HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
❑ate:
os"I.- - 4R �
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: 8002 Lakeside Way Fort Pierce, FL 34951
Property Tax ID #: 1301-603-0150-000-4
Site Plan Name:
Project Name: Garren gas
I DETAILED DESCRIPTION OF WORK:
install 500 gallon underground LP tank with gas line to generator
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit — check all that apply:
_Mechanical �as Tank _ Gas Piping — Shutters
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3845.00
Generator
Sq. Ft. of First Floor:
Residential x
Lot No. 4
Block No. 22
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
❑WNER/LESSEE:
CONTRACTOR:
NameJimmy Garren
Name, Manuel Tobar
Address:8002 Lakeside Way
Company: Thompson Gas
City: Ft Pierce State:
Zip Code: 34951 Fax:
Phone No.7724656349
Address:1786 SW Biitmore ST
City: Port ST Lucie State: FL
Zip Cade: 34984 Fax:
Phone No7727778133
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County LicenseLG45341
11 Vd1UU UI WFINUuCLIUR is z5uu or more, a ntWKUto Notice or commencement is required.
If value of HAVC 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:
Address:
City: State:
Zip: Phone
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 contiict with any applicable Hame 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, I do hereby agree that I will, in al I 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 frorn 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 lender or an attorney before commencing work or record>inp vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Pres ce or Online Notarization
this day of 2020 by
this iSl day of U 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pruned
1`. 4
(Signature of Notary Public- State of Florida }
(Signature of t c- St
C0M 1 232W
Commission No. (Seal)
`
Commission N EXPIRES:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
a V.:]lul Lu
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`Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981. Fax 772-318-6672'r
Valm Beach 561-752-0214, 1700 Latham Rd, Suite 21 West Palm Beach, FL_ 33409"
Proposal / Agreement
Jimmy Garren
8002 Lakeside Way
Ft Pierce, FL 34951.
772-465-6349
CMGarren@att.net
June 1611, 2020
1) Thompson Gas to supply and install (1) customer owned 500 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 by Thompson Gas
�Vor the sum o
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
other charges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 is due @ Signing
$3,350.00 is due @ 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:
Brian Orr
Acceptance of Proposal
I, dg&Ln. Gig- g&A,1 (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 above.
Date
Signature
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
e#RzL� "4-'a
PRINTED NAME
�2a't �
SIGNATURE
DATE
Wage 3 of 3