HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A- ;t-ac) Permit Number:
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COUNTY
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:
Additional work to be performed under this permit -check all that apply:
-Mechanical `Gas Tank _ Gas Piping _Shutters — Windows/Doors
_ Electric _ Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $ L192L — Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: -
coin
Name
Name: Curtis Sammons
Address:city
Company: Custom Air Systems, Inc.
, �
Zip ode: Il�r�?0 Fa State.
Zip Code: _ 3 Fax:
Phone No.
Address: 1615 SE Village Green Drive
City. Port Saint Lucie State: FL
Zip Code: 34952 Fax: 772-335-1968
E-Mail:
P h o n e N o 772-335-3232
Fill in fee simple Title Holder on next page (if different
E-Mail custairsys@aol.com
from the Owner listed above)
L
State or County License CAC051810
I
If vnlno e Senn
- - ----- -• ...-•" 1--c ui wrnmencemenz is requlrea.
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:
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 permiuthorize
St. Lucie
makes
y the t_
which is nocontlict with any applicable ion Ho eat is Owners Assoranting ciationt will rules, rules aby bylaws or and permit holder
that maybuild
restr ctborprohibit s ch
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
COUNTY OF_
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _) day of �lfj.l2crbe ( , 20L by
The forgoing instrument was acknowledged before me
this day of f\I��le��� 20��by
12
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of identification
Produced
Personally Known OR Produced Identification
Type of Identification
Produced
I
(Signature of Notary Public State of Florida)
,1 oi�Y r� CHRISTINE B
Commission No. iri vS,�JrILb 4 � MYCOMMISSION#
(Signature of Notary Public- State of Florid y a
I o�� . °`9G CHRISTINE 8
mission No.cly 95� 546 * COMWSSIONft
EaPIRES:ApA4.
7EXPIRES:Aprg
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REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
>546
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772)335-3232 • Fax( 772) 335-1968
Proposal and Agreement 0
Customer Name �1 �1oo
Address �� ��(4—ire-0
City, State, Zip SL ELI -� n ELg
Phone J 2w— Date!
Job Address , %�L, 'P
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 U Model Number(s)eply J
SEER EER AFUE Btuh Cooling A!'� Btuh Heating CFM
❑ 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
❑ Insulate refrigerant suction line(s)
B-;nstall refrigerant drier(s)
(ei�vacuate refrigerant system
C-'large to manufacturer's specs
C:�et all federal, state & local laws
❑ Option (below)
❑ Remove existing equipment from premises
❑ Install energy saving setback thermostat
❑ New copper wire from to
❑ Make 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
❑ New vent pipe and cap
Can
work area to customer's satisfaction
densation overflow safety switch
urricane Fasteners for outdoor unit
Fl
-r-n/a6y� q
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a
yrgU . oD
Terms
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ �New return air filter grill
,B- eet all code requirements
12111rear
system start up
❑ear parts warranty
❑ labor warranty
❑ Z year compressor warranty
❑ year servic agre ent
El a;
Total Investment $ O, 00
Taxes
Total Amount $
Down Payment $
Balance Due