HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f��i'-o�U ace Permit Number:
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 t-'`' Residential
i PERMIT TYPE:
PROPOSED 1WRt}1�E�1JIE'±1 t LA ..._._
Address: a J I//l��.) 14 J�inLc-)G V/ ►T CO 0 3
Property Tax ID#: ��oC 3 5�0 -(��'� C.I '• CAD y Lot Na.
Site Plan Name: Block No.
Project Name:
QETAt1.EL3'°DESCRY fF)NRiC, ;
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Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters V Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First floor:
Cost of Construction:$ Utilities: —Sewer `Septic Building Height:
OWNER/LESSEE: Ofl.AIFTR OR.,..
Name LJ I I I%ay-u Je �c�tllff5 Name: Curtis Sammons
Address: l C rK c5+ Company:Custom Air Systems, Inc.
City: Y O f V� State: '1f- Address: 1615 SE Village Green Drive
I
Zip Code: O -f vFax: City: Port Saint Lucie State:FL
Phone No. ok 7- _ 10 y Zip Code: 34952 Fax: 772-335-1968
E-Mail: Phone No 772-335-3232
Fill in fee simple Title Holder on next page(if different F-Mail custairsys@aol.com
from the Owner listed above) State or County License CAC051810
I
If value of construction is$2S00 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.
SUPPLEMENTAL CONSTRUCTION! LIEN LAW INFORMATION!:
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.
Thefollowing building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 RECORDMIG YOUR NOTICE OF COMMENCEMENT
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 0't COUNTY OF
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this N day of -Do-e-fMID-el ,20_—AQ by this day of De-e— 20,�O 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
Produced / Produced
_ fY� _mod ! H` ,� _ �/-��/ -�.'�� V '7 "�--- /✓��:.d.' "".,��"�C_._.-�
{mot_f� '.�: �.- ✓J/��c�Gc�l��-� t�itr�/J�
(Signature of Notary Public-State of r1orida j (Signature of Notary Public-State of Florio T�
yf.FiRISTINE B H ,� ,: ,2vO�C. CHRISTINE B H
�23
�. l MYCQkMiSS10NCommission No_L ��`�� MYCOI!MISS10N8 rrrission No_�tt4 . EXPIRES i
O F Aoc EXPIRES:ApA 4. 1 ��F ��OQ��c Banded Pvu&rdget!t vcas
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RFVIFW
DATE
RECEIVED
DATE I
COMPLETED
ev.
3 - Custom Air Systems Inc.
(�1615 SE Village Green Drive - Port St.Lucie,FL 34952 f 0
(772)335-3232 - Fax(772) 35-1968 �t"0
�o Proposal and Agreement � ,,4
7 ) e0
Customer Name Tpn S Phone 2 d 7 r ��"" 1 do� Date
dad �' AlA �a Q
Address Job Address
City, State, Zip 1 T 7 �p, � 7 17 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
Q
QMake Model Number(s)
SEER EER AFUE Btuh Cooling Btuh Heating CFM
Imallation shall include:
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b
0
X in boxes = Yes
❑ New Amp disconnect Remove existing equipment from premises ❑ New condensate drain system
❑ New Amp electric service ❑ Install energy saving setback thermostat ❑ New condensate pump
❑ New low voltage wiring ❑ New copper wire from to ❑ Install aux. condensate drain pan
❑ New weather resistant equipment stand ❑ Make air tight plenum transition ❑ New high efficiency air filter
El New reinforced equipment pad ❑ new supply diffuser(s) ❑ New humidification system
❑ New vibration isolation pads ❑ New duct run from to ❑ New return air filter grill
❑ New properly sized refrigerant lines ❑ Noise reducing flexible duct connector ❑ Meet all code requirements
❑ New clean, dry ACR copper tubing ❑ Balance for uniform supply air distribution ❑ Complete system start up
❑ Insulate refrigerant suction line(s) ❑ Provide for external combustion air ❑ year parts warranty
❑ Install refrigerant drier(s) ❑ New gas piping from to ❑ year labor warranty
❑ Evacuate refrigerant system ❑ New vent pipe and cap ❑ year compressor warranty
❑ Charge to manufacturer's specs ❑ Clean work area to customer's satisfaction ❑ year service agreement
❑ Meet all federal, state & local laws ❑ Condensation overflow safety switch ❑
❑ Hurricane Fasteners for outdoor unit a 7 7 s-b
❑ Option (below) ❑ Total Investment $ -
Pck 1 Ir e tw __--_-- Taxes $ 0
tal Amount $
0Sy
Down yment $
aBala a Due $
Terms:
Acce tan (C ) Approval (Co )
By 20 By Date V/1 kaj