HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 0 I a Permit Number:
0.
Building Permit. Application
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue, Fort Pierce FL 34982 Resi:ential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Additional 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: $ ��3� .00
Sq. Ft. of First floor: _
Utilities: _Sewer _Septic
OWNER/LESSEE:. -:
Name73-vSevh Eliza6e ('aJ' Ong
Address: f77 M(�-}-er� n e.�✓1 L'�
City: t2n r �- '54- �U C i r State: FL
Zip Code: Fax:
Phone No. �U
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Building Height:
Name: Curtis Sammons
Company: Custom Air Systems, Inc.
ea�rP«. 1615 SE Village Green Drive
City: Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
P h o n e N o 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:
City: State:
Zip: Phone
Address:
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 ana instaiiauon as inaicdLcu.
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 orpprohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which mayapply.
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."
,—I_
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA p STATE OF FLORIDA
COUNTY OF X16-oC �%' COUNTY OF
The forgoing instrument was acknowledged before me The forg$oing instrument was acknowledged before me
this day of r I ( 20 �Uby this ;0 day of A p t - i � . 20�bby
��ji' �1� Sq MmGns C�G[RTlS S/3i�1Is20nS
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
5 2 S`,6 otic PU, CHRISTINE B ENI
Commission No.4Gt Y MY COMMISSION 0G
t a
o EXPIRES:Alid4.
!._ 4
Personally Known %' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Flori CHRISTINE B E
ro ; ...�,
ISH No. Cl a 95a 5 `� 6 � MYCOMMISSIONI
)21
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
r Y�
r
fo
pz,n(c ( ✓
C� � 160.01 Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
( (772)335-3232 • Fax(772)335-1968
1�
Proposal and Agreement
U
Customer Name '5 , k C—CV `One Phone v� / ����y Date
Address
17-7 ej % ` & f O1/lE�/a�Wd1ob Address _
City, State, Zip raj F/ � -9'fT6a Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal
setKs 1
Equi ment Specifications
el Numbers I -7
Make Mol p j/
SEER EER AFUE Btuh Cooling— Btuh Heatingr CFM
Installation shall include:
JX in boxes = Yes
J❑ New Amp disconnect ❑ Remove 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 ❑ Make air tight plenum transition ❑ New high efficiency air filter
IC 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 ❑ Meet all code requirements
❑ New clean, dry ACR copper tubing ❑ Balance for uniform supply air distribution ❑ Complete system start up
❑ Insulate refrigerant suction line(s) ❑ Provide for external combustion air ❑ year parts warranty
❑ Install refrigerant drier(s) ❑ New gas piping f to ❑ year labor warranty L
❑ Evacuate refrigerant system ❑ New ven r compressor warranty
❑ Charge to manufacturer's specs Clean work area customer's satisfaction ❑ year i agreement I
❑ Mee all federal, state & 1 ws ❑ Condensat' ov flow safety switch ❑ `I
❑ Hurricade sten rs for outdoor unit "7D_-0 t)�
Option (below) ❑ Total Investment $
Ir - a
Taxes $
r 1 Total Amount $
pDown Payment $
� Balance Due $
Ter
A eptance ( sto ) Approva an
n B Date By
Date �8