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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: • 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 TYPE: PROPOSED IMPROVEMENT Lt3CATION . Aaa ress: J ra 7 J /emu /To //o uJ a!ry Property Tax ID#: �ya5^'10S—Ol/y OpD-O Site Plan Name: Project Name: Addit' nal work to be performed under this permit— check all that apply: Mechanical Gas Tank _ Gas Piping Shutters _ Electric _ Plumbing _ Sprinklers Generator Total Sq. Ft of Construction: Cost of Construction: $ aas Sq. Ft. of First Floor: Utilities: _ Sewer _ Septic OWNERAESSEE: NamerldA_�Q.¢ �v Address: d&fo 9 p,?�¢ y , - ez City: 4'e-ci- State: fL Zip Code: AY5oZ Fax: Phone No._5 oe"-„f E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) Lot No. Block No. Windows/Doors Roof Pitch Building Height: Name: Curtis Sammons Company: Custom Air Systems, Inc. Address: 1615 SE Village Green Drive City: Port Saint Lucie State: FL Zip Code: 34952 Fax: 772-335-1968 Phone No 772-335-3232 E-Mail custairsys@aol.com State or County License CAC051810 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY: _ Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Not Applicable Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTWF nF rnNNFNrFNFNT A Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA pp COUNTY OF X6 STATE OF FLORIDA & k oC.LLGiL COUNTY OF fc� The forgoing instrurrnt was acknowledged before me The forgoing instrument was acknowledged before me this —&— day of At-1 20 il by this 3-o— day of201 q by - L'(// TrS S. Mh90n5 euRTlS S/3h1inp/25' Name of person making statement. Name of person making statement. Personally Known �_ OR Produced Identification Personally Known �(' OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public- State of Korida) (Signature of Notary Public- State of Flori CHRISTINE B ••CHRISTM Commission No. �2Gt 0 5 �S4b io • B t * MY�t of el CV p$ My COMMISSION# mission No. a Jr 6 * '• EXPIRES: April EXPIM&Apd4. t ��oR��o Bpid�dThuBudpU REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. DiAbo) / Uer,"4 000000000000000000©000®®®®®®®� Custom Air Systems Inc. 1615 SE Village Green Drive • Port St. Lucie, FL 34952 (772)335-3232 • Fax ( 772) 335-1968 Lr Proposal and Agreement {'.�' r� fill! Customer Name l ' �%�1��f�' Phone Date Address % 5eta L 49 o 1..� Job Address City, State, Zip Work Phone(s) L We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal. fL Equipment Specifications a ,,C � ATKE Model c Number(s) e AT " o 5 (0 Make l SEER t K EER AFUE Btuh Cooling 3S Btuh Heating CFM Installation shall include: /1/ C -,5-, f' e ,-, �i (L� L V1U O,wn (� 5�� ��;.�f� c a c X in boxes = Yes r� ❑ New Amp disconnect Remove existing equipment from premises ❑ New condensate drain system L ❑ New Amp electric service ❑ Install energy saving setback thermostat ❑ New condensate pump ❑ New low voltage wiring ❑ New copper wire from to ❑ Install aux. condensate drain pan r C New weather resistant equipment stand XMake air tight plenum transition ❑ New high efficiency air filter /Mew reinforced equipment pad ❑ new supply diffuser(s) El New humidification system / L New vibration isolation pads ❑ New duct run from to ❑ New return air filter grill f 7- New properly sized refrigerant lines ElNoise reducing flexible duct connector Meet all code requirements L ❑ New clean, dry ACR copper tubing ❑ Balance for uniform supply air distribution X Complete system start up ❑ for warranty r ❑ Insulate refrigerant suction line(s) ❑ Install drier(s) Provide external combustion air year parts ❑ New from to year labor warranty L refrigerant gas piping C Evacuate refrigerant system C Charge to specs ❑ New vent pipe and cap ❑ year compressor warranty Clean work area to customer's satisfaction ❑ year service agreement r manufacturer's /Meet all federal, state & local laws ❑ Condensation overflow safety switch ❑ L urricane Fasteners for outdoor unit ❑Option (below) Total Investment $ ❑ r Vie Taxes $ fL C"h or 6WC4 Total Amount $ ' b✓�v �� t -� W� ;,.i f Oj 'vL O J Down Paymeat $ Balance Due $ (° Terms: ll l Acceptance (Cstomer) �J a Approve (Co_rrjpany) / Date By Date!By ,k l ®o©m000000000