HomeMy WebLinkAboutBuilding PermitAIM APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (0 A Izi -za-D` 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) 462-1.578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: -I ` l lcG _ �{ i � V C,-7
Property Tax ID #: ` 1515 - N_ tcl `Dic - S Lot No. I
Site Plan Name: IZ Voir 7aVILL
,r1 Block No.
Project Name: _ 1 -" al G� U r) G1� D
DETAILED DESCRIPTION OF WORK:
VV
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
Mechanical _Gas Tank —Gas Piping _Shutters _ Windows/Doors
_ Electric — Plumbing _ Sprinklers _ Generator _ w_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
11
CONTRACTOR:
Name QV_ CLr) nI C:L-1C(C!i`1cid,0
Name: 0_U
Address:_=q L 7r I r ? )n \/kd I 131VG1
Company:
Do
City: R YJ_ SSA , C i C_ State: T!U
Zip Code: 34 q„5 Fax:
Phone No. - -MID l U)
Address:
City: VA' Q-]' C,1
Zip Code: -340-1Q) t t
Phone No 5L0 t ' � Low
Stater
Fax: L�� D I
• 32 -SD
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail
State or County License G[Ac_ 62- on (_0
VON U= WI i V117L1 UUUVII 1] ?4JULF Or F"Ure, a KrLUKUtu IvoTue or 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, wails, 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 J013 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1Sev. L/ // Ay
Signature of Owner/ Lessee/ tractor as Agent for Owner
Signature of Co tractor/L€cense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 3L Lyt zx
COUNTY OF Jaz r' L- -kl-t
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this,day ofu 20 20 by
this d y ofi i.i 20 by
S'1.�5"�7a ,1 �' Lei ►�i+—��
n'�
���-� l i-� �G�P_ f
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 - -PL,
Produced _E L. _D L
U
(Signat f Notary Public- State of Florida j
(Signature of otary Public- State of Florida )
Commission No.
AUDREtS$�)MER
Commission No. ��ff..
sr �aAUDREY STUENMER
NotaryPuhlic State of Florida
• Nctary Public - State of Florida
Commission GG 317544'_°
REVIEWS
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Commission S G 317544'"
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VEGETA
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REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
1Sev. L/ // Ay
Certificate of Product Ratinas
AHRI Certified Reference Number: 9194415 Date : 07-19-2020 Model Status: Active
AHRI Type: RCU-A-CB
Series: 14 SEER AC
Outdoor Unit Brand Name : CARRIER
Outdoor Unit Model Number (Condenser or Single Package) : CA14NA042*0**A*
Indoor Unit Model Number (Evaporator andlor Air Handler) : FB4CNF042L
Region: Southeast and North (AL, AR, DC, DE, FL, CA, 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 CARRIER product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 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 : 39500
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 11.50
t"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 Certificafion Program Participant is no longer producing BUT is still
selling or offering for sale.
Ratinas that are accompanied by WAS indicate an involuntary re -rate. The new Dublished rating is shown along with the Drevious (i.e. WASI ratina.
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.ahridirectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI_ This Certificate shall only be used for individual, personal and
AM
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,
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.ahridirectory.org, 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.
@2020Air-Conditioning, Heating, and Refrigeration Institute
CERTIFICATE NO.:
132396718346149924