HomeMy WebLinkAboutFuel.Gas-Percy_11298 Muller Rd_App & ContractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
CC)UNTY
F L 0 R 4 D R
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: LP GAS
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: 11298 Muller Rd. Fort Pierce FL 34945
Property Tax ID #: 2333-133-0001-0005 Lot No.
Site Plan Name: Rebecca Percy Block No.
Project Name: Rebecca Pere
DETAILED DESCRIPTION OF WORK;
Install 39 of gas line from existing tank to new generator
CONSTRUCTION INFORMATION;
Additional work to be performed under this permit— check all that apply:
Mechanical —Gas Tank VGas Piping —Shutters _ Windows/Doors
— Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of construction: $ $1441.50
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _ Septic Building Height:
OWNERJLESSEE:
CONTRACTOR:
Name Rebecca Percy
Name: Tom Fite
company: Ferrellgas
Address:11298 Muller Rd.
City: Fort Pierce State: FL
Address: 3232 SE Dixie Hwy
Zip Code: 34945 Fax:
City: Stuart State: FL
Phone No. 772-409-3224
Zip Code: 34997 Fax: 772-287-3456
E-Mail:__ _ hPcca@intP,_r_rete_ lom
Phone No 772-287-4330
Fill in fee simple Title Holder on next page I< if different
E-Mail KimWilkins@ferrellgas.com
from the Owner listed above)
State or County License 31370
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED notice of Commencement Is required.
DESIGNER/ENGINEER: Not ApplicableI MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone:
Address:
City: state:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: TNot Applicable
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 priorto 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 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 RECORDING YOUR NOTICE OF COMMENCEMENT:"
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Martin
COUNTY OF Martin
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of T 20_ _ by
this day of 120 by
Tom Fite
Tom Fite
Name of person making statement.
Name of person making statement.
Personally Known OR Produced identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary P Ii i�,i-Ffarid j y L. ;IiLi<! 3s
!R
i'Y Ct P; iSSi( ?ti :.'
f
nature of Notary P lic- ,
ate o> IQrida )K ��LY L.1"lt.i<:'.:5
Commission No. FF063 r �=
C
mission No. FF 631
x
? j F
5, NCI ver L,r 28 20
� PI ;�. 28:20
l}nr�nnr
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/ 19
Doug Kelp
OFe 119as. Account Manager
772 216-2656 cell 772 287-3466 tax
doupk0o
0ferraffoas,com
us omer
ID 96337451
Rebecca Perot-Dfawdy
11298 Mufer Rd
Ft Pierce FL 34946
b eccat�inte[acvele.co rre
Phone 772 409 3224
To install:
Install up to 30' of new gas fine from existing ILP tank to never ganerator.
P.fUat meet all state and focal codes,
Ext. Line up to 30' of gas piping
frtt Line up to 00' ofgas piping
Date: 17 Au_g-20 -
Purchase Gas L 15wbnly
$ 450.00 'ferinirnum of 5156.00 addihonal pertooY�
'Mln€mum al USM62 a4ditlonal per foot4p
Final Connect and 1 outlet
$
225.00
Safely Check an a Start Up
Regulators
$
275.00
Regutnlors.st,utotrva6ces,Rtsaas etc.
Sub Total
$
950.00
Fax
7-00%a S
66.50
f3>zrfnit
TOTAL
$
1,A41.50
.... ..., e„e.,---116 ss Wprocuswn9& mere win oa Rotmioiatatamas.
• Fwreligas is not respon$fl a rardamege to Grg pipes or lines (taduding ttr pHon, slaotdgeta,)tlof muked by centre) rocaling aertic� liomeaarreris r9apo0sr3:a to
mark 7heh ovm sprYnkFer wlnwvoka9a tines
• FarraY9as€a nvt rnapons3Qie forplacemera or pttyaiceta�ustmenl o[appSances.
• fern&Bat€srmtresponsthle forftnagetoormplacemerdoflandscaying.comfab�sid&ff&soranye3nckftat
• CustOmarisrevonsUefor ptwl7ulglaborandoomersfanldttooDnveftany gas applw.w orusentgroparle,
• Garteratam are regLqred to have a tle)o-bfe Bea to wened10 gas.
Cuslorrre d cra raual be app(ared prior to caaarnentemanl of anywark-
• Any deavrng,d[re+cttonal borin%excess We fools. artvtaI rode" mqu" an addill*n dtargo,
• 80adin9 of gas In t0 be done by etchers.
• UndnrGmund Im0s includes calhoac prolecUaa,
• A$SO%dep*sRfs due upon aaceplanm. A f0%canceiation pena4yxdS apply.
Please 319n if yoq have reed & agtoc 10 the rorepo€Mg propowd contract &accept It
-rm undsrsigno4 sprees 8sat in the
tor any &amatlomeyloss andfor Rik
necessary to 56gaw any df thetemu s eendewn s of gtisa r&acl, drat the undersig aha31 ha respwrsiMe to FerrellBas LP
Feae7gasLPralpRIIMtothe enforcememelprtscoelract•
Customer Signature;
— Date.
Ft rcellgas Signature
Dater
Valid for 30 Dayc
Contact 1nkrnteation
Penny Randall 961 746 4534 Ext 25194
Kim Wilkins 772 287 4330 Ext 22578
Jane Conner 772 287 4330 Ext 25101
3232 SE Dixie Highway, Stuart FL 34997