HomeMy WebLinkAboutBuildinng PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - .- Permit Number:
Building Permlt Application
Planni
"PLEMENTAL<
Designer/Architect/Engineer:
Name
Mailing Address
City
Zip Phone
❑ Not Applicable
State
Fee Simple Title Holder's Name: ❑ Not Applicable
Name
Mailing Address
City
Zip Phone
State
IATION
Mortgage Company:
Name
Mailing Address
City
Zip Phone
Bonding Company:
Name
Mailing Address
City
zip Phone
❑ 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 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
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.
Signaa of Owner/Agent/Lessee
STATE OF FLORIDA
COUNTY OF MARTIN
The fore ping instrument was acknowledged before me
this.Z day of (�, 2p� Irby
(Name of Person Acknowledging)
(Si f Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Iden 'fication oduced
]/- rTLVrt UAl31vt
Notary Pvblic-State of Florida
{FBC 6t11 E 8My Commission Expires
i `O January 21, 2023
Contractor/License Holder
STATE OF FLORIDA
COUNTY OF MARTIN
The foregoing instrument was acknowledged before me
this day of c r C_�i 20 ?�tby
C--- L�c
(Name of Person Acknowledging)
(Signature of Notary Public - State of Florida)
(Print, Type, or Stamp Commissioned Name ofNotary Public)
Personally Known OR Produced Identification 1/
Type of Identification Produced
C.07MIS3ion # GG 2931-67
" January 21, 2023
A bAft Disclose Statement -- This document may be a 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 form at www.martin-fl.uslaccQssibility-feedback.
Rev. 01-19
Certificate of Product Ratings
AHRI Certified Reference Number: 202356664 Date: 07-29-2020 Model Status : Active
AHRI Type: SPY -A (Year -Round Single -Package Air -Conditioner, Air -Cooled)
Series : LX SERIES
Outdoor Unit Brand Name: YORK
Outdoor Unit Model Number (Condenser or Single Package) : PCG4A361002X2"
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, VVV, WI, VVY, 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 YORK 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 : 35200
SEER: 14,00
EER (A2) - Single or High Stage (95F) : 11.00
f"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
selliring Oro
re ng for sale.
Ra s that accom anied bv WAS indicate an invalunta re -rate. Tho new ublished ratiri2 is shown along with the previous l.e. 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,
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.ahrid irectory. erg, 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.
0202OAir-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 1 32417 49 5 989 527 7 1 6 4