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HomeMy WebLinkAboutGilliganPermitAll APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A9 �� ZO Permit Number:
• R I r
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
PERMITTYPE:HVAC Equipment ChangeOut
..-a MIN; -',SUN
Address:
Property Tax ID #: �> 00 r Lot No.Z7
Site Plan Name: Block No. y/
Project Name:
Like for like AC replacement
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3 �/Z- �i7
13NSTRUCTION INFORMATION: -------.-----
AddYitioal work to be performed under this permit - check all that apply:
Windows/Doors
echanical _ Gas Tank —Gas Piping _ Shutters —
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: /'9 Sq. Ft. of First Floor:
Cost of Construction: $ 7, �O0 Utilities: —Sewer _Septic Building Height:
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SIR
Name: Steve Smith
Name J544 .44317
/
Address: //Z/P� 4v�p
Company: Steve Smith Air Conditioning
Address:8001 Eden Road
�T• City: / /lll/ State: 1-�Z
Zip Code: �� _ Fax:
City: Fort Pierce State: FL
Phone No. 77�-- 3'oJr7li�" -rOJr7
Zip Code: 34951 Fax: 772-461-2036
E-Mail:
Phone N0772-461-1425
Fill in fee simple Title Holder on next page ( if different
E-Mailstevesmithac@aol.com
from the Owner listed above)
State or County License CAC1 813454
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.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
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 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 T E JOB BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITU YnLtal panpolvilib AN ATTnRNFY RFFnRF RFCORDING YOUR NOTICE -OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
Lor
COUNTY OF S-� (�U C_N F
COUNTY OF ,e
The forgoing instrument was acknowledged before me
The forging instrument was acknowledged before me
this L`Iday of "&"%A 20j� by
this � day of �I!L1,14 _ 20�j by
';
9eiJe-n S^- t 4
& V CO M t -r14
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification �_
Personally Known OR Produced Identification k
Type of Identification
17R1 L I C- C-*J S. E
Type of Identification
Produced u C-
Produced VuL
ignat a of ota Public- S to of Florid ChristopherJ.
rxdgl nature f Notary Public- State o Stephanie Moure
NOTARY PU
LICn NOTARY PUBLI,
Commission No, vz:L-) � STATE OF
4"g"e
@6i00%ission No. Fr93''7A % STATE OF FLO4
Cornrr#R GG
2758 =Comm# FF9573f
419
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_T
COMPLETED
Rev. 2/7/19
Certificate of Product Ratings
AHRI Certified Reference Number: 202326606 Date : 10-15-2020 Model Status : Production Stopped
AHRI Type : HRCU-A-CB (Split System: Heat Pump with Remote Outdoor Unit -Air -Source)
Series: LX SERIES
Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : TH4B4222
Indoor Unit Model Number (Evaporator and/or Air Handler) : AE42CX21+TXV
The manufacturer of this CHAMPION HEATING AND COOLING product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1, Performance Rating of Unitary
Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 40000
SEER: 15.00
EER (A2) - Single or High Stage (95F) : 12.25
Heating Capacity (1-112) - Single or High Stage (47F) : 40000
HSPF (Region IV) : 8.20
t"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being
marketed but are not yet being produced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
Ratings that are accompanied by WAS indicate an involuntary re rate. The new published rating is shown alono with the Drevious (i.e. WAS) rating.
DISCLAIMER
AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for,
the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the
unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the
directory at www.ahrld irectory.org.
TERMS AND CONDITIONS
This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and 181101
confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated;
entered into a computer database: or otherwise utilized, in any form or manner or by any means, except for the user's individual. JOW NNW
personal and confidential reference. AIR-CONDITIONING. HEATING.
CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE
The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better"
and enter the AHRI Certified Reference Number and the date on which the certificate was Issued,
which Is listed above, and the Certificate No., which Is listed at bottom right
©2020Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132472442879144189