HomeMy WebLinkAboutHeming gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Mr. wccmg
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E, 15 1° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:GaS tank
PROPOSED IMPROVEMENT LOCATION:
Address: 9401 Poinciana Ct Fort Pierce, FL 34951
Property Tax I D #: 1334-503-0024-000-7
Site Plan Name:
Project Name: herrings gas
Lot No.22
Block No.
DETAILED DESCRIPTION OF WORK: j
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 Y&as Tank —Gas Piping Shutters Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 4295A0
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Alfred Hemings
Name:
Address:9401 Poinciana Ct
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Company: lqvb
Address: V
City: Ft Pierce State:
Zip Code: 34951 Fax:
Phone No.
City: Vt
{� State:`
Zip Code:; r � k +Cl t Fax:
Phone No _)IN 1(X6
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail
State or County License ns �I-b
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
❑ESIGNERIENGINEER: _ 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: iNot 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 paying twice far
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
wlin Ienaer or an attorney oetgre copmencing work or recorcling your Notice of Qa0Mencement.
Signature of Owner/ LesseeXorAractor as Agent for Owner I Signature of Cc6tActor/License Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF COUNTY OF C�6
5wo-r-n to (or affirmed) and subscribed before me of
�3 Physical PreAence or Online Notarization
this ;KLhay of . 2020 by
tl I ( P r 0JJ tl.M \M (A �
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Pwduced
{Signature of Ndf - at�a-Flofi°Fr5
� uy CDPfN1iS`aii11 f} La{j 23234(
Commission No. • �`; r',� ':"- QiRES:4,Sgg- 2422
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REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DAZE
COMPLETED
Sworn to (or affirmed) and subscribed before me of
hysical Presgzce or Online Notarization
this ay of - 2020 by
Name of person making statement. '
Personally Known `� OR Produced Identification
Type of Identification
(Signature of NotMlkllrELLL
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Commission No. "? *- CCikiMIS51��; 232946
Eon cd is ru ilrr, u�lie [lsrdrs�tr,t�r
$UPERVISREVIIEWOR REV EW PNS I y REVIEW I SEA TURTEV EWLE MANGRO
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*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1700 Latham Rd, Suite 2, West Palm Beach, FL, 33409*
Proposal / Agreement
Alfred Hemings
9401 Poinciana Ct
Fort Pierce, FL, 34986
772-468-9931
BudHemings@aol.com
June 411, 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 fine to be installed by Thompson Gas
or the aura. of: $4,2 .00
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 ail 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
othercharges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 is due @ Signing
3 800.00 is due @ Completion
vve 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 Pra ❑sal
1, � �`-'' 41kIly5 (printed name), authorize Energized Gas to
complete the work in accordan e with the above specifications and conditions. I agree to pay as per
terms outlined above.
S-
Signatu
❑ate ' z�s n
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, the
typed or written language shall govern.
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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 pall a permit and can be submitted
along with this signed proposal.
*To include sod replacement a charge of $335 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
PRINTED NAME
SIGN TORE
G04,0
4�
DATE
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