HomeMy WebLinkAboutBuilding Permit Application Gas DuygoAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/22/2020
Permit Number:
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: Gas Installation
PROPOSED IMPROVEMENT LOCATION:
Address: 5707 Eagle Dr. Fort Pierce, FL 34951
Property Tax ID #: 1312-500-0073-000-8
Site Plan Name:
Project Name: Duygo Gas
X
Lot No. 72
Block No.
DETAILED DESCRIPTION OF WORK:
Install and supply customer owned 500 gallon underground tank and install gas line and regulator to generator with final connect
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 9695.00
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Donald and Shirley Duygo
Name: Michael Flaxman
Address:5707 Eagle Dr.
Company: Energized Electric
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No.804-472-4810
E-Mail: shirlannva@gmail.com
Address: 4252 Bandy Blvd.
City: Fort Pierce State: FL
Zip Code: 34981 Fax:
Phone No 772-466-1095
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Permitting.energized@gmail.com
State or County License EC13006279
it value of construction is Z500 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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not App
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: X Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Name:_
Address:
Address:
City:
City:_
Zip: Phone:
Zip:
Phone:
X Not Applicable
State:
X 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 attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature /Li er
STATE OF FLORIDA
7F-F-
STATE OLORI A
COUNTY OF
COUNTY OF qi-Jfat, 4_111W"
Sworn to (or affirmed) and subscribed before me of
Sor affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
"�wo
ysical Presence or Online Notarization
this Z�L day of :EU®S- , 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known L-�OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
( gnature of No ary Public- St o a,Wes w Cowdell
My Commission GG 23843
Commission No. (Seal)
x
Commission No. �eal`f s 07/09/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5
Energized Gas Inc
Propane and Natural Gas Specialist
Proposal / Agreement
it Duygo
5707 Eagle Dr.
Ft. Pierce, Fl. 1 34951
80J4-472-4810
S-WidaiLi
June 12th, 2020
Energized Gas hereby agrees to furnish all labor and materials necessary for the completion of
services as specified below:
1) Thompson Gas to install and supply (customer owned) 500 gallon underground
tank and install gas line and regulator to generator and final connect
2) Price includes all labor, material and permitting
3) Price includes backfilling and removing dirt (if applicable)
4) Price includes Propane monitor.
5) Price does not include the first fill of the propane tank
NOTE: Gas line to be installed by Thompson Gas
I-'-'j - 11
r R"T' Ca"he o",-e�-'am, ou �W 039695,(501`1
1786 SW Biltmore St, Port ST Lucie, FL, 34984 *Licensed & Insured FL34747
Toll Free 855-PROGAS4 *Treasure Coast 772-777-8133 *Palm Beach 561-752-0214 *Fax 772-318-6673
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
other charges/fees.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$395.00 is due @ Signing
$3300.00 is due @ Final Connection
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:
Ron Weimerskirch
Acceptance of Proposal
I, (printed name), authorize Energized Gas to
complete the work in acc rd ce with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date C 12- Z-O
Signature
Page 2 of 3
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.
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installer is 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
A.
PRINTED NAME
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§JtNATtjkE'
Page 3 of 3