HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C� -D "40 Permit Number:
rrr
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
Building Permit. Application
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATIIM.F..
Commercial Residential V
Address: 6Z.11? Ale?l1*15 131yi
Property Tax ID#: Y50 I?- S -DI -le el:�W-I Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF:WORiC
01te- az-,( ZlIl'c- 2, A Ivs-cer ovl,- jp/7►-�
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit -check all that apply:
[/Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First floor:
Utilities: —Sewer _Septic
Block No.
_ Windows/Doors
_ Roof Pitch
Building Height:
OWNER/I ESSEE:.
C0 -R ,C.R-
Name 7-6 a /S ar t
Name: Curtis Sammons
Company: Custom Air Systems, Inc.
Address: �?6� �l�'�1I`/ted �,&
City: State: FG
Address: 1615 SE Village Green Drive
Zip Code:_ Fax:
City: Port Saint Lucie State: FL
Phone No. 770? ?,? -9
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)
State or County License CAC051810
-A
- -- - -- -- --- - -e a iccwrcLJCu ivvuce or commencement is requwrea.
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 thepermit 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
WIIiH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF & �G t COUNTY OF J'e �GLCI�_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ,�J day of yrAf,�2 20i,� by this dJ day of &ae?, 20� by
,/'Lt R TIS J� dl m 0 rt.S eu Q T S N45? f� S
Name of person making statement. Name of person making statement.
Personally Known X OR Produced Identification Personally Known A- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Fforida )
r r� CHRISTINE B ENI
CGv 05251 mooU."19
Commission No. * MYCONIMISSION�G
EXPIRES: April d,
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Public- State of Flori
tot: CHRISTINE B EI
'ISH
rission No. / MY COMMISSION #
Gt % Asa 5 � 6
)21� � EXPIRES:Apn1
4j " ��c d nxu Budge W
SUPERVISOR I PLANS VEGETATION I SEA TURTLE I MANGROVE
REVIEW I REVIEW I REVIEW REVIEW REVIEW
Custom Air Systems Inc.
1615 SE Village Green Drive - Port St. Lucie, FL 34952
(772) 335-3232 - Fax ( 772) 335-1968
Proposal and Agreement
Customer Name v– � Phone Date 4�1
Address Job Address
City, State, Zip SC'v-QeOC-L r 345 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) k r ' 19 --,Z) k 4
SEER_ EER AFUE Btuh Cooling Btuh Heating] 0/ CFM
Installation shall include:
h
❑ New Amp disconnect ❑ Remove existing equipment from premises
❑ New Amp electric service ❑ Install energy saving setback thermostat
❑ New low voltage wiring ❑ New copper wire from to
❑ New weather resistant equipment stand ❑ Make air tight plenum transition
❑ New reinforced equipment pad ❑ new supply diffuser(s)
❑ New vibration isolation pads ❑ New duct run from to
• New properly sized refrigerant lines ❑ Noise reducing flexible duct connector
❑ New clean, dry ACR copper tubing ❑ Balance for uniform supply air distribution
❑ Insulate refrigerant suction line(s) ❑ Provide for external combustion air
❑ Install refrigerant drier(s) ❑ New gas piping from to
❑ Evacuate refrigerant system ❑ New vent pipe and cap
❑ Charge to manufacturer's specs ❑ Clean work area--to-satisfaction
❑ Meet all fede -state & local laws ❑ Condensation over swl Ztn—
❑ Hurricane Fasteners for outdoor—unit-
- \
❑ tion (below) ❑
1-6e re-Ack-
W
p
+0
Terms
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ New return air filter grill
❑ Meet all code requirements
❑ Complete system start up
❑ year parts warranty
❑ year labor warranty
❑ year compressor warranty
❑ year service agreement
11
tal Investment $v
Taxes $
Total mount $
Down,,-Payme.it $
Balance Due $
u
Acc ptance (Customer) J Approval n as
c. Date By Date