _
}C3)Refrigerant L.L. Dryer_ Supply P enurn 1 - Notes for scarce of work, TOTAL $ (a 19
-
Wofrgerant Pipe ❑ New PReconnect ❑ New Duct System
❑ New Elleconnect roetum Plenum t BWo Duct Work
❑ Refrigerant Pipe Cover ❑ Now �kReconnect ❑ Fuel Piping
❑ Expansion Valve r ❑ Electronic Air Cleaner ❑ Electrical Wiring ❑ CASH ❑ CHECK#
C-S
>@Tstat -Type A) I ❑ Media Filter ❑ Home Service Plan -
I'll onnect to Exist:ng ❑ PCO 1 Term (364 days) ❑ CREDIT CARD (LAST 4#a)
G
E"ei=trical ❑ UV Light
w Plywood Deck ❑ Humidifi EXP APPROVAL
OUR GUARANTEES FINANCING 6-r-le� O+
Comfort Guarantee �4iome Protection Guarantee
4-Hour Service Guarantee 00% Unconditional Money -Back Guarantee
•
'ARS 's not responsible for preen sting ductwork. See Terms and Conditions on the back of ih,s document for details.
• Written nustomer authorization w1l be obtained before beginning any unforeseen additional or extended work
• ANY CLAIMS FOR CONSTRUCTION DEFECTS ARE SUBJECT TO THE NOTICE AND CURE PROVISIONS OF CHAPTER 558, FLORIDA STATUTES
• 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 agreement. 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 ackncw't;dge that my right to can -al has been explained to me orally and in writing, and withoul waiving my right to cancer. I authorize the performance of
the work, subject to all terms and cnaditions set forth on the reverse side hereof, plus any taxes upon completion.
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 mo e o therwise create a lien on your property
that could be foreclosed on It you do not pay. Be sure you understand all i arts o e nt bete u sign.
CUS-I£R SIGNATURE 04M `1,GO!G04e!EPRPKNT
lQ Z.
CUSTOMER SIGNATURE DATE CA E
113 2010 Amon^ Rvsidonlint Servkas L LC. All rights iesmvad. A@Sl o7e FL 190124 1140124 R 2%F
Certificate of Product Ratings
AHRI Certified Reference Number • 9489533 Date: 06-29-2019 Model Status : Active
AHRI Type: RCU-A-CB
Sodas: 14 SEER AC
Outdoor Unit Brand Name: PAYNE HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : PA14NC030'0"A'
Indoor Unit Model Number (Evaporator and/or Air Handier): F84CNF030L
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, 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 reglon(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 ANSI/AHRI 2101240 with Addenda 11-and 2, Performance Rating of Unitary
Air -Conditioning & AirSotirce Heat Pump Equipment and subject to rating accuracy by A14RI-sponsored, independent, third party testing
Cooling Capacity (AZ) - Single or High Stage (95F), btuh : 28200
SEER :14.00
EER (A2) - Single or High Stage (9517) :12.00
j" Active" Model Status are those that an AHRI Certificatlon 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 .onger producing BUT Is still
setting or offering for sale.
Ratings_that are_accompanlod by WAS indicate an involuntary m-rate. The now Published ratIna Is shown atone with the previous (i.e. WAS) rating.
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 pioduct(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 date listed on this Certificate. Certified ratings are valid only for models and conflguratlons listed In the
directory at www.ot3ridirectory.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; copled; disseminated;mlwu
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
a REFRIaERAlnON INSTITtITE
The Information for the model cited on this certificate can be verified at www.ahridiroctory.org, click on "Verify Certificate' link
Nr,ral r lif- betrcr"
and enter the AHRI Certified Reference Number and the date on which the certlffcato was Issued,
which Is listed above,,and the. Certificate No.�which Is listed at bottom rightm.
AA
"1s2aa2gam4oe699
02019Air-Conditioning, Heating, and Refrigeration Institute
i O.: