HomeMy WebLinkAboutHayes gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACC17PTED
Date: Permit
Number:
abCU1C�DC
a
1 . ° " 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 FOR:GAS TANK
PROPOSED IMPROVEMENT LOCATION:
Address: 4919 Tamoka Ct Fort Pierce, FL 34951
Property Tax ID #: 1312-801-0136-000-2
Lot No.333
Site Plan Name:
Block No.
Project Name: Hayes gas
DETAILED DESCRIPTION OF WORK:
Install 500 gallon underground gas tank with line to generator and final connect
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: 4295.00 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer
Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Noreen Hayes
Name: Michael
Company: Energized
p Y�
Address:4252
Flaxman
Address:4919 Tamoka Ct
Electric
City: Ft Pierce State
Bandy Blvd
Zip Code: 34951 Fax:
City: Ft Pierce
State: FL
Phone No.7729711752
Zip Code: 3498
Fax:
E-mail:
Phone No 77241361095
Fill in fee simple Title Holder on next page ( if different
E-Mail energize
generators@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 require
1.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is requi
ed.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATIO
DESIGNE
Name:_
Address:
City:
Zip:
GINEER: - Not Applicable
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGECOMPANY:
Name:
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 perrr it.
St. Lucie County makes no representation that is granting a permit will authorize th a permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or a id 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 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 Commenceme t 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 the jobsi before the first inspection. If you intend to obtain financing, consult
with lender or an attorney be ore mmencing work or recording our Notice of Corp.rT ncement.
Signature of Owner/
as Agent for Owner I Signature
Holder
STATE OF FLOWDDA STATE OF FLORIDA
COUNTY OFF P COUNTY OF
Sworn to for affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
hysical Preseqce or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this 1 ")t3, day of U y ` ' 7) r . 2020 by
�y� � �� X. � _ .--�' A� ,. Yo I T
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Know <' ; OR Produced Identification
Type of Identification Type of Identification
r 1
1
(Signature of Notary Py�, r� (Signaturtf:to=P>tbfr�
O�NiELL^ b0 6C6?Lv DI�NIL-"LLE i {�;dC�,l.'1�-:i
k r r n I^n :�, ii tjr
Commissior6 Flo t F'YC OM.1,1 . , # G S A° ���,
'r Xg�ic a Ju , 27. �u Commis 11= MY COMMISSIONS GG 23 a1)
he U d �r r u• ; EXPIR[
t 4,_ � YriPfo,�Fv__ :;;��g� �I e�_tt< Eon�edThruPl�ta;y�un;ir,!Jni3erv;riiers �
REVIEWS FRONT ZONING SUPERVISOR PLANS VEG TATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Energized Gas Inc
Propane and Naturat Gas Si) &iatist
Proposal / Agreemi
Noreen Hayes
4919 Tamoka Court
Fort Pierce, FL 34951
772-971-1752
NNNHAYES@aol.com
Energized Gas hereby agrees to furnish all labor and materials
services as specified below:
1) Thompson Gas to supply and install (customer (
propane tank and install line and, regulator and
2) Price includes all labor, material and permitting
3) Price includes backfilling and removing dirt (if al
4) Price does not include the first fill of the propane
5) First fill at 1.99 per gallon billed at tank Install
nt
for the completion of
Fned) underground 500 gallon
nal connect to generator
)plicable)
, tank
1786 SW 8iltmore St, Port ST Lucie, FL, 34984 *
Toll Free 855-PROGAS4 *Treasure Coast 772-777-8133 *Palm
d & Insured FL34747
561-752-0214 *Fax 772-318-6673
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 roposal/Contract date
$1,697.00 is due @ Signing
$2,597.50 is due @ Final Connection
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: _
Ron Weimers h
I, �= (printed name), authorize Energized Gas to
complete the work in acco dance with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date
gnature
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