HomeMy WebLinkAboutGullini gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE: LP TANK
PROPOSED IMPROVEMENT LOCATION:
Address: 9512 Shadow LN, Ft Pierce, FL, 34951
Property Tax ID #: 1334-602-0106-000-3 Lot No. 225
Site Plan Name: Block No.
Project Name: Gulluni tank
DETAILED DESCRIPTION OF WORK:
Install 500 gallon underground LP Tank with gas line to generator and final connect
CONSTRUCTION INFORMATION_
Additional work to be performed under this permit— check all that apply:
`Mechanical Gas Tank Gas Piping _ Shutters Windows/Coors
— Electric _ Plumbing _ Sprinklers Generator u Roof Pitch
Total 5q. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4295.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jennifer Gulluni
Name: Manuel Tobar
Address: 9512 Shadow LN
Company: Thompson Gas
City: Ft Pierce State
' Address: 1786 SW Biltmore St
Zip Code: 34951 Fax:
City: Port ST Lucie State: FL
Phone No. $604905749
Zip Code: 34984 Fax-
E-Mail:
Phone No 7727778133
E-Mail
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
State or County Ucense beg*= )
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:
BONDING COMPANY: Not Applicable
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 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 ATJORNEY,,BEFORE RECORDING YOUR NOTICE OF JEOMMENCEMENT."
Signature of Owner/ Lessee/Contr`.�fctor as Agent for Owner
Signature of Contracfor/License Holder
STATE OF FLORID
STATE OF FLO
COUNTY OF
COUNTY OF�
The fo Ding instr nt was acknowledg before me
this day U lU
The fp {rg'oing instru ent was acknow€edg before me
of 2[l, )by
this n day of 24 by
Naryle 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
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(Sign ¢tr i ? gtary Bab[ 'r�ida )
(Signatur f-
! 1 Y ",i ••.. DANIELLE GONMVE
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= fi11Y COMMISSION # Ga 232946
Cvmrnissi NO �� =- My CoMmIS.SIiN # G� �s
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Com •: EXPIRES. dune 27, 2022 (S 1)
EXPIRES: lune 27, 202
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°f `° �nnr#ed ihru Idatar� Public UndarwritQn
sanded Tiiru Not Public Underwriters
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEWS=ROZONING
SUPERVISOR
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
*Treasure Coast 772-466-1095, 4252 Bandy Blvd. Fort Pierce, FL. 34981, Fax 77?-318-667?'
"Palm Beach 561-752-0214. 1700 Latham Rd. Suite 2, West Palm Beach, FL. 334119*
Proposal / Agreement
3ennifer Gulluni
9512 Shadow Lane
Fort Pierce, FL 3495.
860-490-5749
joe3ena 12(@aol.com
June 3, 2020
1) Thompson Gas to supply and install (1) customer owned 500 gallon
underground LP tank with gas line to generator and final connect
2) Obtain all permits & inspections needed
3) Price includes backfilling and removing dirt
4) Price does NOT include filling the tank with propane
NOTE. Tank and lune to be installed by Thom son Gas
Far the sum v, fs �_ $4,295.9
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 all charges billed, applicable taxes, applicable legal fees and
other charges/fees.
PropasaUContract pricing good for 30 days from Proposal/Contract date
$495.00 is clue @ Signing
$3,800.00 is due @ Generator startu
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:
Brian Orr
Acceptance of Proposal
ILi i
__j l (pri;,ted name), authorize Energized Gas to
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complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
j 1A
e.
Sig
Date,/") —3
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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 terms which are printed and those which are typed or written, th
typed or written language shall govern. e
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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
PRINTED NAND
JVf
`SIG NATU&E
DATE
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