HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE: INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 81 Permit Number;
ti I J
s
Building Permit Application
Planning and Development Services
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 I
I PROPOSED IMPROVEMENT LOCATION: I
Description:
Property Tax ID #: T V
Site Plan Name:
J�� In I - AYW
Project Name:
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
Replace AC, exact change out with ton, SEER, KW AC unit
�0 d u&i NM
Lot No.
Block No.
CONSTRUCTION INFORMATION:
9VAC
na wor to e e orme un er t is permit —c ec a app y:
Gas Tank E]Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ MOO
5 Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name .
Name: Dennis Zacek
Address:
Company: ARS American Residential Services
City J State
Address: 2800 US Hwy 1
Zip Code: Fax:
City: Vero Beach State: FL
Phone No.zu
Zip Code: 32960 Fax:
E-Mail:
Phone No. ��a'�`�'-� •-I am3
Fill in fee simple Title Holder on next page (if different
E-Mail KAr + AAS • CsOr(%
from the Owner listed above)
State or County License: CMC1249753
It 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 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
commencine work or recordine vour Notice of Commencement.
_ Signature of O er/ Lessee/Agent w Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF s,Luce
The fQLgoing inst ent was acknowledg fore me
this day of 20 by
Dennis Zack
of person
re of RofaK Public- State
Personally Known x
Type of Identification
Commission
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF $I Lucie
The for ing instr ent was acknowledg efore me
this day of 201 by
Den is Zacek
N
erson a now d g of u ic- ate of Florida }
SULLIV 10er pally Known x OR Produced Identification
K
oN # GGO' �%p of Identification Produced_ .
(,j6TIRES February 09. Oz'
ission No.
"_ _-
COMMISSION
gXPIRSS February
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
535
Certificate of Product Retinas
AHRI Certified Reference Number: 9481127 Date: 08-12-2019 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) : PA14NCO24'0"A'
Indoor Unit Model Number (Evaporator andfor Air Handier): FB4CNF024L
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 Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing;
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 22800
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 11.50
t'Aclive' Model Status are those that an AHRI Certification Program Participant Is currently producing AND selling or offering for sale; OR now 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 s 01
selling or offering for sale.
Raling5_that are accompanied by WAS indicate an involuntary re -rate. The new published retina Is shown along with the previous (i.e. WASI ratlna.
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.ahFidirectury.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; AW- 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,ahridlrectary.org, click on 'Verify Certificate' link ue make Ide beirci"
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.: 132100892585234125