HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- ;J
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) 462-1.578 Commercial Residential x
PERMITTYPE:GaS Line
PROPOSED IMPROVEMENT LOCATION:
Address: 12796 NW MARINER Ct, PALM CITY, FL, 34990
Property Tax ID #: 4425-603-0039-000-0 Lot No.
Site Plan Name: Block No.
Project Name: DeNisco gas
DETAILED DESCRIPTION OF WORK:
Install aboveground gas connection to generator and final connect
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank ?S Gas Piping _ Shutters _ Windows/Doors
Electric — Plumbing ^ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 895.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Chris DeNisco Name: R ' DAddress:
12796 NW Mariner Ct Company: FhQ ;' "[ -
City: Palm City State:-TU Address:1786 SW Bilt . re St
Zip Code: 34990 Fax: City: Port St Lucie State: FL
Phone No. Zip Code: 34984 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page { if different E-Mail energizedgenerators@gmail.com
from the Owner listed above) State or County License
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:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 thepermit 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:
41 U-1AU
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF
Theomg instr ent was acknowledbefore me
this )Nay of 2 by
f-� I( I ve ( . - )�- J
Name of person making statement.
Personally Known OR Produced Identification _
Type of Identification
Produced
YA
(Signature of Nota ry Public- S e of Fllpc d
taYA DANIELI GONIALVE5
Commission No, COVMI M�GG232946
EXPPES: June 27, 2022
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. I1771 -T--
_&� am,&(..0 _
Signature of Contractor/License Holder
STATE OF FLORtD
COUNTY OF
Thea ping instr meet was acknowled d before me
thi — " day of Z by
Name of person making statement.
Personally Known 'IC OR Produced Identification
Type of Identification
Produced
(Signature cjf_.Publi-;5e oQ d4.,
�.
;GG 23294
Commissia 1� Ir". 27,2i{l5pa
PubiioUtidenrrr Xg
SUPERVISORPLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
*Treasure Coast 772-466' 1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-5672*
Palm Beach 561-75 -0-214, 1700 Latham Rd, Suite 2, West Palm Beach, FL, 33409*
I
Proposal / Agreement
Chris Denisco
12796 NW Mariner Ct
Palm City, FL, 34990
CDenisco(ablive. corn
April 2V, 2020
1) Thompson Gas xfl supply and install aboveground gas line to generator and final
connect
2) Obtain all per, &inspections needed
or the sum of. --
95 -- -
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 ail charges billed, applicable taxes, applicable legal fees and
other charges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 iS due @ Signing
400.00 iS due Q. Completion
inr.,
..r.,r„ , —wLL Li 1c; UPruI I U11 ty yuu f7d ve extenaea us to quote on this work and would
like to thank you in advance for your Consideration.
Authorized signature:
James Cowdell
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.
r
SitanatUr�
Date J —:�d�0
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 terns 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 f=inal 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 NA)41E
SIGNATURE
DATE
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