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HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: e Building Permit Application Planning and Development services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential >e PERMIT APPLICATION FOR: To Select From dropbox, click arrow at the end of fine PROPOSED IMPROVEMENT -LOCATION.- Address: OCATION.Address: 1 Legal Description: P,0- 16 --, Property Tax ID #: f - S-- -_ S�G - r'> - Lot No. Site Plan Name: Block No. Project Name: Setbacks Front _ Back: Right Side: _ Left Side: DETAILED DESCRIPTION OF WORK 1,4 CONSTRUCTION: INFORMATION: itiona wo toEe e orme un er t is perm rt - c HVAC Gas Tank ®Gas Piping Electric © Plumbing Sprinklers Total Sq. Ft of Construction: 13 �v I , Cost of Construction: $ �2 V 00 �- OWNER/LESSEE: Name Address: -2;! 1 S Sot �...� City: u C_ State: Zip Code:• Fax: Phone No. E -Mail: T- L-- 7-0 � Shutters Q Windows/Doors Generator 11 Roof Roof pitch Sq. Ft. of First Floor: _ Utilities: OSeptic Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Building Height: Name: Company: Address: C- e- City:— t2C- State: f� C... Zip Cod y -�-.3 Fax: Phone No. E -Mail: ., State or County License: c- A c. 1 If value of construction is $2SW or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL coNSTRUCnON LIEN LAW INFURMA1Ti)N . Designer/Architect/Engineer: ❑ Not Applicable Name Mailing Address City State Zip Phone Fee Simple Title Holder's Name: ❑ Not Applicable Name Mailing Address City State Zip Phone Mortgage Company: Name Mailing Address City Zip Phone Bonding Company: Name Mailing Address City Zip Phone ❑ Not Applicable State ❑ 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 architectiengineer 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. Signature of Owner/Agent/Lessee STATE OF FLORIDA COUNTY OF MARTIN The foregoing instrument was acknowledged before me this day of 2q2Ltby (Name of Person Acknowledging) (Signature of Notary Public — State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) of Contractor/License Holder STATE OF FLORIDA COUNTY OF MARTIN The foregoing instrument was acknowledged before me this 1=day of n� {20-�vby w- I- • e— Cp --�- (Name of Person Acknowledging) (Signetd a of Notary Public -- State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification c'� Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced "Y'ptBr t TAYLOR GAGNE TAYLOR GAGNE � 1p¢ U jiy y441111i pY A (FBC 6th Edition 2417) Comrnission # GG 293167 �. + Cammissio� Il GG 293167 ,,n off` My Comrnission Expires11 �,,ov v�}�' ,-- 11 _', %~+�„<<,ae`,°�; My Commission Expires n"`sID1111Y ==Cwt - This document may be reproduc-eTupon request in an alternative format by contacting the County ADA Coordinator (772) 320-3131, the County Administration Office (772) 288-5400, Florida Relay 71.1, or by completing our accessibility feedback form at www -martin fl tas(accessi gity-feedback. Rev. 01-19 CERTIFIED 401110.1 a AHRI Certified Reference Number: 10261763 Date: 08-15-2G20 Model Status: Active AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower) Outdoor Unit Brand Name: FUJITSU Outdoor Unit Model Number (Condenser or Single Package) : F03614CSJ Indoor Unit Model Number (Evaporator and/or Air Handler) : FH3017TPS*SN Region : Southeast and North (AL, AR, DC, DE, FL, GA, Hl, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, AK, CO, CT, ID, 1L, IA, IN, KS, MA, ME, Mi, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT, VT, WA, WV, wl, wY, U.S. Territories) Region Note: Central air conditioners manufactured priorto 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 FUJITSU product is responsible for the rating of this system combination. r 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 : 33800 SEER: 14.00 EER (A2) - Single or High Stage (95F) : 11.50 ?"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 selling or offering for sale. Ratings that are accompanied by WAS indicate an involuntary re -rate.. The new published rating is shown along with the previous (i 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 t 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. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at click on " "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. 9202OAir-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132419656635147775