HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.
Permit Number:
S S J _
P
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
I PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description &��)Px �;s�n,�- � _ u� _Uo� a
Property Tax ID it; •YJ Lot No.
Site Plan Name _ Block No. 9a
Project Name:
Setbacks Front Back: Right Side; _ Left Side:
DETAILED DESCRIPTION OF WORK:
Replace AC, exact change out with ton, SEER, KW AC unit
CONSTRUCTION INFORMATION:
Additional workto Formedunder this permit —check a apply:
�HVAC OGasTank Gas Piping In _ Shutters ❑ Windows/Doors
OElectric 0 Plumbing 11 Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $ ���. _ Utilities: Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t C
Name: Dennis Zacek
Address+
Company: ARS American Residential Services
City!1i���Ullf_� State.EL•
Address: 2800 US Hwy 1
Zip Cade: Fax:
City: Vero Beach State: FL
Phone No
Zip Code: 32960 Fax:
E-Mail:
Phone No.�c� ��� •� a
Fill in fee simple Title Holder on next page ( if different
E-Mail: st_& oagsAoxs • C-o'M
from the Owner listed above)
State or County License: CMC1249753
IT value or construction is ycsuu or more, a REWHOED 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 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 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
commencing work or recording vour Notice of Commencement.
_ Signature of 0 er/ Lessee/Agent Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF StLme
The f going ins m nt w knowledge &fore me
this _LD_ day of t� 20 by
zacek
(Name of person a
STATE OF FLORIDA
COUNTY OF 51lucis
The ifing instrument was cknowledgt beforeme
this ,T, day of IM 20 LJ_ by
Dennis
person acly
of Florida )
Personally Known X OR Produced Identification Personally Known x OR Produced identification TM
Type of Identification Produced Type of Identification Produced
Commission No �35 (Seal)
Commission No.����& 5 (Seal)
Revised 071 i 5120 MY COMMISSION GG071535
.�• �o -
EXPIRES Februa 092021 =y ;'_= MY COMMISSION Ik GG071535
ry, EXPIRES February W, 2021
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
MANGROVE
REVIEW
SEA TURTLE
REVIEW
DATE
COMPLETE
INITIALS
Certificate of Product Ratings
AHRI Certified Reference Number : 9511931 Date: 07-16-2019 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) : PA14NC046'0"A'
Indoor Unit Model Number (Evaporator andlor Air Handler) : FB4CNF048L
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, 1L.
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 Instaled In regions) 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 ANSVAHRI 210/240 with Addenda 1 and 2, Performance Rating of Unitary
Air -Conditioning & Alr-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 : 43500
SEER ,14.00
EER (A2) - Single or High Stage (95F) . 1150
t"Active" Model Status are those that an AHRI Certificat on Program Participant Is currently producing AND selling or offering for sale; OR new models that era 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
Bell ng or eNering for sale
Ratings that ere accompanied by WAS Indieale an Involuntaryru-ratq..The now published rat no is shown along with the previous (i.e. WAS) rating.
DISCLAIMER I
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsiblllty for.
the productfs) listed on this Certificate. AHRI expressly disclaims all liability for damages of any klnd arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valld only for models and configurations listed in the
directory at www,ahridlrectory 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 referencerence Dpurposes. The contents of this Certificate may not, In whole or In part, be reproduced; cepled; 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 be verified at www.uhridirectory.org, click on 'Vsrify Carti l:C 3W link we melee lire bcllct-
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 CERTIFICATE NO.: 132077510541581426