HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ! \ ( �q Permit Number:
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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:e.�,i,r�1-PC'[l_�(�E'��i.. �C{—
Property Tax ID . Lot No.
Site Plan Name: Block No.
Project Name " _l--- --
Setbacks Front Back: Right Side: _ _ Left Side:
DETAILED DESCRIPTION OF WORK:
Replace AC, exact change out with ton, „�� SEER, 15 KW AC unit
_Fo 1a p-?em,�-4� �-(2)\-�a
CONSTRUCTION INFORMATION:
Additional work to e er1ormed under this permit — Check all apply:
0HVAC Gas Tank ❑Gas Piping In _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ [n� Utilities: USewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name _„ _
Name: Dennis Zacek
Address:
Company: ARS American Residential Services
City: State:
Address: 2800 US Hwy 1
Zip Code:,. Fax:
City: Vero Beach State: FL
Phone No.<. a•w6w
Zip Code: 32960 Fax:
E-Mail:
Phone No., "
Fill in fee simple Title Holder on next page ( if different
E-Mail:
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 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 your Notice of Commencement.
_ Signature of 0 er/ Lessee/,^ gent
STATE OF FLORIDA
COUNTY OF SiLucae
The forgoing ins ument was acknowledged before me
this-& day of 20 by
Dennis Zacek
Name of person knopjedging
ic- State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
Commission Noi,} (Seal)
MY COMMISSION # GG071535
Revised 07/ 15/2014 ;- EXPIRES February 09, 2021
Signature of Contra r/License Holder
STATE OF FLORIDA
COUNTY OF StLurx
The forgoing instrument was acknowledged before me
this ,i day ofrl P- P .� , 20 �q _ by
Dennis Zacek
(Nne f person a ,.ow a ging )
ig rre of a y - STate of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No.L_L_aa J (Seal)
MY COMMISSION # GG071535
EXPIRES February 09, 2021
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INITIALS
Certificate of Product Ratinas
AHRI Certified Reference Number: 7499224 Date: 11/8/2016
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: RA1442AJ1
Indoor Unit Model Number: RHIP4221STAN
Manufacturer: RHEEM SALES COMPANY, INC.
Trade/Brand name: RHEEM; RUUD
Region: Southeast and North (AL, AR, DC, DE, FL, GA, Hl, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA
AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, Ml, 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.
Series name:
Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC.
Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing:
Cooling Capacity (Btuh): 41500
EER Rating (Cooling): 11.50
SEER Rating (Cooling): 14.00
LEER Rating (Cooling).
` Ratings followed by an asterisk (') Indicate a voluntary rerate of previously published data urdess accompanied with a WAS which Indicates an involuntary rerale
DISCLAIMER
AHRI does not endorse the product(s) listed an 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.shridirectory.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; capled; 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 a REFRIGERATION INSTITUTE
The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate' link ue make Ide 6rrrer
and enter the AHRI Certified Reference Number and the date an which the certificate was Issued,
which Is listed above, and the Certificate No.. which Is listed at bottom right
@2014 Air -Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 131230664379744882