HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ST. LuCM—
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
PERMIT APPLICATION FOR:GaS
PROPOSED IMPROVEMENT LOCATION:
MUUfeSS: . 111 �ancO I GRrVIL r'Iuiue, r-L 6WIn1
Property Tax ID #: 1327-701-0011-000-9
Site Plan Name:
Project Name: Valle Suzanne Gas
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential x
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 3,195.00 Utilities: Sewer Septic
Lot No.
Block No.
Buildin H i ht
Pond
Pitch
g eg
OWNERAESSEE:
CONTRACTOR:
Name Valle Suzanne
Name: Michael Flaxman
Address:3608 Twin Lakes TER
Company: Energized Electric
_
City: Fort Pierce State:
Address:4252 Bandy Blvd
Zip Code: 34951 Fax:
City: Fort pierce FI
State:
Phone No.7723320715
Zip Code: 34981 Fax:
E-Mail:FSV2007@mac.com
Phone N0772-466-1095
Fill in fee simple Title Holder on next page ( if different
E-Mail energizedgenerators@gmail.com
from the Owner listed above)
State or County LicenseLQ31756
if value of construction is 2SOO nr mnra = PrrnDn Cn ru : _c n_
v__
vv......c..\.c IMNI1 IJ ICgU11CU.
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 MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: Address:
City: State: City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 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 the Florida Building
plans, 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
of Commencement must be recorded in th ublic records of St.
to your property. A NoiFencing
Lucie County and posted on the jobsitfore the first inspection. If
you intend to ain financing, consult
with lender or an attorne befor o work or recordin o r N ice
o mmencement.
Signature of Owner/ Lessee/Con ra r a Agent for Owner Signature of on actor/ icense Holder
STATE OF FLORID��STATE OF FLORI
COUNTY OF COUNTY OF
Sworn o (or affirmed) and subscribed before me of Sw�9n to (or affirmed) and subscribed before me of
Physical Pre `\
ce or Online Notarization Physical Prese ce or Online Notarization
this ���"day of 2020 by this 4Wday
of 2020 b Y
N
- � 'Llail 11T-TnmqQp�
-
Name of person making statement.3
Name of person making statement.
Personally Known OR Produced Identification Personally Known<!K OR Produced Identification
Type of Identification Type of Identification
Pr ced Pro d
(Signature of i otatMee
I �!� !#i�E�82SA8 (Si a<o a I� S Cyr .
EXPIRES: ,tune 27, 2022 PAY COMMISSION # GG 23�., .,
Commission otaryPubi(c d vriters Co "= 2 r
rinn&d 7hn3 N f ,ISea l )
— �. GYorra�e.
1P z022 t
_ Bonded Thru Notary Public Uoden nitors
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
ffEL
MAEG-1:7"TRD C-1,
P -'
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1550 Latham Rd, Suite 3, West Palm Beach, FL, 33409*
Proposal / Agreement
Susan Valle
3608 Twin Lakes Terr
Fort Pierce, FL 34950
772-332-0715
FSV2007@mac.com
July 8, 2020
1) Thompson Gas to supply and install (1) customer owned 250 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
or the sum o : $3,195•00
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
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
f � y/
VC, % e- (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.
Signatu
Date 7b a /'-:Z '0
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
c t c Gi l� ;l l le
PRINTED NAME
x
r ;
!§-I G N Air URE
7 /�/�
DATE
Page 2 of 2