HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
CdUNIYY
F L. O R' I D R
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:GAS LINE
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential x
Address: 9032 Champions Way, Fort ST Lucie, FL, 34986
Property Tax ID #: 3334-501-0048-000-1
Site Plan Name:
Project Name: Ruggles gas
Lot No.34
Black No, A
I DETAILED DESCRIPTION OF WORK: I I
install above ground gas line to generator and final connect
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank eSGas Piping _ Shutters Windows/Doors
Electric —Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 800.00
Generator Root Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name Brian Ruggles
Name: UGNi Y-
Address:9032 Champions Way
Company:_h(J r, �
City: Port ST Lucie Stater
Zip Code: 34986 Fax:
Phone No.5169711057
Address:1786 SW Bilimore St
City: Port ST Lucie State: FL
Zip Code: 34984 Fax-
Phone Nona
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
State or County License�_��L-}
IT value or consiruciion is !>25uu or more, a KrL:UKUEU 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: lV
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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.
holder to build the subject structure
St. Lucie County makes no representation that is granting a permit will authorize the any
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 5t. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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."
hjTz,
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Sf C/'Ve•' e
STATE OF FLORIDA
COUNTY OF Lr✓G •`-e
The forgoing instrument was acknowledged before me
this /'K day of _`jy rje . 20.10 by
The forgoing instrument was acknowledged before me
this _/9 day of , erne 20,A -) by
Mc. -noel To6%,r
fiver , —1,06 C,r
_
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
{Si ature of Nota I
[Si ature of No
Notary Public State of Flanda
Commission No. Jart�a W C�11
Fry mess G 936434
Expires 07H]912422
Notary Public of Florida
Commission No. James W CAW
IL
•MWres OMY TI�g p2 GG z36434
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
1
e�.
"Treasure Coast 777-460-1095 - 4752 BandN Bled_ Fart Piace. FL. 41)81, Fwr 772-318-667?:::
*Palm Beach 561-752-0214. 1700 Latham Rd. Suite I West Palm Beach, FL, 3 409*
Proposal 1 Agreement
Brian Ruggles
9032 Champions Way
Port 5T Lucie, FL, 34986
516-971-1057
RugglesB@me.com
4rh, 2920
1) Thompson Gas to supply and install aboveground gas line to gen rator and final
connect
2) Obtain all permits & inspections needed
NOTE: Line to be installed lay Thom son Gas
LF the sum oh $SOO.00
Ties°
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 ProposaI/Contract date
495e00 9*, dUS @ SE0'1FTl
We appreciate 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 Lussier
W.****************** ***********
Acceptance of Proposal
i, �-� , Z--S-- (printed name), authorize Energized Gas to
complete the work in accordance wiitl'the above specifications and conditions. I agree to pay as per
Date
This agreement shad 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
tped or written language shall govern.
Page 2 of
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
KxC1117/"d /'j
PRINTED NAME
NA
DATE
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