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HomeMy WebLinkAboutBysshe permit app and subAll APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 20 Permit Number: 0 Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: Property Property Tax K Site Plan NamE Project Name: 5 - DETAILED DESCRIPTION OF WORK: aoo '6TL) Tram ry R'I -!9_ p -. New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit— check all that apply: XQMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: 44O Sq. Ft. of First Floor: 3120 Cost of Construction: $ L1202 — Utilities: _ Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name p Name: ecif.6az t4ile(' Company: Milers 6-4, Tv -At. A it Address: Hol NW I &xm-ens `,(Ee V City: 20-I rk State: R- Zip Code:Fax: Phone No. --Y) 1-336 — 8OHIo Address: .-5 (n) CGI: R C(- 4e - City: ?OCT ST. Lucy State: F—L. Zip Code: y�( 3 Fax: Phone No E -Mail: C" bsA !sS 1�e 0.a(7 ccxY�, • Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail J6_kAQ,@. W I 11elS- 0-A*('d.,1 C tC • CPyk State or County License CAC.05bb')'�:_ 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 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: Zip: Phone: City: 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 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 lender or an attorney before commencing work or recording your Notice of Commencement. 'r4l . Signa u e of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization this a day of 2020 by rrPd eA i C - I( 4 Name of person making statement Personally Known OR Produced Identification Type of Identification Commission No. �Z�j ( '� 2-- &u'- Sign��f Contractor/License Holder STATE OF FLORIDA COUNTY OF LLtC. 4t— S orn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization this .5 day of 2020 by Name of person making statement. Personally Known OR Produced Identification Type of Identification Producedfir -„--„„ (SignattFe of Notary Public- State of Florida) Commission No. 2 Z.. (Sea a o REVIEWS REVIEWS FRONT ZONING 1� SOR PLANS VEGETATION SEATURTLE 9- E COUNTER REVIEW REVIEW REVIEW REVIEW DATE �NZA Li RECEIVED DATE COMPLETED Rev. 5/6/20 PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES - - - Building & Code Compliance Division • BUILDING PERMIT SUB -CONTRACTOR AGREEMENT (Company Name/Individual Name) the ! C i -i Cck (Type of Trade) For the project located at have agreed to be Sub -contractor. for (Primary Contractor) Street Address or Property Tax -ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice. CO , ACTOR SIGNATURE (Qualifier) rade-rick dffer PRINT NAME C- jL SUB -CONTRACTOR SIGNA E (Qualifier) (;�"L_ f'M� PRINT NAME COUNTY CERTIFICATION NUMBER State of Florida, County of S + L u c COUNTY CERTIFICATION NUMBER of State of Florida, County of SE- d_,,'e The foregoing instrument was signed before me thisday of 2010 by '�Pd" ;CjoG= f !/(? is known ✓ has a who personally or produced as identification. Signature of Notary Public °t,y A• �J/ 5 S Qu � �� / (7�NIIA f V” �kt Print Name of Notary Pu tic I atur o Notary Public L �,+ �'•?„off x: x(4 O o .. Print Name of Notary Public +y e z N c)-< d N G) N _ O EO 21 pl O N .a t- 0 Z Z C N G) N N Revised 11/16/2016 "y N C- jL SUB -CONTRACTOR SIGNA E (Qualifier) (;�"L_ f'M� PRINT NAME COUNTY CERTIFICATION NUMBER State of Florida, County of S + L u c The foregoing instrument was signed before me this ZZt1 d day of j l7 !y ,20Z,6_,by,7 ho is personally know _or has produced a as identification. Signature of Notary Public °t,y A• �J/ 5 S Qu � �� / X= p '2 f V” �kt Print Name of Notary Pu tic =1. i y 3 r— N Q N QO. OO 0 N c)-< d N G) N _ O EO 21 pl O N Certificate of Product Ratings AHRI Certified Reference Number: 202373740 Date : 08-05-2020 Model Status : Active AHRI Type : HRCU-A-CB-O (Mini -Split Heat Pump, with Remote Outdoor Unit Air -Source, Free Delivery) Outdoor Unit Brand Name : Trane / Mitsubishi Electric Outdoor Unit Model Number: NTXSMT18A112A' Indoor Type : Mini -Splits (Non -Ducted) Indoor Model Number(s) : NTXWMT18A112A` Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1, 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 (95F) : 17200 EER (95F) : 10.50 SEER: 18.00 High Heat (47F) : 18000 Low Heat (17F) : 11500 HSPF : 10.00 Sold in?: USA, Canada 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 prod uced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an involuntary re -rate The new published ratino is shown alono with the previous (i.e. WAS) ratina. 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 .�>��-e,az:: . „ confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; o . `' 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.ahridirectory.org, click on "Verify Certificate" link gee 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. ©2020Air-Conditioning, Heating, and Refrigeration Institute I CERTIFICATE NO.: 132411116633134347