HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
D
a n ter:_
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34.482
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR:Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: 8632 Lonesome Pine TRL Fart Pierce, FL 34945
Property Tax ID #: 2323-701-0029-000-9
Site Plan Name:
Project Name: Kalb gas
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 _YGas Tank _ Gas Piping _ Shutters
_ Electric ` Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 4495.00
OWNER/LESSEE:
Name Gloria Kalb
Address:8632 Lonesome Pine TRL
City. Ft Pierce State:
Zip Code: 34945 Fax:
Phone No.
Sq. Ft. of First Floor:
Residential X
Lot No.14
Block No. B
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner fisted above)
CONTRACTOR:
Name:Manuel Tobar
Company: Thompson Gas
Address:1786 SW Biltmore ST
City: Port ST Lucie
Zip Code: 34984
Phone No7727778133
E-Mail
State or County LicenseLG45341
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.
Fax:
State. FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable � MORTGAGE COMPANY:
State:
Not Applicable
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 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 attorn011 before commencin work or recordin our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF COUNTY OF
Swo,n to (or affirmed) and subscribed before me of
Physical Pre s nce or Online Notarization
this day of 2020 by
Name of person making sta. ement.
Personally Known X,"OR Produced Identification
Type of Identification
Sy rn to (or affirmed) and subscribed before me of
" h sical Pres nce or Online Notarization
this ay of 2020 by
Name of person maki statement.
Personally Known OR Produced Identification
Type of Identification
Produced
,. ` ' MY COMMlSS10N # GG 232946 c
CvmS4r= a 27, 2D22 ($e y !Y CoMMtSsiO'v # z
' Commis EXplpE5: Jana 27, 2022
.4
` of ��°P' E-Nded Thru Notari Public UnderwrhOfs '', od iP ' Fnn,te ru u
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
$ ANGRO
REVIIEWDR + REV EW VREVEWEGETATION S EVEWEATURTLE MEV EWVE
Treasure Coast 772-466-1095, 4252 Bandv Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1700 Latham Rd, Suite 2, west Palm Beach. FL. 33409*
Proposal / Agreement
Gloria Kolb
8632 Lonesome Pine Trail
Fort Pierce, FL 34945
732-691-5066
Kolbgj2outlook.com
June 29, 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
Ko r: t�heum of: ��$4,,495-vo
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
othercharges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 is due @ Signing
$4,000.00 is due @ Generator startup
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance or your nsideration.
Authorized signature:
Brian Orr
Acceptance of Proposal
(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 (o
Sig
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 2
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
SIG TUF�tj
DAT
Pa-e 2 of 2