HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number:
0
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: rc5 C-- �- I i -.. .
Legal Description: -S/f2 %.y r L- i - _/ S c
Property Tax ID #: _„� �, 0� - i C7 l � ,r-, cps--'> -- .X71 (z � --- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
OWNER/LESSEE:
CONTRACTOR:
Name A ,.,.��_, .. S �
Name:
T 1--
company
��'�`"1.L'--c.-:"ter !'3 r1
City: S f �� -c` State: _E�-
Address: S -
Zip Code: !--” n, ^- S Fax:
CONSTRUCTION INFORMATION:
_71TTrup'nal
Phone No. -5-1 / - 0 7 -7 1
Zip Code: -9 '-/ 9 S--? Fax:
E -Mail:
work to Be herformed under
this permit - cfieck
all appy:
from the Owner listed above)
"VAC Gas Tank
E]Gas Piping
_ Shutters
Windows/Doors
Electric Plumbing
OSprinklers
Generator
Roof Roof pitch
Total Sq. Ft of construction:Q t.)
S . Ft. o€ First Floor:
Cost of Construction: $
Utilities_. 0Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A ,.,.��_, .. S �
Name:
Address: w ' 2 �� - 12- � ,
!►'°.tee.. ♦ -. �•
company
��'�`"1.L'--c.-:"ter !'3 r1
City: S f �� -c` State: _E�-
Address: S -
Zip Code: !--” n, ^- S Fax:
City:LL- - State: T�
Phone No. -5-1 / - 0 7 -7 1
Zip Code: -9 '-/ 9 S--? Fax:
E -Mail:
Phone No_ -X21 21 °_ -,! /l F- - 3-F-
Fill In fee simple Title Holder on next page [ if different
E -Mali: C- - e Com`- C �,� ... .'s� • C
from the Owner listed above)
State or County License: I c- I
if value of construction Is S2M or more, a RECORDED Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
Designer/Architect/Engineer: C3 Not Applicable
Name
Mailing Address
City
Zip Phone
State
Fee Simple Title Holder's Name: ❑ Not Applicable
Name
Mailing Address
City
Zip Phone
State
Mortgage Company:
Name
Mailing Address -
City
Zip Phone
Bonding Company:
Name
Mailing Address
City
Zip Phone
0 Not Applicable
State
0 Not Applicable
State
Notice to Owner: There are some properties that may have deed restrictions recorded upon them. These
restrictions may limit or prohibit the work applied for in your building permit. It may be to your
advantage to check and see if your property is encumbered by any restrictions.
Owner/Contractor Affidavit: Application is hereby made to obtain a permit to do the work and installations as
indicated. I certify that no work or installation has commenced prior to the issuance of a permit.
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 Code 6th Edition (2017) and Martin County
Amendments. Plan revisions on all structures exempted by code from architect/engineer design may be done by
permit holder.
Warning to fawner: 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
commencing work or recording your Notice of Commencement.
I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
of Owner/Agent/Lessee
STATE OF FLORIDA
COUNTY OF MARTIN
The fore 0mg instrument was acknowledged before me
this day of '5 ", 20J Qby
c, --A—
(Name of Person Acknowledging)
(Signature of Notary Public — State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Identification Produced _ iJ L-
(1•BC 6tht 1 ptary Public -State of Florida
- commission is GG 293167
of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF MARTIN
The fore ging instrument was acknowledged before me
this —day of 2 > 2Us�y
jj
(Name of PersonAcknowledging)
(Signature of Notary Public — State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Identificatlan Produced
TAYLOR GAGNE
Commission #k GG 293167
My Commission Expires
tl-'. )3nuefy 21, 2023.. ""���<<�„ 3k{
ent
maybe r�UVVJIAnes in an ternative format
by contacting the County ADA Coordinator (772) 320-3131, the County Administration Office (772) 288-5400,
Florida Relay 711, or by completing our accessibility feedback forte at www-martin-fl.uslaccessibility-fie bac
k.
Rev. 01-19
Certificate of Product Ratinas
AHRI Certified Reference Number: 10261839 Date: 07-23-2020 Model Status : Active
AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower)
Outdoor Unit Brand Name: FUJITSU
Outdoor Unit Model Number (Condenser or Single Package) : F03616CSJ
Indoor Unit Model Number (Evaporator andforAir Handler) : FH3617TTS*SN
Region : All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS,
MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, 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 fegion(s) for
which they meet the regional efficiency requirement.
The manufacturer of this FUJITSU product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 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 : 34200
SEER: 16.00
EER (A2) - Single or High Stage (95F) : 13.00
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 Certification Program Participant is no longer producing BUT is still
selling ar cffering for sale.
Ratinas that are accompanied by WAS indicate an involuntary re -rate. The new published ratina is shown MOM with the previous (Le. WAS) rating.
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
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, Am
personal and confidential reference. AIR-CONDITIONIMG, HEATING,
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The information for the model cited on thts 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. —
(P202OAir-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132400238170202494