HomeMy WebLinkAboutWhiteside gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Fierce FC 34982 Residential X
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Gas fine
PROPOSED IMPROVEMENT LOCATION:
Address: 1333 Lancewood TER Palm Cify, FL 34990
Property Tax ID #: 4426-804-0023-000-5
Site Plan Name:
Project Name: Whiteside gas
DETAILED DESCRIPTION OF WORK:
Install underground gas line to generator from existing LP tank
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit– check all that apply:
Mechanical — Gas Tank 46Gas Piping ` Shutters Windows/Doors Pond
Electric —Plumbing Sprinklers — Generator Raaf
Pitch
Total Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction: $ 795.00
OWNER/LESSEE:
Name Robert Whiteside
Address: 1383 Lancewood TER.
City: Palm City State:
Zip Code: 34990 Fax:
Phone No. 9738667664
E -Mail:
Utilities: —Sewer _Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:Michael Flaxman
Company: Energized Electric
Address:4252 Bandy Blvd -
City: Ft Pierce State: FL
Zip Code: 34081 Fax:
Phone N07724661095
E -Mail energizedgeneratorsAgmai l.com
State or County License LQ31756
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Nat Applicable
Name:
Address:
City: State:
,Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip -'_Phone: -
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 Nome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. iconsult 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, walls, 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with fender or an attorne before cornmencin worm or recordin our Notic of Corrlencement.
Signature of
as Agent for Owner + Signature of
STATE OF FLORIDA STATE OF FL I
DjA
COUNTY OF COUNTY OF
Swa-to (or affirmed) and subscribed before me of
Physical Pr ence or Online Notarization
this r dlay of 2020 by
Name of person making statement"
Personally Known <_ OR Produced Identification
Type of Identification
(Signatu
' '?q s DANIELLE GONCALVES
om m issictrl *�-�-,E�XPIRES:
MY COMMISSION # G4B
r JuDe 27, 2022
F°Fr "r' Bondetl ihru Nobry Pubk UndanK bre
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Holder
S to (or affirmed) and subscribed before me of
�hysical Preseace or Online Notarization
this' `day of 2020 by
Name of person making statement.
Personally Known �70R Produced identification
Type of Identification
{Signature oflic-SAWIl MOVES
COMMISSION # GG 232 A6
Commission IN =y EXPIRES -Am
u Notary Pott!= ur1dLF-, itm
PIANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Piero, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1700 Latham lid, Suite 2, West Palm Beach, FL, 33409*
Proposal 1 Agreement
Robert Whiteside
1333 Lancewood Terr
Palm City, FL, 34990
973-856-7564
RGWhiteside- gmail corn
June 101h, 2020
1) Thompson Gas to supply and install underground gas line to generator and
final connect
2) Obtain all permits & inspections needed
NOTE: Line to be installed by Thompson Gas
(1 r the sum of.- $79,5.007
TERM&
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 tee 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
other charges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 is due @ Signing
300.00 is due Q Completion
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature: L
Roger Lussier
Acceptance of Proposal
I
I, .. (Printed name), authorize Energized Gas to
complete the work in accordance with the above speciflcations and conditions, Y agree to pay as per
terms o�rtni ed above.
Signature
Date� 7 v
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of the
parties and supersedes all 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 3
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
PRINTED NAME
S NATURE
DATE
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