HomeMy WebLinkAboutCCF10082020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L ' "20 Permit Number:
ICOUNTY
Building Permit. Application
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
I PROPOSED IMPROVEMENTLOCAT- 10t
Address: SaO DeCl;-- Dc'
Property Tax ID #: I313 _ cJ�Z `Z�� Lot No.
Site Plan Name: Block No.
Project Name:
AILED DESCRIPTION.OF ViIOM {
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CONSTRUCTION INFORMATRON;
Additional work to be performed under this permit - check all that apply: -
✓Mechanical _ Gas Tank _ Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Uz)9�5 Utilities: —Sewer; _Septic
-Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CO f}R:
Name('harle5 , Z)1*V/'oL ne-H�cyr4
Address::5a 1.3 nPtC I(L-Orl Or
Name: Curtis Sammons
Company: Custom Air Systems, Inc.
Address: 1615 SE Village Green Drive
City: EOCA \ ''2cCe. State: f:-(,
Zip Code- 3L.(c)6 1 Fax:
Phone No. 99C-5-
City: Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail custairsys@aol.com
State or County License CAC051810
I
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City.-
ity:Zip-
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 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 OFill �r Si-� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this S' day of 20 Lc) by this 'Z� day of (7Q �� 2p2U by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida J
tRy'uCHRISTINE 8 Elf
Commission No. L2Gt' J KJ q64'0"'
MYCOMMISSION#Lc
EXPIRES: ApA 4.
Personally Known ;�r- OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florid a
ISH 2°�* CHRISTINE R E
mission No_ * MYCOMNdSSIONi{
121 "� F EXPIRES: Apni
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772)335-3232 • Fax(772)335-1968
[Iva Proposal and Agreement
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Customer Name C.1jw - ��e4 _
Address „5:-213/ Jn
City, State, Zip
PhoneDataC-' ,�
Job Address .T1 �
�- f
Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make Model Number(s)
SEER EER AFUE Btuh Coolin Btuh Heating CFM
U New Amp disconnect
❑ New Amp electric service
❑ New low voltage wiring
❑ New weather resistant equipment stand
New reinforced equipment pad
❑ New vibration isolation pads
❑ New properly sized refrigerant lines
❑ New clean, dry ACR copper tubing
--E Insulate refrigerant suction line(s)
Mall refrigerant drier(s)
Z -Evacuate refrigerant system
1�r C arge to manufacturer's specs
Cwt all federal, state & local laws
❑ Option (below)
;1-�move existing equipment from premises
❑ Install energy saving setback thermostat
❑ New copper wire from to
-ake air tight plenum transition
❑ new supply diffuser(s)
❑ New duct run from to
❑ Noise reducing flexible duct connector
❑ Balance for uniform supply air distribution
❑ Provide for external combustion air
❑ New gas piping from to
❑ Ww vent pipe and cap
Z Clean work area to customer's satisfaction
Wndensation overflow safety switch
Jd'Hurricane Fasteners for outdoor unit
b/ da4lZ 3
Terms:
X in boxes =
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
Yes
❑ New return air filter grill u
-"eet all code requirements
�Compl system start up
❑ _Z year parts warranty
❑ —Z year labor warranty
❑ year compressor warranty
❑ year se ce a r ment
❑ 116) -,Q-- •' S �L
Total Inve �ttS $ L
Taxes $
Total Amount $
Down Payment $
Balance Due $ S
Acceptance (Customer) Y Approval (C a
By ���
ate - y Date