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HomeMy WebLinkAboutKrchnak gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date Permit Number: s5r� LIl� OR h, © �.. .. C� t C.ti G OL Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential X 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FORIP WANK PROPOSED IMPROVEMENT LOCATION: Address: 2631 CONIFER DR, FT PIERCE, FL 34951 Property Tax ID #: 1334-502-0087-000-3 Site Plan Name: Project Name: Krchnak tank DETAILED DESCRIPTION OF WORK: Install 1000 gallon LP tank with gas line to generator and final connect New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit— check all that apply: _Mechanical IX —Gas Tank _ Gas Piping _ Shutters Electric _Plumbing _Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 4995.00 Generator Sq. Ft. of First Floor: Lot No.206 Block No. Windows/Doors _ Pond Roof Pitch Utilities: _Sewer Septic Building Height: OWNERAESSEE: CONTRACTOR: NameOoe Krchnak Name: Address:1522 Thumb Point Dr Company: City: Ft Pierce State: _ Zip Code: 34949 Fax: Phone No. 7725771Ill Address:1786 SW Biltmore St City: Port ST Lucie State: FL Zip Code: 34984 Fax: Phone No E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above} E-Mailenergizedgenerators@gmail.com State or County License it value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of HAVC 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 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 paying twice for improvements to your property. A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recording vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License older STATE OF FLORIDAC-IN STATE OF FLORI � � � COUNTY OF �V�� COUNTY OF A 9 fro Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of slcal Pres Online Notarization h sical Pre ence or Online Notarization to this ay of 2D20 by this y of Z02D by Name person making statement. Name of person making statement. _ �OR I Personally Known Produced Identification Personally Known` OR Produced Identification Type of Identification Type of Identification Produced � Produced t✓i_ JI � ��' lam' I (Signature o (Signatur Ot�V BUG DA1�IJELLE OONCAL`JES = ?' _ _ _ , YeU MNIELLF u°.sW' ES �� Commission € :t. t�lyCOUlt�ilSSIOlV# � 34fi Commissi "_ l�YCO€ R1lSSlt3ia#0(32 e�1) 4' EXPIRES: June 27, 2022 FnF "' ?'ac '[ i IRF:a: 'Ufl& 27, 20 F,q?, Bcrtded itiru NQfa c:�ded ;,It;, Tan.zry PublicUnderw 6tars REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. v, *Tivasiw Ccm,;l t 772-4 36-�095, Ba"dy Bhd, Fort Fierce. FL, 34981, FaN T72_ 18-66;�':, '' PaIiII Fiei1.ch-561-75-'-0.214L 1700 i.-a�A.lir m Rd, Suitt 2, Vv�,s i-�� fir &� ,Kx �, FL, 3401 : Proposal / Agreement Joe Krchnak 2631 Conifer ®r Fort Pierce, FL, 34951 772-577-1111 3oeK chn krexom April 29th, 2020 1) Thompson Gas to supply and install (1) customer awned 1,000 gallon underground LP Tank with 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 filling the tank with propane, first fill will be $1.99/g NOTE: Tank_and ling bg ins-t@11ed by Th m n Ggs 6r the sum o Charge & Payments: Charges are due in full at time serviees 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 4 5,00 its due @ Signing 500.00 is due @ Corn ietion vve appreciate one opportunity you have extended us to quote on this work and would like to thank you in advance for your consideration. Authorized signature. Roger Lussier Acceptance of Proposal sprinted name), authorize Energized Gas to complete the work in accordance with the above specifications and conditions. I agree to pay as per terms outlined above. ®ate d Sigc tore 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 SI ATU RE -FC ATE Page 3 of 3