HomeMy WebLinkAboutKistner gas app, contractAl! APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
e
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:S
PROPOSED IMPROVEMENT LOCATION:
Address: a'f , n G/(J o� .5 + �-0C►' e FL 3 y S lO
Property Tax ID #: 3 741 Lot No,
Site Plan Name: X;5 64tf
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
and rte a n eG
CONSTRUCTION INFORMATION: i
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Total Sq. Ft of Construction:
Gas Tank Gas Piping
Plumbing _ Sprinklers
Cost of Construction: $ . 6 15 . 0,0
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: — Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -rigName:
Blake Cowdel!
Address: $o`� / 7 / c itn le 64-t C
Corn pany:Energized Gas
City: Dc'1- J f 2-ocC State: 1-:L
Zip Code: 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@gmail.com
State or County LicenseLG34747
" I-- vI ♦.a. I]d%I U, LIU11 p y74Juu UI If lure, a KtLUKULU IVOL]Ce Gi LOMmencement 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:
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 hofder 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."
hxi� ��g
2a,& rtwxm
Signature o wner/ Lessee/Contractor as Agent for Owner
STATE OT FLORID. M . ^
COUNTY OF ; A
The or Ding instru ent w ac nowlecl before me
this ay of 20�y
(JA' (
Signature of Contractor/License Holder
STATE OF FLO
COUNTY OF
g instru en as acknowled before me
thif 20 by
ThT(YX
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
{signature of N r, <'xsliic,- 5taIi CALM 5
,.
*: *_ MY COMMISSION # GC- 232945
Commission No. "'• �•o, EkPIRES: 2022
.`' { �'
`oF rL Booded Thru Notary Public uncterwritars
Name of person making statement,
Personally Known `, OR Produced identification
Type of Identification
Produced
{Signature o
Commission
s'.
%fis' ' f?atblI - _ r
*: ic§Y . IN S 232946
-",,, EXPIRES:Jue2�7 2i?�
t !�= a
° *� Not r1 POIi nters
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.271
G
*,treasure Coast 772-466-1095, 4252 Bandv Blvd, Foil Pierce, FL, 34Q81. Fax 772-318-6672*
*Paltn Beach 561-752-0214, 1700 Latham Rd. Suite 2, West Palm Beach, FL, 33409*
Proposal / Agreement
William Kistner
8217 Martinggale Lane
Port St Lucie, FL, 34986
WPKistner@cimall.com
May 2oth, 2020
Energized Gas hereby agrees to furnish all labor and materials necessary for the completion of
services as specified below,
I) Supply and install underground gas line to generator and final connect
2) Price includes all labor, material and permitting
NOTE: Gas line to be installed by Thompson Gas
or the sum of.- $6 .00
TERMS:
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
$695.00 is due @ Completion
We appreciate the opportunity you have extended us ro, quore on MIS lNQrx ana vvvuru
like to thank you in advance for your consideration.
Authorized signature:
Michael Flaxman
Acceptance of Proposal
(printed 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. ,
Date
Signature
This agreement shall be construed under the laws of the State of florlda. 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 NOA/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
S 6c,
DATE
Page 3 of 3