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HomeMy WebLinkAboutBuilding Permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -- ©ate: Permit Number: 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 -T PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ------------ PROPQSED IMPRQVI 1uIIwIT,LOXA�OtN Address: --f Legal Description: —{ �,^, r•on / Property Tax ID #: L-f Lot No. Site Plan Name; Project Name: Block No. Setbacks Front Back: Right Side: Left Side: ...�I:TAI�Eo a�scRlPTlQnI ol= rolzl�: [icoNTR U TEO N. I N FgRMAIONT 10 a.wto e e rm under r is permit -check a app Y UHOGasTank ❑Gas Piping Shutters QWindows Doors Electric El Plumbing Sprinklers El Generator Roof Roof pitch Total Sq. Ft of Construction: 5 . Ft, of First Floor: Cost of Construction: $ capJ Utilities:nSewer Septic Building Height: QWNER/11 EEF C UR Name c ,r Name: Address: Company: City: State' �L Address: fr- Zip Code: 3 q Fax: City: State:_L:]C Phone No. �-jy Zip ode: q 5a Fax: E-Mall: Phone No. F z 1 - Fill in fee simple Title Holder on next page ( if different E-Mail: c, 6 from the Owner listed above) State or County License: C� ff ►raiue of construction Is $2500 or more, a RECORDED Notice. of Commencement is required. Designer/Architeet/Engineer: Name Mailing Address City _ _.. Zip Phone © Not Applicable State Fee Simple Title holder's Name: Name Mailing Address City Zip Phone ❑ Not Applicable State Mortgage Company: Name Mailing Address City—. _. Zip Phone Bonding Company: Name Mailing Address City Zip Phone © Not Applicable State ❑ Not Applicable State Notice to Owner: There are some properties that may have deed restrictions recorded upon them. These restrictions may limit or prohibit the work applied for in your building permit. It may be to your advantage to check and see if your property is encumbered by any restrictions. Owner/Contractor Affidavit: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. 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 Code 6th Edition (2017) and Martin County Amendments. Plan revisions on all structures exempted by code from architectlengineer design may be done by permit holder. 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 commencing work or recording your Notice of Commencement. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. of Owner/Agent/Lessee STATE OF FLORIDA COUNTY OF MARTIN The f�oregoing instrument was acknowledged before me this ' :Y_. day of Ttr r G , 20 ,Qy (Name of Person Acknowledging) _ (Signature of Notary Public — State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) Pmonally Known OR Produced Identification Type of Identification Produced (FBC 6th Edition 2114,1 € AY L V n u Nu rm r V%tjotary Public -State of -Florida of Conuactor/License Holder STATE OF FLORIDA COUNTY OF MARTIN The foregoing instrument was acknowledged before me this.-I-4 day of ~3'� r . 2o2`-hy lZ— G (Name of Person .Acknowledging) (Signature of Notary Public — State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced IAYI OR CAC; F !nary Public -State of €orid Cr>rnmission ti GG 243167 r' fires A" Accessibilitv o be January 27, 2 by contacting the Coup r 2 3131, the County Administration Office (772) 28&SM, Florida Relay 711, or by completing our accessibility feedback format www.martin.tf.us/accessibility-feedback. res Rev. 01-19 Certificate of Product Ratings AHRI Certified Reference Number: 7599223 Date : 06-24-2020 Model Status: Active AHRI Type: RCU-A-CB Series : SILVER 14 Outdoor Unit Brand Name: AMERICAN STANDARD Outdoor Unit Model Number (Condenser or Single Package) : WA40361-1 Indoor Unit Model Number (Evaporator and/or Air Handier) : TEWA01330H21+TDR Region : Southeast and North (AL, AR, DC, DE, EL, GA, HI, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, WI, WY, U-S. Territories) Region Note.- Central air conditioners manufactured prior to January 1, 2015 are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016 central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. The manufacturer of this AMERICAN STANDARD product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of ANSIIAHRI 2101240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (A2) - Single or High Stage (95F), btuh : 33600 SEER: 15.00 EER (A2) - Single or High Stage (95F) : 12.50 f"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being marketed but are not yet being produced."Production Stopped' Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings Ehat are accompanied by WAS indicate an involuntary re -rate. The now published rating is shown along with the previous (i.e. WAS) rating. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.a h rid irectory.o rg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or In part, be reproduced; Copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's Individual, A-M personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.a h rid irectory.o rg, click on `Verify Certificate" link we make life better — and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which Is listed at bottom right C2020Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1323747119962056193