HomeMy WebLinkAboutNoris gas app, contractRE INFO MUST BE COMPLETED FOR APPLICATION TO BE Permit ACCEPTED
Number:
wj
p:. 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 X
PERMIT APPLICATION FOR:GAS TANK
-------------
PROPOSED IMPROVEMENT LOCATION:
r_ 4 nc Al ---r ,Irin ('.ir Fnrt Pierce. FL 34982
Address:
Property Tax ID #: 3410-503-0318-000-4
Site Plan Name:
Project Name: Noris gas
DETAILED DESCRIPTION OF WORK:
in -tau goo gallon underground gas tank with line to generator and 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 _ Wind
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3995.00
Sq. Ft. of First Floor:
Lot No. 18
Block No. K
Doors _ Pond
Utilities: —Sewer _Septic Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
Name Charles Noris
Name- Michael Flaxman
Company: Energized Electric
Address:4252 Bandy Blvd
City: Ft Pierce
Address: 6126 Alexandria Cir
City: Ft Pierce State: _
Zip Code: 34982 Fax:
Phone No. 7724892494
State: FL
Fax:
Zip Code: 34981
Phone No7724661095
E -Mail energizedgenerators@�mail.com
State or County License LQ31�56
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a KtLUKUtU NoTice 0r L0mmencemenL 1b reyuu cu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
(Signature of N ar,, ,; Vic- Sta
y §, f �Rf
DESIGNER /ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Address:
City:
_ Not Applicable
Address:
Commissio o:
•.ForFL, Underwriters
City: State:
Zip: Phone
State:
Zip: Phone:
E.onded Thru
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Address:
City:
Not Applicable
Address:
City:
Zip: Phone:
Zip: Phone:
UWNEK/ t",VIV 1 KAL I UK 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 m 3y 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, pe form 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 on -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 po ted the jobsite before the first inspection. If you intendp obtain financing, consult
,rtorn efore commencing work or recording youryotic commencement.
with lender or �
Signature of
STATE OF FLO
COUNTY OF
as Agent for Owner I Signature
Swprn to (or affirmed) and subscribed before me of
7%sical P esence or Online Notarization
this day o S R(� 2020 by
Name of person making statement.
st
Personally Known / O_
R Produced Identification
Type of Identification
STATE OF FL
COUNTY OF
cense Holder
SwShys�i'cal
r affirmed) and subscribed before me of
Presence or On ine Notarization
ay of 2020 by
Name of person making statement.
Personally Known R Produced Identification
Type of Identification
Produced
(Signature f,�1 PubIiOPME4
s.
(Signature of N ar,, ,; Vic- Sta
y §, f �Rf
EL d
MY COMMISSION # GG 232946
EXPIRES: June 27(§&)
, .., ,
!°'Y00M
ALVES
ISSION#GG 232946
Commissio o:
•.ForFL, Underwriters
Commission No.
"'"��' !
ES:Ju49422
BondedThru otaryPublic
E.onded Thru
Notary Public
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEAT
RTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REV
EW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Treasure Coast 772-466-1095, 4252 Bartdy Blvd- Fort Pierce, FL, 34981, Fax
*Papp. Beach 561-7522-0214. 1550 Latham Rd, Site I. West Paini Beach -
Proposal / Agreement
Charles Noris
6126 Alexandria Cir
Fort Pierce, FL 34982
772-489-2494
CenCan!Do —
-@gmail.com
1) Thompson Gas to supply and install (1) customer owned 500
underground LP tank with gas line to generator and final conn
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
318 -6672r
It I40Q*
July 15, 2020
Tallon
rt esu-in of' - 'k-
, i
i9�S ua i
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 d to
�'s v!
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with sta dard 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, convertin appliances or
carbon monoxide detectors
Additional charges may apply if rock and/or roots are encountered during the exca
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
to obtain final approval.
If home is located in flood zone, the additional cost will be the responsibility of the
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
along with this signed proposal.
*To include sod replacement a charge of $395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE
PRINTED NAME
S NATURE DATI
n process.
customers failing
eowner if a tank tie
can be submitted
TERMS
DIKZ�l
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