HomeMy WebLinkAboutBesanko gasAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit
Lau
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
Number:
Residential x
-
PERMIT APPLICATION FOR: N
PROPOSED IMPROVEMENT LOCATION:
Address: 21210 GLADES CUT OFF RD
Property Tax ID #: 4221-232-0039-000-6
Site Plan Name: 21210 GLADES CUT OFF RD
Project Name: Kirsten A Besanko
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Move LP gas hook up 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 _ Generator—
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 795.00 Utilities: _Sewer
Windows/Doors _ Pond
Roof Pitch
Septic Building Height:
OWNERAESSEE:
CONTRACT
R:
Name Kirsten A Besanko
Name:Michael
Company: Energized
Address: 4252 E
City: Ft. Pierce
Zip Code: 3498
Phone N0772-4
E-Mail energizeclgenerators@gmail.com
State or County
laxman
Address: 21210 GLADES CUT OFF RD
Electric
City: Port St. Lucie State-:!"'
Zip Code: 34987 Fax:
Phone No.772-464-7457
andYBlvd.
State: FI
Fax:
6-1095
E-Mail: KristenAlanna495@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
License LQ31756
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 requir
d.
t
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'
DESIGNER/ENGINEER: —Not Applicable
Name:
MORTGAGECOMPANY:
Name:
Address:
City:
Zip:
_ Not Applicable
Address:
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:
vvvlvtK/ WIM 1 KAL I OR 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 wil
in accordance with the approved plans, the Florida Building Codes and St. Lucie Cour
The following building permit applications are exempt from undergoing a full concur
accessory structures, swimming pools, fences, walls, signs, screen rooms and access(
WARNING TO OWNER: Your failure to Record a Notice of Commencemen
improvements to your property. A Notice of Commencement mus
Lucie County and posted on the. jobsite before the first inspection.
with lender or an at
rryey be,re commencing work or recording
Signature of Owner
STATE OF FL
COUNTY OF
tractor as Agent for Owner I Signature of
Sworn to (or affirmed) and subscribed before me of
�Ptiysical Pre nce or Online Notarization
this J —day of Il , 2020 by
Name of person making statement
Personally Known < OR Produced Identification
Type of Identification
Produced
(Sign
r@ I A
T' w COMMISSION # GG 232946
CommieiY 27,2022(Sea
in all respects, perform the work
i Amendments.
ency review: room additions,
ry uses to another non-residential use
may result in paying twice for
be recorded in the public records of St.
f you intend tt.9,obtain financing, consult
our Notice Q Commencement.
ctor/,i_icense Holder
STATE OF FLORID
COUNTY OF
Sworn to (or affi rmed) and subscribed before me of
Physical Pr nce or Online Notarization
this 1dayof ' " "}/). ,� 2020 by
Name of person making statement. l
Personally Known OR Produced Identification
Type of Identification
(Signatur Sf.N
EXPIRED: June 27, 2022
Commissi yk candn<fIMMAN hbtlnUnd b
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
TERMS®
Charges & Payments: Charges are due in full at time services are rendered inless 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 roposa I /Contract date
$495.00 iS due @ Signing
$300.00 is due @ Completion
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:
Brian Orr
********************************************************************
complete the work in accordance with the above specificationsa d conditions. o s. I agree to), authorize a ased per
terms outlined above. 9 pay p
ature
This agreement shall be construed under the laws of the State of Florida. This agreeme
parties and supersedes all previous verbal or written agreements: there are no other ai
set forth herein. If any conflicts exist in this agreement between terms which are printe
typed or written language shall govern.
CONTRACT TERMS AND COND
Date
nt contains the entire understanding of the
ireements, representations or warranties not
d and those which are typed or written, the
NS
Page 2 of 3
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierc , FL, 34981, Fax 772-318-6672*
*Palm .Beach 561-752-0214, 1700 Latham Rd, Suite 2, West Palm Beach. FL_ 33409*
Proposal / Agreement
Kirsten Besanko
21210 Glades Cut Off Road
Port St. Lucie, Florida 34987
772-464-7457
KirstenAlanna495@gmail.com
4" 04 'P
1) Move LP Gases and final connect to generator
2) Price includes all labor, material and permits
For the
September 2, 2020
Of: $795.00
Installation will comply with all local and state regulations and be donsistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of nstallation*. This includes but is not
limited to; damaged/broken sprinkler lines and/or damaged/broke water or sewer lines.
This contract price does NOT include bonding gas lines, converting putlets, converting appliances or
carbon monoxide detectors
Additional charges may apply if rock and/or roots are encountered during the excavation process.
Deposit will be forfeited if customer cancels after the permit process is initiated.
Customer is responsible for obtaining HOA/POA approval. Installers 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 �395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
'�'J&75Z) A. B Fseatz)
PRINTED NAME
W
IRG'NATURE
F
Ll //-9 /,�,7C� I
DATE
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