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HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 [ Permit Number:.
n s
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-3578
PERMIT TYPE:
Building Remit Application
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax 1D #:
Site Plan Name:
Project Name:
Commercial Residential
�.4 W /.LW_Nlp;1Ms.*��jr�[ +
DETAILED DESCRIPTION OF WORK:
tt
CONSTRUCTION INFORMATION:
V
Additional work to be performed under this permit—check all that apply:
Mechanical Cas Tank — Gas Piping _ Shutters
Electric _ Plumbing Sprinklers _ Generator
Total Sq. Ft of Construction:: `p Sq. Ft. of First Floor: _
Cost of Construction: $
W
Lot No. 73
Block No.
NdF7rX
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 6-h% itA4 c 16
Name:lG [
Address: P �9
Company:
City: 0'1- U'C"r State: _
Zip Code: `+ Fax:
Phone No. 17 ° Y - Oco
E -Mail: I/b&ZjEMf.moi(.= C
Address: ;Yn 5W e
City: State:
Zip Code: WWO Fax:
Phone No �% ' %/l 7
Fill in fee simple Title Bolder on next page ( if different
from the Owner listed above)
E-MailW"1 r+M- 13WYbu l-1
State or County License b l-3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL. CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/ENG [NEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 JOJB SITE BEFORE THE ¢IRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENPFA OWAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C_nMMFNCFMFNT_"
ev.
lal,14
Signature of Owner/ Lessee/Can t s gent for Owner
Signature of Contractor/Liven r
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The foAgoing instrumant was acknowledge before me
The far Ding instrum nt was acknowledgeefore me
this day of LST 20by
this day of L , 20 by
'
�-
Name of person mailing statement.
Name of person making statement.
Personally Known OR Produced identification
Personally Known OR Produced Identification
Type of ldentifica ion
f Identification
Produced " TIFFANYCATRINI
Prod ed "° 7IFFANYCAfRINI
*: Commission # GG 1$5159
Expires February 13, 2022
: Commission # GG 1$515
Banded i}uuTwyFain lnsurance
4W700'TP6`GPPa= Expires February 13,20
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f CLQ „ . Randal Thm Tray Fal" Inum
of otary Public- State o ori a)
(SigTs—��cno.
(Sig t , f N ary Public- Sta e of Florida }
Com(Sea[j
Comr ss' n No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Certificate of Product Ratings
AHRI Certified Reference Number: 201907216 Date :09-09-2019 Model Status : Active
AHRI Type: RCU-A-CB
Series: DAVE LENNOX SIGNATURE XC21 SERIES
Outdoor Unit Brand Name: LENNOX
Outdoor Unit Model Number (Condenser or Single Package) : XC211-060-230-11
Indoor Unit Model Number (Evaporator and/or Air Handier) : CBA38MV-048-230*+TDR
Region: Ali (AK, AL, AR, AZ, CA, CO, CT, DC, DF, 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, SO, 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 LENNOX 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 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 : 57000
SEER: 16.00
EER (A2) - Single or High Stage (95F) : 12.15
-"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; C)R 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.
Ratin s that are accam anied by WAS indicate an involuntary re -rate. The new eublished rating is shown along 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 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.ahridirectory.org.
TERMS AND CONDITIONS filon
This Certificate and Its contents are proprietary products of AHRI. This Certificate shah 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,
Arw
personal and confidential reference. AIR-CON017110NINCv, HFJyTING,
& REFRIGERATION iNs7 ri-rrE
CERTIFICATE VERIFICATION
The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link w�-, crake life berter'
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.
1321252588©9567457
@2019Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: i
Ilk
AN worf,
M
Client Name: rt
Address:
Phone
Replacen
Brand:
Tonnage:
SEER:
Warranty: Parts:
$
Additional investments:
Add Supply Duct W/Grille
Labor:
355.84
Sub Total:
Addith
Attic/Ceiling Mount Air Handler
$
490.50
10 Year Labor Warranty
$
1,360.32
5 Year Labor Warranty
$
819.68
Re -Surface Air Handler Stand
$
201..65
Re -insulate Air Handler Stand
$
160.04
Replace Disconnect Switch
$
i8`3.49
Add Disconnect Switch
$
231.47
Add Electrical Whip
$
102.56
T-Stat (Non -Programmable)
$
120,40
T-Stat (Programmable)
$
170.93
Re-route Drain Line ( upto 25')
$
138.96
Condensate Pump W/ Line
$
582.06
Replace Condensate Pump
$
422.33
Replace Supply Plenum
$
356.25
Replace Return Plenum
$
356.25
Replace Both Plenums
$
638.74
Seal Entire Duct System
$
712,83
Filter Rack
$
156.94
Surge Protcetor
$
372.78
Additional Materials Deeded:
www.honestairinc.com
PH: 772-232-1114
FAX:772-232-1118
Email:
Date:
C.A.
ient5
$
Additional investments:
Add Supply Duct W/Grille
$
355.84
Sub Total:
Add Return Duct W/ Grille
$
355.84
Thru The Wall (by pass) Grille
$
288.85
Line Voltage Wire (upto 25')
$
219.90
Low Voltage Wire (upto 25')
$
183.68
Condenser Pad
$
228.80
Crane Service
$
490.50
Replace Refrigerant Line Set
$
1,074.35
2 Preventative Maint.
$
138.00
Gas Pipe Extension
$
86.20
Indoor Air Quality Products
PMAC Air Cleaner
$
870.91
UV Complete
$
1,142.67
UV Dual Bulb
$
1,016.58
UV Coil Scrubber
$
692.78
Oxine Duct Sanitizer
$
,_354.25 -
Equipment Total:
$
Additional investments:
$
Totall.A.Q,
$
Sub Total:
$
By signing this contract you are entering into a binding agreement
Total investment:
between yourself and Honest Air, int. The amount stated in "tots! 1 f fsdei.
investment" is the amount to be paid upon completion of the Total investment includes: Taxes, Permit, Breakers, Installation,
work described above. Failure to pay the full amount will result in removal Disposal of existing equipment, labor, and all additional items listed.
of equipment and any fees associated with such:work as well as any legal fees.
Date: --
I, the Client, agree to pay the full amount stated for the: work described.above.
Date:
I, the Comfort Advisor, agree to oversee.th�'work stated above.and to insure proper installation thereof.