HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date : Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone : (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORIP TANK
PROPOSED IMPROVEMENT LOCATION :
Address: 2713 Bent Pine DR Fort Pierce, FL 34951
Property Tax ID #: 1334-502-0009-000-3 Lot No. 92
Site Plan Name: Block No.
Project Name : Maimed gas
DETAILED DESCRIPTION OF WORK :
install 500 gallon underground tank with gas line to generator
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 — Windows/Doors — Pond
— Electric _ Plumbing — Sprinklers . Generator — Roof Pitch
Total Sq. Ft of Construction : Sq . Ft. of First Floor:
Cost of Construction: $ 4195.00 Utilities : _ Sewer _ Septic Building Height:
OWNER/LESSEE : CONTRACTOR :
NameVictor Melmed Name: Michael Flaxman
Address: 2713 Bent Pine DR Company: Energized Electric
City: Ft Pierce State Address: 4252 Bandy Blvd
Zip Code : 34951 Fax: City: Fort Pierce State : FL
Phone No, 609-709-3261 Zip Code: 34981 Fax; 7723186672
E-Mail : Phone N07724661095
Fill in fee simple Title Holder on next page ( if different E-Mail energizedgenerators@gmail.com
from the Owner listed above) State or County LicenseLQ31756
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: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name : Name :
Address : Address :
City: State : City: State :
Zip : Phone Zip : Phone :
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name : 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 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 an, applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult lth 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 thejobs'te before the first inspection . If you intend to obtain ancing, consult
with lender or an attorneyb re mmencin work or recordin our Not of Co cement.
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Signature of Owner/ Lesse /C� tt act r as Agent for Owner Signature o 0 tr ctor/Licep a Holder
STATE OF FLORID STATE OF FLORI
COUNTY OF �� Q C COUNTY OF LZ
Sw.jn-to (or affirmed) and subscribed before me of Svt. rn to (or affirmed) and subscribed before me of
6 sical Pre c or Online Notarization \ Physical Pres or Online Notarization
thls ay ofr , 2020 by this Nay of 2020 by
Name of person making statement. Name of person making statement.
Personally Know)� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
uced Pr ced
a re f, &I"u ' 0 WNW* a2 2846 (Signatu ' of N'PIF u
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EXPIRES: June27 20212 "^ - MYCOMMISSION # GG2;fa al )
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"ru Notary Putlic Undenm
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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* Treasure Coast 772-466- 1095 , 4252 Bandy Blvd , Fort Pierce, FL, 34991 , Fax 772-319-6672 *
*Palm Beach 561 -752-0214, 1550 Latham Rd, Suite 3 , West Palm Beach, FL, 33409 *
Proposal / Agreement
Victor Melmed August 25 , 2020
2713 Bent Pine
Fort Pierce , FL 34951
609 - 709 - 3261
PBrown413@gmail . com
1 ) Supply and install ( 1 ) customer owned 500 gallon underground LP tank with
gas line to generator and final connect
2 ) Obtain all permits & inspections needed
3 ) Price includes extended service
4) Price includes backfilling and removing dirt
5 ) Price does NOT include filling the tank with propane
For the sum of. $49195. 00
( I
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
$495 . 00 is due @ Signing
3, 700 . 00 is due @ Generator startup
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 :
John Maruri
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Acceptance of Proposal
I, b1 t c- 1 D &4 Att Ime ( printed name) , authorize Energized Electric
to complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
/n f �- Date
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I � �
Signature
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.
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CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard 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, 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
� i fp /1 (f
PRINTED NAME &a �f
SIGNATURE DATE
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