HomeMy WebLinkAboutSenn gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit; Number:
i
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Building Permit Application
Planning and Veve�aprnent Services
Building and Code Pegulation Division
2300 Virginia Aver) ue, Fort Pierce FL 34982
Phone: (772) 4611-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE"
GaS lICIC:
PROPOSED IMPROVEMENT LOCATION:
Address: 1618 NWI BUTTONBUSH CIR, PALM CITY, FL, 34990
Property Tax ID #: 4426-840-0004-000-8 Lot No.3
Site Plan Name: Block No.
Project Name: Seim gas
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DETAILED DESCRIPTION OF WORK:
Install underground gas line to generator and final connect
1 CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank -gGas Piping Shutters
Electric I Plumbing
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Total Sq. Ft of Cons'ruction:
Cast of Construction: $ 1295.00
OWNER/LESSE
Name Laurence Sonn
— Sprinklers
Address:1618 NW, Buttonbush Cir
City: Palm City State:
Zip Code: 34990 Fax:
Phone No.7723439912
E-Mail:
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
Fill in fee simple T�tle Holder on next page ( if different
from the Owner listed above)
CO NTRACTO R.
Name: Blake Cowdell
Company:Bnergized Gas
Address:1786 SW Biltrnore St
City: Port ST Lucie State: FL
Zip Code: 34984 Fax: 7723186672
Phone No7724661095
E-Mail energizedgeneratars@gmail.cam
State or County LicenseLG34747
If value of constructi_ln is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7i500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENOINEER: , Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no wor or installation has commenced prior to the issuance of a permit.
St. Lucie County makles na 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 andcovenants 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 Uie 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 buifdin� 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.'
Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The Nr%ng instrur'n was acknowledg�dJ before me
this r day of f� 20
�[ j by
Rlavo (_ 0,rAJ_0
Name of person
Personally Known OR Produced Identification
Type of Identification
Produced
[signature of T 5 ;�,u ie "�piF,�1� L I�LVES
MY COMMISSION 4 GG 232945
Commission N ="= -_
. _ IRES, Jar�l 4022
�•` 1': `. Of..•nfed'I;uu Nniary NhIl Lind rvrr'sle
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of �ContraAto,Holder
STATE OF FLORI[ —
COUNTY OF
The fob ing instrumpnt was acknowledg d before me
this U day of __-! F /0 3 6y
A
Name of person making statement. iii••1
Personally Known~ OR Produced Identification
Type of Identification
Produced
(Signature of rf-it.
ic-' MYCOMMISSiON 4 GG 232946
Commission N "r -; EXPIRES: June (may
_yru Notctrr f ur3F. die,a
Llrrdrn
PLANS I REVIEW VEGETATION
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$EA REV EWLE I
MANGROVE
,asurq Coast 772-466-1095, 4252 Bandy Blvd. Fort Pierce FL. 34981, Fax 772-318-6672�
*Palt Beach 561-752-01-14, 1700 Latham Rd, Suite -' Vdist Palm Beach, F1., 33409*
Proposal / Agreement
Laurence Senn;
1618 Buttonbulsh Or
Palm City, FL, 34990
772-343-9912 i
LUSenn@aol.c m
May 4th, 2020
1) Thompson Gas to supply and install underground gas line to generator and final
connect
2) Obtain all permits & inspections needed
NOTE: Trine to be installed by Thompson Gas
T RMSa
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
$495.00 is due @ Signing (PAID �S/A4/2o2Q)
$800.00 is due 0 Cosnpl tion
We appreci,'te the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
Roger fussier
Acce tance of Pro oral
AdIZl;�A44 �L(printed name), ), authorize Energized Gas to
complete the�ork in accordance with the above specifications afid conditions. I agree to pay as per
terms outline above.
Date
Signature
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This agreement shall b; construed under the laws of the State of Florida. This agreement contains the entire understanding of the
parties and superseded all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If an conflicts exist in this agreement between terms which are printed and those which are typed or written, the
typed or written language shall govern.
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CONTRACT TERMS AND CONDITIONS
Installation will c mply 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.
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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 buoyangy 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
>�� 1,11-2
SIGNATURE
6-- j 3 7-0
DATE
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