HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3" \q- 2-O Permit Number:
Building Permit. Application
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential
Address: .-SI rN
Property Tax ID It: {-L5 1 (31 " QCC) - - Lot No.
Site Plan Name:
Project Name:
Block No.
CONSTRUcnON INFORMATION:
Additio al work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $ Atp �L Utilities: _Sewer —Septic Building Height:
OWNERAESSEE:
C#3 £t:
Name A-
Name: Curtis Sammons
Address: �y �,�}-h(i�
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City: State:
Zip Code Fax:
City: Port Saint Lucie State: FL
Phone No.,,'�;CNZ -.5LAt -, t;;_ (4
Zip Code: 34952 Fax: 772-335-1968
E -Mail:
Phone No 772-335-3232
Fill in fee simple Title Holder on next page ( if different
E -Mail custairsys@aol.com
from the Owner listed above)
IL .._..--t----------• 1---- ---
State or County License CAC051810
- -- - --••-•-��•�•• iuVIC, a iccwrturu,vorJce or commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
152546
Itwes
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 NOTICE OF COMMENCEMENT."
K�&��
( ), S_
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Signature of Owner/ Lessee/Contractor as Agent for Owner
-
Signature of Contractor/License Holder
STATE OF FLORIDA��1 p 4w
STATE OF FLORIDA /
COUNTY OF V!6
COUNTY OF .2 k n�LiC� C
The fctr oing instrument was acknowledged before me
The foygoing instrument was acknowledged before me
�6-�
this day of --•;��C�� , 20[_( --=by
this � 1 day of '\ _� l 120,L( by
&h TIS S6 MinOr1.S
CuRTIS 61m hi S
Name of person making statement.
Name of person making statement.
Personally Known Z, OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida/
��s
40, °t^Rr r�e� CHRISTINE B EN
Commission No.�5��
p 5 * f MYCOMMISSION#G
t CHRISTINE B ENGI
ISH °r'
nission No. i V 5a 5 q 6 * MYCOMMISSIO U# G
A-10 EXPIRES:Apr114 2EXPIRES:
ApnT 4,
021 �Of Bonded
F�°Thru BudgetNotiry
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
152546
Itwes
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952I`
(772) 335-3232 • Fax( 772) 335-1968 -
Proposal and Agreement
Customer Name Pm -A4/ St2 / Phone j -o8--3 7 / ��Z3 t Dat
/�
l� - pot Address if 7 l 13 o t f Job Address
City, State, Zip PS l- SA l Ct-T-?YYS-2-, Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make Model Number(s)
SEER EER AFUE Btuh Cooling Btuh Heating CFM
KS--XIOStA,61 //As S- <7H BlAc%t, HA," I✓a'I"r
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S <1 '
ee-re
A -.
Glc o
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cCi —
X in boxes = Yes
❑ New Amp disconnect
VRemove existing equipment from premises
❑ New condensate drain system
❑ 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
❑ New weather resistant equipment stand
"ake air tight plenum transition
❑ New high efficiency air filter
❑ New reinforced equipment pad
❑ new supply diffuser(s)
❑ New humidification system
❑ New vibration isolation pads
❑ New duct run from to
❑ New return air filter grill
❑ New properly sized refrigerant lines
❑ Noise reducing flexible duct connector
(P' Meet all code requirements t�
❑ New clean, dry ACR copper tubing
❑ Balance for uniform supply air distribution
[?'C tete system start up d t O
!`r
❑ Insulate refrigerant suction line(s)
❑ Provide for external combustion air •
ED year parts warranty
❑ Install refrigerant drier(s)
❑ New gas piping from to
❑ year labor warranty
CEvacuate refrigerant system
❑ New vent pipe and cap
❑ f� year compressor warranty
Charge to manufacturer's specs
❑ Clean work area to customer's satisfaction
❑ year service agreement
Meet all federal, state &local laws
11 Condensation overflow safety switch
❑ ��,-c' ( O�•r'S 4�
1:14urricane Fasteners f r outdoor unit
��✓/°��
❑ Qpiiettrelenv)
❑ Su /lrt'T'd'
Total Investment $
u �
Taxes $
Total Amount $
0,1 yLSlonrOIs se�rovO fLs AlecO`' Down Payment $
So AM f 4/-( B LA U'L- -� Balance Due $
Terms: i Cc G"
Acceptance (C s Approval (Company)
y Date By Date O
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