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HomeMy WebLinkAboutPierson gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: OWN Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: LP TANK PROPOSED IMPROVEMENT LOCATION: Address: 6043 Alexandria CIR, Ft Pierce, FL 34982 Property Tax ID #. 3410-503-0173-000-5 Site Plan Name: Project Name: Pierson tank DETAILED DESCRIPTION OF WORK: Permit Number: Building Permit Application Commercial Residential x yu W" U191tJU1IU Lr- I d1IY. WILF] gas Ilne to generator and final Connect CONSTRUCTION INFORMATION: Additional work to be performed under this permit— check all that apply: _Mechanical Gas Tank i Gas Piping Shutters Electric Total Sq. Ft of Construction: Plumbing , Sprinklers Cost of Construction: $ 2995.00 OWNER/LESSEE: Address: 6043 Alexandria CIR, City: Ft Pierce State: Zip Code: 34982 Fax: Phone No. 2488672605 Generator Sq. Ft. of First Floor: Lot No. 4 Block No. F Windows/Doors ` Roof Pitch Utilities: —Sewer —Septic Building Height: E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Name: Vldr�" Company:"+ r ' j t C Address: City: State: FL Zip Code: Fax: Phone No E-Mail State or County License xi" 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:_ Address: city: Zip: Phone FEE SIMPLE TITLE HOLDER: Name: Ad d ress: City: Zip: Phone: State ` Not Applicable MORTGAGE COMPANY Name: Address: City: Zip: Phone: Not Applicable State: BONDING COMPANY: Not Applicable Name:_ Address: City: 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, 1 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 COMMENCEMENI, MUST BE RECORDED AND POSTED ON THE 6 SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND T TAIN FINANCING, CONSULT WITH YOUR LEN R OR AN ATTORNEY BEFORE RECORDING YOUR NOTI MMENCEMENT." Signature of OyVnerl LessA/Contractor as Agent for Owner STATE OF FLORI" COUNTY OF The forgoing instr ent was acknowledged before me this W11day of ZO-b by i Naryle of person making statement. Personally Known OR Produced Identification Type of Identification Produced Holder COUNTYOF ORID The forgoing ins�wment was acknowled ed before me this day of t 2by Name of person making statement. Personally known X OR Produced identification Type of identification Produced (Signature of Notary I ,,� :r;R: {Signature of N roc. c- StaRf�giDbriALVES DANIELLE MYCOM%JJS3I0i1#.GG232946 Commission No. - •= MYOQM(�1�SI�N gG232946 Commission Na. =� PiRE5: J6@j�ii22 � `• , •�;:� EYPtRES:.iuhe 27, 2022 Sornja� 7:.,i,!!at„ �. �; i ;;'c' Bonded Tnru fd�t�;'r r'u6rc Uroicawnt�r � _-- (u6li REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 1 F. f 1 - 7[ *Treasure. Coast 772-460-1095, 4252 Bandy Bled, I~on Pierce, FL, 34981, Fax 772-319-6672* *Palm Beach 561-752-02I4, 1700 Latham Rd, Suite 2, Vest Palm Beach, FL, 33409* Proposal / Agreement George Pierson 6043 Alexandria Cir Fort Pierce, FL 34982 248-867-2605 G Pierso nno7 S PCGlo ba l . net June 3, 2020 1) Thompson Gas to supply and install (1) customer owned 250 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 line to be installed b Tham son Gas f mil" t]i� SxlT�. � � ��� ���]• i]� 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 othercharges/fees. Proposal/Contract pricing goad for 30 days from Proposal/Contract date $495.00 is due @ Signing $7500.00 is due @ Generator startup We appreciate the opportunity you have extended us to quote on this work and would like to thank you in advan for your e sideration. Authorized signature: -� Tian Orr Acceptance of Pro�asal E r IC' S ©/U (printed name), authorize Energized Gas to complete the work in accordance with the above specifications and conditions. I agree to pay as per terms outlined aba4. Signature Date This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of the parties and supersedes ail 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. Page 2 of 2 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 6r-c> iz 6 � -7- P, jE A-) PRINTED NAME , SIGNATU -S'2- DATE Page 2 of 2