HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/5/2021 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION.
Address: 4200 N HIGHWAY A1A 616
Property Tax ID#: 1423-501-0144-000-1
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
LIKE FORE LIKE 2 TON 15 SEER SYSTEM 5 KW HEAT
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: Sq. Ft. of First Floor:
Cost of Construction: $ 4000.00 Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR,:
Name PAUL ACHILLI (TR) Name:CURTIS SAMMONS
Address:86 WILDWOOD ROAD Company:CUSTOM AIR SYSTEMS INC
City: VERNON State:LLt- Address: 1615 SE VILLAGE GREEN DR
Zip Code: 06066 Fax: City: PORT SAINT LUCIE State: FL
Phone No. 772-801-5189 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 E-Mail CUSTAIRSYS@AOL.COM
from the Owner listed above) State or County License CAC051810
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.
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.
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 posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF 'ff tgG11✓ COUNTY OF •� ,Gucis
Swo,rn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓ Physical Presence or Online Notarization � Physical Presence or Online Notarization
this day of <0:N'_1 .:i 4'2020'by this fS day of !c..n,t,c.. ��';2028 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
(Signature of Notary Public-St of Florida ) (Signature of Notary Puy c-Stat o f Florida )
�l 3�3 o�s�Y;ve4 CHRISTINE B ENGLVS 1� n �7 � ti� CHRISTINE a
Commission No. U► 't * *itYCOMMISSIONNGG 5�Gommission No. tn1n �. s(,+59 *�dJ)MYCdMMtSSIONtGG
EXPIRES:April 4,2021 'a \oe EXPIRES:Aprg 4. 1
60rM ud a NqW Se a 0 c� ft,4w n.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Custom Air Systems Inc.
1615 SE Village Green Drive • Port St.Lucie FL 34952 3
(77 )335-3232 • Fax(772)335-1968 �l uy
roposand Agreement
I 0
Customer Name Phone Date I
I l9
Address
-12 iD d /y k I K 4:�-C t(n, Job Address
City, State, Zip F+ i e"«i F I. 3 tM L 9 Work Phone(s)
We will furnish, install and service the equipment listed below at the price, ter s)and conditions outli ed on this proposal.
Equipment Specifications ! �f
I
0
Make Model Number(s) �
SEER EER AFUE Btuh Heating CFM
Installatio shall include:
r a v ee- e- Tom t S-��. 0
4 h cfc�o I
� / oaoBT'I.t
ly
e D/
un ` 14-Ac X in boxes = Yes
El New Amp disconnect ✓� 5 ❑ Remove existing equipment from premises ew condensate drain system
❑ New Amp electric service Install energy saving setback thermostat ❑ New condensate pump
❑ New low voltage wiring ew copper wire from t ❑ Install aux. condensate drain pan
tlj ❑ New weather resistant equipment stand ❑ Ma transition ❑ New high efficiency air filter
❑ 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�Condensation overflow safety switch ❑
,,--��' a Fasteners for outdoor unitFasteners for outdoor unit
❑ O ti(belavGj ❑ Total Investment $
Taxes $
Total Amount $ cgo• O cl
t
,' � a Down Payment $
D � Balance Due $
Terms:
Acceptance (Customer Approva y
Date By Date
MR 6-
® —