HomeMy WebLinkAboutCCF04102020_00011All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
�� -� Permit Number:
7'
Building Permit.Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
PROPOSED IMS
Address:
Property Tax ID #:
Site Plan Name: _
Project Name: _
DETAILED DESCRIPTION Of WORK:
CONSTRUCTION INFORMATION
Additional workto be performed under this permit - check all that apply:
(Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $� Utilities: _ Sewer _ Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:�OM'FR
T4}R:
Name
Name: Curtis Sammons
Address: 6y�/� �� OIL
Company: Custom Air Systems, Inc.
City: t�,i / State:
Address: 1615 SE Village Green Drive
Zip Code: Y�Z Fax:
City: Port Saint Lucie State: FL
Phone No. 77a W-67 ¢Sfd
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
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:
I
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
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 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
WITH 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
COUNTY OF jy_ fU.e�
STATE OF FLORIDA
COUNTY OF j �G�GCG
The forgoing instrument was acknowledged before me
The for oing instrurn t was cknowledged before me
this day of �z G 20 a by
this � day of , 20 k by
S/mty,,
(I/�- T/ 5 ._,qn1m0n-5
T1S `
Name of person making statement.
Name of person making statement.
Personally Known _ OR Produced Identification
Type of Identification
Personally Known it OR Produced Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Oforida)
(Signature of Notary Public- State of Flori
,,++ OoAy pu1i CHRISTINE B EN
Commission No. l 6i0sZs�6 r f
* # MY COMMISSION t GO
EXPIRES: Apni
ISH CHRISTINE B E
MY COMMISSION# G
fission N0.GtGf 95a Jr�F� A-10
n EXPIRES: April4 2\oma
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
Customer
Address A-7 D/
City, State, Zip
We will furnisl
Make
SEER
InstaHatie�r-sfia
C-oPj /AS4 C--�
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772) 335-3232 • Fax ( 772) 335-1968
Proposal and Agreement
lee II'AD
_
Phone 7/L` A e
Job Address
Date
M
7 Work Phone(s)
install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Model Number(s)
EERY AFUE Btuh Cooling Btuh Heating CFM_
%� IG�`�S�—� J!�e 0) 'k
Anti.. iX /—j -P rant
f«IA.r aAirc �-, S%'LI(Arr;t( S'rm /_f' 10--(slttj It,/
a ° { n q3Z ; .IIcM yX3 d �tN�sc Uhl: iznu(/Yo�_3 d 20r
.OfT A$ X_-�6 -- Iclealy\ IW 0 — I rre_dA /$ 72YS — I rrulft 4 qi.Zp —
% _ S �4.), 7 I eeKc K-- \4 4N5 6 -- I r'h--L^ / \1 X 5 7_ o — Ir'h -C/- d t/q X 4
o� ✓1 a( �Taxes $ 0
Total Amount $
(P%/` rLJ S iv����' Down Payment $
Terms:
Acceptance (Customer)
By
Balance Due $
i Approval (Company)
Date By
Date
• X in boxes =Yes
❑ New Amp disconnect
❑Remove existing equipment from premises
❑ ew 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
EX Make 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
C3"Meet all code requirements
O
❑ New clean, dry ACR copper tubing
❑ Balance for uniform supply air distribution
Er' Com tete system start up
❑ Insulate refrigerant suction line(s)
❑ Provide for external combustion air
❑ year parts warranty
❑ Install refrigerant drier(s)
❑ New gas piping from to
❑ i/ year labor warrantyVieAl^,X
❑Evacuate refrigerant system
❑ New vent pipe and cap
❑ year compressor warranty
u Charge to manufacturer's specs
❑( Clean work area to customer's satisfaction
❑year se� ice -agreement
Meet all federal, state & local laws
d Condensation overflow safety switch
❑_sr -'•t / DRft.� ; oft5
J Clgtiew{bcltrw)
Q Hurricane as Heys or outdoor unit
❑ �87'',
Total Investment $
o� ✓1 a( �Taxes $ 0
Total Amount $
(P%/` rLJ S iv����' Down Payment $
Terms:
Acceptance (Customer)
By
Balance Due $
i Approval (Company)
Date By
Date