HomeMy WebLinkAboutMoxham gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
`C G1K.
Ln' tv 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 Tana
PROPOSED IMPROVEMENT LOCATION:
Address: 1537 NW Sweetbay Cir, Palm City, FL, 34990
Property Tax ID #: 4426-803-0050-000-0
Site Plan Name:
Project Name: Moxham gas
Lot No.
Black No.
I DETAILED DESCRIPTION OF WORK: I
Install 500 gallon underground 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 ` Gas Tank —Gas Piping _ Shutters
— Electric _ Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 4000.00
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Douglas Moxham
Name:
Address:1537 Sweetbay Cir
Company:1�Cr��.�_A
City: Palm City State
Zip Code: 34990 Fax:
Phone No.7728783571
Address:1786 SW Biltm�re St
City: Port ST Lucie State: FL -
Zip Code: 34984 Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next pager if different
from the Owner listed above)
E-Mailenergizedgenerators@gmail.com
State or County License `
If 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.
5LIPPLEMENTAL CONSTRUCTIQN LIEN LAW INFDRMATIDN: �
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 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.
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 Hoene 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 poo€s, 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6f C&c.`e_
COUNTY OF
Sworn to {or affirmed} and subscribed before me of
Physical Presence or Online Notarization
this L day of _ ,S vn e 12020 by
Sworn to {or affirmed} and subscribed before me of
V Physical Presence or Online Notarization
this /e- day of 3'Qet e- , 2020 by
--IVIC—nVe-1 Tnbo!{L
12iGrn ual obaLf-
Name of person making statement.
Name of person making statement.
Personally Known `� OR Produced Identification
Personally Known i� OR produced Identification
Type of Identification
-
Type of Identification
Produced A
(Sig ture of Notary
Notary Pub Staff o[ Florida
Commission No. James ssm GG!
Comrrli:saon 236434
Expires 0710912022
Produced
AM
(Sig tore of Not - e f Florida).
Commission No. NotS wCp p� +
MY Commission GG 4W434
or Expires 071)RO
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS VEGETATION SEA TURTLE A OVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
*'Yreasure C trust 772-466-1 OQ5, 4252 Bandv Bled. Fort Fierce. t" l.. 34981. Fax 7
`'htlm Beach 561-75?-0" 14, i 701) Latbmi Rd. Suily ?, West Palm BQm:h, Fi
Proposal / Agreement
Doug Moxham
1537 5weetbay Ci r
Palm City, FL, 34990
772-878-3571
Doug Mox 1942@)amaii.com
1) Thompson Gas to supply and install (1) customer owned
underground LP tank with gas line to generator and final
2) Obtain all permits & inspections needed
3) Price includes backfiiling and removing dirt
4) Price does NOT ir7clude filling the tank with propane
s) /fir- j i�C Ie f. p�n
NOTE: Tank and line to be installed by Thom son Gas
18-6672*
3 -1,109*
500 gallon
connect
7th, 2020
['or the sum of.- $4,000.00
AS Ea
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
appl[cable 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 1S die @ Signing
$3. ,05-00 iS due @ Generator
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
Acceptance of Proposal
(panted name), authorize Energized Gas to
�r
complete t work in accordance with the above specifications and conditions. i agree to pay as per
terms outlined above,
Date
naru
2 0
This agreernerit shall' bd construed -under the-laws•of the State of Florida: This -agreement -contains the -entire ubderstanding 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 [anguage shall govern.
Pave 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
-/� /-n 0/- �6 --, 0-, ° �a"-e
WNTO NAME
2�
SIGN URE DATE
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