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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: V Permit Number:AA Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax:(772)462-1578 PERMIT APPLICATION FOR: via Address: I ✓c Y ✓ ��l��1Q ,37 9'/ Property Tax ID#: �3�U"Sy� •i��cJfO �©IJV� Lot No. _, Site Plan Name: Block No. Project Name: a - Vy eJb k�iWl 106 New Electrical Meter Second Electrical Meter 110 I Additional work to be performed under this permit—check all that apply: �R $Mechanical _Gas Tank —Gas Piping _Shutters v Windows/Doors ,Pond r;§ _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction:cc Sq. Ft. of First Floor: _ Cost of Construction:$ V Utilities: —Sewer Septic 33 Building Height: Im¢ t ar e 04 ' I Name � / Name: 2. Addre v �1e Y Company: �� Lt Cit State: Address: Y Zip Code: Fax: City: ��!*I° State: Phone No. _ Zip Code: 3 q 4C5 Fax: E-Mail: Phone No Q _ Fill in fee simple Title Kolder on Axt page(if different E-Mail Al from the Owner listed above) State or County License 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. 777777.7 41, Rp, ., r N 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: I Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. ak I certify that no work or installation has commenced prior to the issuance of a permit. it 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 1 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 p d on the jobsite before the first inspec ' If you intend to obtain financing, consult with baoder or an atWrnev before commencingwork or re di g your No ' e ommencement. Si natu of Ow r/Lessee/Contractor as Agent for Owner Signature of C ractor/License Holder 10 STATE OF FL RIDA� ) , I STATE OF FLORIDA / , � COUNTY OF lC�(.�t I COUNTY OF (�(,{ I Swor to(or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of 1 �/_Physical Pres a or Online Notarization P ysical Prese a or nline Notarization this of 2020 by this day of 020 by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification Type of Identification Type of Identification ProcILAd Produce rAtay 1K a,� l (Signature of Notary Pu (Signature of Notary Publi -St e g ca RICIAR.HILL "' PATRICIAR.HILL MY ISSION#GG 976680 �' MY COMMISSION#GG 976680 Commission No. " ommission No. Cad'�s:April 7,2024 ro= ``FJ(PIRES:April 2024 Bonded ThN Notary Public Underwriters ''FPF F�°a; Bonded Thru Notary Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE — -- --—{ RECEIVED DATE i — -- COMPLETED ev. This combination qualifies for a Federal Energy Efficiency Tax Credit when op placed in service between 1/1/2015 and 12/31/2020. a CERTIFIED € I www.ahridii,ectory.org low- rtificate of Product Ratings AHRI Certified Reference Number:8703698 Date:12-03-2020 Model Status:Active j a, AHRI Type:RCU-A-CB(Split System:Air-Cooled Condensing Unit,Coil with Blower) j , Series:SILVER 16 tr Outdoor Unit Brand Name:AMERICAN STANDARD 3 1. I f;' Outdocr Unit Model Number (Condenser or Single Package):4A7A6042J1 Indoor Unit Model Number(Evaporator and/or Air Handler):TEM4AOC42S41+TDR Region: All(AK,AL,AR,AZ,CA,CO,CT,DC,DE,FL,GA,HI,ID,IL,IA,IN,KS,KY,LA,MA,MD,ME,MI,MN,MO.MS, 3 MT,NC,ND,NE,NH,NJ,NM,NV,NY,OH,OK,OR,PA,Rl,SC,SD,TN,TX,UT,VA,VT,WA,WV,Wi,WY,U.S. X, l(• Territories) Region Note: Central air conditioners manufactured prior to January 1,2015 are eligible to be installed in all regions until June 30,2016.Beginning July 1,2016 central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. The mantt�ottfrt�r t�this AMERICAN STANDARD product is responsible for the rating of this system comt�nattloh Rated asJoillomin accord6trice,with the latest edition of AHRI 2.10/240 with Addendum t Ap of Of Unitary A,-Cor.d.Gcning &Air 4dpment and subject to rating accuracy lay AHRI-sponsored,independent,:tttird patty testing: Cooling (",4Sing[e or Higl&Stage(95F),btuh 41000 SEER EE<(A2)- car frt�Marge(9l} :13.00 j :. a - t 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 along with the previous(i.e.WAS)rating. DISCLAIMER t 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and 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. A&" 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 He boo r"^ 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 ERT1FICATE NO.: 132514884851W385a