HomeMy WebLinkAboutScan_2020-12-08-103831962All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
` 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: , /V A
PROPOSED IMPROVEMENT LOCATION:
Address: ',k-�l0
l f
Property Tax ID #:?i ��J � �7�Z'--�o,��- � -� Lot No.
Site Plan Name: S'l�y u91.1 CA 6jUb %jil 'I[I>) Block No. It
Project Name:
DETAILED DESCRIPTION OF WORK:
1�%C>/ lam I . . -> `� ��f�0'. ;�-i
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
J� Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric —Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: ! Pi
Company: If 4 1 Q 2
Address: S i 0
City: / S State: _
Zip Co e:� Fax:
Zip
Phone No. _Z?/ l 796 7 R IS
Address: IV)
City: S"i I 1./e State:C_
Zip Code: 3 tfcl S Z Fax:
Phone No 0/7 2- —3-3> ., _2-0cp /
E-Mail
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License c�%4 — C— cSg6 6y
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
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 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.
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 IMPROYEMENTS 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."
Si of Owner/ Lessee/Contractor as Agent for Owner
SignWeAO Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA t
Coo
COUNTY OF S-E- Ly c t t Cam >,��
COUNTY OF �-T' L v c t e N'C-A,�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
g '�6CFy 6'ER— by
this day of �il> EE" _ 20 � by
this day of 20�o
Name of person making statement.
Name of person making st tement.
Personally Known ✓taOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida }
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State of Florida -Notary Public
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Rev.12/ // 19
Niemeyer Circle Port
Port St. Lucie, FL 34952
Clean Air
11-ectincliegies
PROPOSAL AND AGREEMENT
A/C Sales Service Installation
By Jeffrey Almeida - Lic # CA-0058660
CUSTOMER pNAME
ADDRESS 00 4, b.,,
CITY, STATE, ZIP Po r-V a,� J
(772) 335-2061
Fax 335-1802
PHONEy Q 6 " q Fff -DATEf
JOB ADDRESS
WORK PHON
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on all pages
of this proposal.
EQUIPMENT SPECIFICATIONS
Make GrA1121h + I Model Number(s) ec— q A 42-
SEER EER BTUH Cooling v BTUH Heating G CFM
Installation shall
New low voltage wiring
reinforced equipment pad
New vibration isolation pads
New properly sized refrigerant lines
Ijlew, clean, dry ACR copper tubing
Charge to manufacturer's specs
Insulate refrigerant suction lines
Install refrigerant drier(s)
�cuate refrigerant system
R ove existing equipment from premises
nstall new 7o I thermostat
N copper wire from to
Complete system start up
.. _ —11 ..y. r,..,,,u... ---.—
New dehumidistat
Ne supply diffuser ( oil
✓New duct run from to`.
New return air filter grill
Ng+ie reducing flexible duct connector
lean work area to customer's satisfaction
New condensate drain system
Install aux. condensate drain pan
New high efficiency air filter
____�A'eet all code requirements
_year parts warranty
_year labor warranty
__L�Y_year compressor
_year service agreemen
,,' Q _
Option (below) Alternative (below) Is (_ Is not) included in price
Terms: 'qq9� '4 �i;�+�� .'N �y! LA-6c! 10 y!TS. Installed Price
e-,,,PA.- 0(-- __Fly n �iY� .- /JnAi .{a /At..af
Acceptance
Date
L,
Total Amount $
Down Payment $
Balance Due $
Date:
?0 1 c1d
Certificate of Product Ratings
AHRI Certified Reference Number: 8560563 Date : 12-08-2020 Model Status : Active
AHRI Type: SP-A (Single -Package Air -Conditioner, Air -Cooled)
Series: LX SERIES
Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING
Outdoor Unit Model Number (Condenser or Single Package) : PCE4A42*
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,
MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S.
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 manufacturer of this CHAMPION HEATING AND COOLING product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1, Performance Rating of Unitary Air -Conditioning
& Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing:
Cooling Capacity (A2) - Single or High Stage (95F), btuh : 41500
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 11.00
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 prod uced."Prod uction Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still
selling or offering for sale.
Ratinas 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
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;
fins On `,
entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual,
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 life better -
and enter the AHRI Certified Reference Number and the date on which the certificate was issued,
which is listed above, and the Certificate o. which is listed at bottom right.
CERTIFICATE NO.:
132519295091246575
02020Air-ConditioningHeating,and Refrigeration Institute