HomeMy WebLinkAboutLugar gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Per it Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: GAS TANK
PROPOSED IMPROVEMENT LOCATION:
Address: 9408 Pinebark CT Fort Pierce, FL 34951
Property Tax ID #: 1327-801-0058-000-7
Site Plan Name:
Project Name: Lugar gen
DETAILED DESCRIPTION OF WORK:
Install 500 gallon underground gas tank with 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
_ Electric _ Plumbing _ Sprinklers General
Total Sq. Ft of Construction: _
Cost of Construction: $ 4295.00
Sq. Ft. of First Floor:
Residential X
Lot No. 169
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer T Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
NameThomas Lugar
Name: Michael
Company: Energized
Address:4252
City: Fort Pierce
Zip Code: 349E
Phone No772
E -Mail energize
State or Count
Flaxman
Address: 9408 Pinebark CT
Electric
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No. 2077172161
3andy Blvd
State: FL
1 Fax:
661095
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
dgenerators@gmail.com
License LQ31756
vacua vW11bL1Ul.UU11 ib c,vv or more, a KtLUKUtIJ Notice OT Lommencement isequired.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is i red.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGECOMPANY:
Name:
Address:
City:
Zip:
Not Applicable
City: State:
Zip: Phone
State:
Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Address:
City:
Zip:
Not Applicable
Address:
City:
Zip: Phone:
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 ora d 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 w II, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie Cou ty Amendments.
The following building permit applications are exempt from undergoing a full concu rency 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 mut be recorded in the public records of St.
Lucie County and post on the jobsite before the first inspection. If you intenclbtain financing, consult
with lender or an att ey before commencing work or recording our Notico ommencement.
Signature oyOwpfer/ Lessee/Contractor as Agent for Owner
STATE OF FL'ORI
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization
this!aWay of I i V 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of otar 4 blic- SRi#%Fftl '120
*: My COMFfiSSiON
#G 2329446
Commission EXPIRES : iun�22
I ° one ru
Notary Fu !ic Un erv�riters
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature,6f tract r/License Holder
STATE OF FLOW
COUNTY OF
SwrPysica
to (or affirmed) and subscribed before me of
hlP � ce or Online Notarization
th.qday of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Si atW, Acpf,Nto +WE i 4i�41orid )
MY COMMISSION # GG 232946
W-4nnded
2022Co r�EXPIRFS:June27, al)
r. ThruNotaryPAIN UndamiterS
S ATURTANGRO
REVIIEWOR REV EW VREV EWEGETATION S EV EWLE MREVIEWVE
*Treasure Coast 772-4661095, 4252 Bandy Blvd, Fort Pier'c, FL, 34981; Fax 772-318-6672'*
*Palm Beach 561-752-0214, 1550 Latham Rd, Suite 3, est Palm Beach, FL, 33409*
Thomas Lugar
9408 Pinebark Court
Fort Pierce, Florida 34951
207-717-2161
tdlugar@gmail.com
1) Supply and install (1) customer owned 500 gall
gas line to generator and final connect
2) Obtain all permits & inspections needed
3) Price includes backfilling and removing dirt
4) Price does NOT include filling the tank with pror
based off Thompson Gas" market prices
ID
October 21, 2020
)n underground LP Tank with
ne, price per gallon will be
TERMS:
Charges & Payments. Charges are due in full at time services are rendered
charge and customer agrees to pay a late fee for all past due payments, such 1
applicable law. Customer shall be responsible and agrees to pay for all charges
other charges/fees.
Proposal/Contract pricing good for 30 days from F
$500.00 is due @ Signing (paid
$3,795.00 is due @.Connection
We appreciate the opportunity you have extended us
like to thank you in advance fol your consideration.
Authorized signature:
Jq;Kn Mauri
nless otherwise stated below. Contractor may
es not to exceed the maximum allowed rate by
)illed, applicable taxes, applicable legal fees and
,posal/Contract date
0/21/2020)
Generator
quote on this work and would
(printedname), authorize Energized Gas to
complete the work in accordance with the above specifications arid conditions. I agree to pay as per
terms outlined above,
Signature
This agreement shall be construed under the laws of the State of Florida. This agreem
parties and supersedes all previous verbal or written agreements: there are no other
set forth herein. If any conflicts exist in this agreement between terms which are print
typed or written language shall govern.
Date
nt contains the entire understanding of the
Ireements, representations or warranties not
d and those which are typed or written, the
CONTRACT TERMS AND CODITIONS
Installation will comply with all local and state regulations and be onsistent with standard industry code.
Installers are not responsible for landscaping repairs as a result o 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 encounteredduring the excavation process.
Deposit will be forfeited if customer cancels after the permit proce s 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 I$395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLED
PRINTED NAME
SIdAATU RE
NT OF ABOVE TERMS
DATE
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