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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: H - L.�' a 2a Permit Num er: J - s Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Building Permit Appli4ation Commercial X residential PERMIT TYPE: H Y(vC C�9e 00+ CONTRACTOR: PROPOSED IMPROVEMENT LOCATION: Name Ib570 S.uS 1 _ LLC Address: 57C) S. US 14LOSA Property Tax ID #:341g-Sp,�� - Lot No. 2 " 3 Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: 7 CONSTRUCTION INFORMATION: I 1 Additional 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: $ J' , oo . C) L-) Utilities: —Sewer _Septi- Building Height: OWNER/LESSEE: CONTRACTOR: Name Ib570 S.uS 1 _ LLC NamCe- DcompAy: Address: Sf- City: Zip Code: 3Lwpes Phone No. '7-7?_ E -Mail State or County License 1 1 � Address: �EBlidt City: D State: RL Zip Code: 3LIgW(D Fax: Phone No. Stoll -� R,_;;45z 1 E -Mail: CbM State: Fax: O - Fill in fee simple Title Holder on next page ( if different from the Owner listed above) C)*-- 189 4 (10(4 If value of construction is $2500 or more, a RECORDED Notice of Commencement is rec 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: Address: MORTGAGE COMPANY: Name: Address: City: Zip: Ph Not Applicable City: State: Zip: Phone State: ne: FEE SIMPLE TITLE HOLDER: Not Applicable Name: BONDING COMPANY: Name: Address: City: Zip: Phone: Not Applicable Address: City: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to o 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 cove ants 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 espects, 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 COMME EMEMT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTENI I TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE O COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor icense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this _ day of , 20_ by this _ day of 1 20_ by Name of person making statement. I Name of person making Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public- State of Florida) I (Signature of Notary Pu lic- State of Florida ) Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIC N SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED FLORIDA INDIVIDUAL ACKNOWLEDMENT F.S. 117.05(13) – Effective January 1, 2020 State of Florida County of �4- LLA- c�Q. CALLIE RICHTER MY COMMISSION # GG 319533 T Qo: EXPIRES: April 21, 2023 Bonded Thru Notary Public Undervrtiters (Place Notary Seal Stamp Above) The foregoing instrumen was acknowledged before me by means of [fJ Physical Presenc ❑ Online Notarization this A— day of (i l 2 2q� , , by i c, hCA-e l (Name of Person Ackno ' dging) (Signature of Notary Public -State of Florida) C'�'tr ', { 'ie f (Printed Name of Notary Public) 7Personally Knox IrJ Produced Ident Type of Identifii c tion ►n Produced: s Law - Description of Attached Document Complete this section to deter alteration of the document or fraudulent reattachment of 1hisform Title or Type of Document: u.+) i Oe(M k Document Date: (7 /,x /�� Number of Pages of Signer(s) Other Than Named Above (i.e. witnesses, minors, etc.): /u / to on unintended document. It cafiof-) Original Document: � 0 www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number: 8459158 Date : 04-15-2020 MoJel Status : Production Stopped AHRI Type: RCU-A-CB Series: LX SERIES Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : TC4136021 Indoor Unit Model Number (Evaporator and/or Air Handler) : AE60CX21+TXV Region: Southeast and North (AL, AR, DC, DE, FL, GA, HI, KY, LA, MD, MS, NC, OK, S,-, TN, TX, VA, AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SQ, UT, VT, WA, WV, WI, WY, U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015 are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016 central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. The manufacturer of this CHAMPION HEATING AND COOLING product is responsible for the rating o this system combination. Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsore d, independent, third party testing: Cooling Capacity (A2) - Single or High Stage (95F), btuh : 56000 SEER: 14.25 EER (A2) - Single or High Stage (95F) : 12.00 ?"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling oro fering for sale; OR new models that are being marketed but are not yet being produced.?Production Stopped? Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an involun a re -rate. The new Dublished ratina is shown adono with the Drevious i.e. WAS ratin . DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarant s as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of th use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configuration listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS "12, This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, pe sonal and At confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; isseminated; A. ■.� la entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user' individual, personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link a make life better - and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right ©2020Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: X32314449484880224