HomeMy WebLinkAboutBuildiing permit appAll APPLICABLE INFO MUST BE COMPLETED FOP. APPLICA T ION TO BE ACCEPTED
Date:
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERM iT TYPE: �
PROPOSED IMPROVEMENT LOCATION:
Address: 6�' �}
Property Tax ID #: � T �G 5�j (
Site Plan Name: to CL L�
Project Name:
DETAILED DESCRIPTION OF WORK:
QDO rn q
CONSTRUCTION INFORMATION:
gt'-Fei—
Commercial Residential
n(V
Quo
Lot Na.
Block No.
if Nle
S ri PT
Additional work to be performed under this permit-- check all that apply:
°Mechanical ` Gas Tank — Gas Piping Shutters
— Electric — Plumbing —
Totai Sq. Ft of Construction:
Cost of Construction: $ 6-7 V,
OWNER/LESSEE:
Name i !7 �
Sprinklers — Generator
_ Sq. Ft. of First Floor:
City: H- State:
Zip Code: 03a U Fax:
Phone No.
E-Mail:
Utilities: —Sewer _Septic
Fill in fee simple Title Holder an next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:fit
Company:.
Windows/Doors
__._ Roof Pitch
Building freight:
City: / -�
FL
State:
Zip Code: Fax: JrG� 1 �� tJO
Phone No.��p�� �� QE..,L�(�
E-Mail L.i✓ LUS I- CQr'll
State or County License tiG 121 � .j
If value of construction is $250D 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:
City: State:
Zip: Phone:
Address:
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 Rome 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 morns 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
QI
l
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatur of C ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALM BEACH
CO U NTY OF PALM BEACH
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this lay of ; 202L)by
this 2zday o't 209Dy
RORY RAMCHARAN
RORY RAMCHARAN
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
l�
i
(Signature of Notary Public- S
nature of Notary Public- St I i }
Notary PUMC State of FI
Commission No. Frq-10to (�y liLLEALI-AMRAT
,,ter
C mission No. �g7oR(og f $�dFi°riva
ommission GG 970989
SX&OS 0313012024
ALI-AMRAT
!I GOfnfniSRian GG 970%9
F.Vim& 03MM024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
PIA
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/71,19
E`IFIE
www.a�h�i�irecz� ry. Qrg
rt!
AHRI Certified Reference Number: 7516610
_ ... Date:
2/1120171
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: GSX140361 K*
Indoor Unit Model Number: AWUF37XX165*+TXV
Manufacturer: GOODMAN MANUFACTURING CO., LP.
Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR
CONDITIONING AND HEATING; ENERGI AIR; FRANKLIN
Region: Southeast and North (AL, AR, DC, DE, FL, 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, SID, 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.
Series name: GSX14
Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO., LP,
Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing:
Cooling Capacity (Btuh): 33000
EER Rating (Cooling): 11.50
SEED mating (Cooling): 14.50
LEER Rating (Cooling):
"Rafings followed by an asterisk (7 indicate a voluntary grate of previous) _ ___ _ .._...W ��--• ____.M���_ �. _ y Published data, unless accompanied with a WAS, which indicates an involuntary rerate.
DISCLAIMER--
AHRI does not endorse the products) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,
the products) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the products}, or the
unauthorized at alteration of data listed on this Certificate. Certified ratings are valid onlyfor models and configurations listed in the
directory atc:.:±.uhiv?
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and
canfiderhiai 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 utilised, in any form or manner or by any means, except for the use s individual,
pemonat and confidential reference.
CERTIFICATE VERIFICATION A4� CdNDI?tDHi34 , r7Elrrlvd,
The i
nformation for the model cited on this certificate can be verified at ;� : , �._,;__,;�,_�,�,,;. ��•.,._ .- click on "Vt:Fiiy vez.NJ cat :' link � RiwF?'?.Et`sEi{A707i;,'^;'?sr�
and enter the AHRI Certified Reference Number and the date on which the certificate was issued, rse rna]ceIife hetter" which is listed above, and the Certificate No., which is listed at bottom right
G02014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131304378073696376
..
CERTIFIED"'
www.ahri�irectory.org
of Produvrt Ratir7r,,1
AHRI Certified
e erence Number: 7516610 Date: 2/1/2017
Product: Split System: Air -Cooled Condensing Unit, Coil with Blower
Outdoor Unit Model Number: GSX140361K*
Indoor Unit Model Number: AWUF37XX16B*+TXV
Manufacturer: GOODMAN MANUFACTURING CO., LP.
Trade/Brand name: GOODMAN; JANITROL; AMANA DISTINCTIONS; EVERREST; ONE HOUR AIR
CONDITIONING AND HEATING; ENERGI AIR; FRANKLIN
Region: Southeast and North (AL, AR, DC, DE, FL,, 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 requi
Series name: GSX14 rement.
Manufacturer responsible for the ratting of this system combination is GOODMAN MANUFACTURING CO,, LP,
Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source
Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third
party testing:
Cooling Capacity (Btuh): 33000
EER Rating (Cooling): 11.50
SEER Rating (Cooling): 14.50
PEER Rating (Cooling):
`Ratings followed by any asterisk (I indicate a voluntary rerate of previously published data, unless accampanfed with a WAS, which 4ndigpes an involuntary rerate.
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 products) 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 t ,, _;.c _ lL:rrcto:.aay.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products ofAHRI. This Certificate shall only be used for individual, personal and
on cfidential 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 far the users individual,
personal and confidential reference. —
CERTIFICATE VERIFICATION
The information for the model cited on this certificate can be verified at!
and enter the AHRI Certified Reference Number and the date on which tits certcate was issued click on "{:er:`} Geri€ ca,e' link
which is listed above, and the Certificate No., which is listed at bottom right —---__�- wea��lifc 1�4
02014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 13130437807369637U