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HomeMy WebLinkAboutSigned AppsAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 8/12/2020 C ID to _.._yam Permit Number: 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 x Residential PERM IT APPLICATION FOR: Tesla Electric Vehicle Charging Station PROPOSED IMPROVEMENT LOCATION: Address: N/A PropertyTax ID #: 3431-122-0001-000-5 Site Plan Name: N/A Project Name: Tesla Ft. Pierce Turnpike St. Lucie County DETAILED DESCRIPTION OF WORK: Block No. INSTALL (4) V3 SUPERCHARGER CABINETS •INSTALL (16) V3 CHARGING POSTS, INSTALL (1) SWITCHGEAR ASSEMBLY WITH INTEGRATED MASTER CONTROLLER •INSTALL (1) UTILITY TRANSFORMER New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional worl<to be performed under this permit —check all that apply: Mechanical x Electric Gas Tank _Plumbing Total Sq. Ft of Construction: Cost of Construction: $ 253000 _Gas Piping _Sprinklers _ Shutters _Generator _Windows /Doors Sq. Ft. of First Floor: Roof Utilities: _Sewer _Septic Building Height: Pond Pitch OWNER/LESSEE: CONTRACTOR: Name Florida State Turnpike Authority Name: Sam Lewend Address: 1211 Governors Square BLVD, Unit Ste 100 Company: EASTERN CUSTOM CONSTRUCTION, INC City: Tallahassee State: FL Zip Code: 32301-2988 Fax: Phone No. 305-527-8180 Address: 906 SE 12TH STREET City: DEERFIELD BEACH State: FL Zip Code: 33441 Fax: Phone No 305-527-8180 E-Mail: sherylblasi@comcast.net Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail sherylblasi@comcast.net State or County License CGC1525742 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: Name: Not Applicable MORTGAGE COMPANY: Name: Not Applicable Address: Address: City: Zip: Phone State: City: Zip: Phone: State: FEE SIMPLE TITLE Name: HOLDER: _ Not Applicable BONDING COMPANY: Name: Not Applicable 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. Inconsideration 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 Coun y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with lendebor �l attorney before commencing work or recording your Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA �p, COUNTY OF I-� rl(/�} Sworfi to (or affirmed) and subscribed before me of ,/ Physical Pres nce or Online Notarization this day of WA t 2020 by Name of person making statement. Perso Ily Known ✓/ OR Produced Identification Type f dtification Pro c I i (Signature of Notary Public- State of Florida ) Commission No. (Seal) ure of Co`rr'�ractor/License Holder STATE OF FLORIDA COUNTY OF �i; lv� �� Swo n to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization this 2 U day of #qV 2020 by Name of person making s atement. Personally Known OR Produced Identification (Signature of Notary Public- State of Florida ) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ��-�� EATECUS-01 KATII ACOR®� DATE (MM/DD/YYYY) r`,_„�.� CERTIFICATE OF LIABILITY INSURANCE s/2o/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LICenSe # LO9O356 CONTACT NAME: EIFS of Florida, Inc. PHONE 433 Plaza Real Suite 275 (A/c, No, Ext): (561) 571-7750 (A/c, No): (561) 571-7711 Boca Raton, FL 33432 ADDRIESS: INSURED Eastern Custom Construction Inc. 906 SE 12th Street Deerfield Beach, FL 33441 rtn\/FRAf,FQ ('FRTIFIr`ATF NI IMRFR• A: c: F: �1��i .�� 1-�����J��� � ��C��1� REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WUD POLICY NUMBER POLICY EFF MM/DDMlYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X CL00282166 9/27/2019 9/27/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISES TO RENTED Ea occurrence 1 OO,000 $ MED EXP An one erson $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: X POLICY ❑ jE � � LOC OTHER: PRODUCTS -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS AUTOS ONLY A�TOS ONLY EAAU074043 10/18/2019 10/18/2020 Ea a8cideDtSINGLE LIMIT $ 300,000 BODILY INJURY Per rson $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY \, / N ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory m NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is reqquired) Certificate holder is included as additional insured with respects to general liability as per endorsement PCG 16 62 08 18 attached to the policy to the extent provided therein. RFRTIFICATF HOI r1FR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE St. Lucie Coun Contractor Licensin tY 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Ave. Fort Pierce, FL 34962 AUTHORIZED REPRESENTATIVE / l ^ 'I ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD