HomeMy WebLinkAboutOlson gas app and contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: (:�, T
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: F' 3 $ /
Property Tax ID #: �� f 6.756 3 " C3)0 S i �, 00 C� _ Lot No. P
Site Plan Name: 6150a 6"-5 Block No. 1
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCT[ON INFORMATION:
Additional work to be perform�d under this permi — check all that apply:
_Mechanical was Tank Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ GC' a
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name`�yc 2 plSG<l
Name: Blake Cowdell
_
Address: u e [ eS
Company: Energized Gas
City: � -i �1' cG� State:L
—to
Zip Code:g �Q, Fax:
Phone No.
Address:1786 SW Biltmore St
City: Port ST Lucie State: FL
Zip Code: 34984 Fax:
Phone No7727778133
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail energizedgenerators@gmaii.com
State or County License LG34747
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
MORTGAGE COMPANY: Not Applicable
Name:
�
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE BOLDER: 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."
r- (�M&
Ildt (W.A"
Signature of Owner/ Lessee/ ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO
STATE OF FLOnl_
COUNTY OF ��,UUA
COUNTY OF
Th forgoing instr ment was acknowledged before me
thi day of E 2q by
The instr ent was acknowledged before me
thisy of 20_ by
��
tfotgoing
rc IL
Name of person making statement.
Name of person making statement.
Personally Known dOR Produced identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ir
{Signature of a [c- StftfDWALVE3
MY COMMISSION # GG 232HO
Commission N i"i �_ IRES:JU{ Ipm
Iloi�ded Y
�''••.,, ,.. '!hullotary
{Signature of Nota �23 5
:q>EoQ�' EXPIRES: June �
Commission No. I ; . � w "r , n
" SOrrdadThruN c Underwriters
PLANS
VEGETATION
SEATURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 1
f
Energized Gas Inc
Ccopwe cmd cffatulud cfa.3 8peciaA6t
Bruce Olsen
5650 Travelers Way
Fort Pierce, FL, 34982
484-343--2015
Br cg@5valize.corn
March 121h, 2020
1) Supply and install (1) customer owned 500 gallon underground LP tank with
extended gas line to generator and final connect
2) Obtain all permits & inspections needed
3) Price includes backfilling and removing dirt
4) Price does NOT include tilling the tank with propane
NOTE: Tank and line to be installed by Thompson Gas
®r the sum of.- $4,24�•�
t786 SW Biltmore St, Part ST Lucie, FL, 34984 *Licensed & Insured FL34747
Toll Free 855-PROGAS4 *Treasure Coast 772-777-8133 *Palm Beach 561-752-0214 *Fax 772-318-6673
PRMm
Charges & Payments: Charges are due in full at time services are rendered unless otherwise stated below. Contractor may
charge and customer agrees to pay a late -fee for all past due payments, such fees not to exceed the maximum allowed rate by
applicable law. Customer shall be responsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees and
other charges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$2,122,50 is Niue @ Tank Installation
2,122.50 is due @ Completion
virtj dpprecrare me opporrunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
{
Authorized signature:
Mich I VFlaan
Acce tance of Proposal
02 (printed niame authorize Energized Gas ). g to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date o�
Signature
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of the
parties and supersedes all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or written, the
typed or written language shall govern,
Page 2 of 3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of installation*. This includes but is not
limited to, damaged/broken sprinkler lines and/or damaged/broken water or sewer lines.
This contract price does NOT include bonding gas lines, converting outlets, converting appliances or
carbon monoxide detectors
Additional charges may apply if rock and/or roots are encountered during the excavation process.
Deposit will be forfeited if customer cancels after the permit process is initiated.
Customer is responsible for obtaining HOA/POA approval. Installer is not responsible for customers failing
to obtain final approval.
If home is located in flood zone, the additional cost will be the responsibility of the homeowner if a tank tie
down, or buoyancy pad is required per the building department
A site survey of your property showing all property lines is required to pull a permit and can be submitted
along with this signed proposal.
*To include sod replacement a charge of $395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
PRINTED NAME
SIGNATURE
DATE
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