HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ST. LIUWE
Cou NT Y
1110 L iJ R I D A
Permit Number:
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
PERMIT APPLICATION FOR:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 5303 Indian Bend Ln Fort Pierce, FL 34951
Property Tax ID #: 1312-800-0031-000-3
Site Plan Name:
Project Name: Darnold gas
I DETAILED DESCRIPTION OF WORK:
Disconnect existing generator, reconnect gas line to new generator
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this ermit — check all that apply:
_Mechanical _ Gas Tank '� Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: _
Cost of Construction: $ 495.00
Sq. Ft. of First Floor:
Residential X
Lot No.200
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ( - (-
Address:5303 Indian Bend Lane
Name: Michael Flaxman
Company: Energized Electric
City: Ft Pierce State: _
Zip Code: 34951 Fax:
Phone No.7723326812
Address:4252 Bandy Blvd
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 7723186672
Phone N07724661095
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail energizedgenerators@gmail.com
State or County LicenseLQ31756
rvmuC ur wnstrucraon is caw or more, a KtLUKUtU Notice or 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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 obta' inancing, consult
with lender or an attorne bef commencingwork or recordin our No ice f Co cement.
Signature of ne / ssee ontractor as Agent for Owner
Signature of Contrac Licen a Holder
STATE OF FL �f►
STATE OF FLO
COUNTY O (,k)z
COUNTY OF
SAorn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ay of 202t by
Swo to (or affirmed) and subscribed before me of
P ysical Presence or Online Notarization
this IPA day of 202k by
Name of person making statement.
Name of person making statement.
Personally Known —_�C_ OR Produced Identification
Type of Identification
Personally Known � OR Produced Identification
Type of Identification
P duced
Ppeduced
(Si agVg
;, ......( =�
Co .' �� GONCgEyES
FISSION # GG 232946 e a I )
June 27
i;af�oP''BOfIdBdTh �2022
rU � PU
(Sign_ e' tar - r i d a
COMMISSION # GG 232946
Comm? : e: EXPIRES: June 27, 2022 (Se
undenvrders8.
_..
)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1700 Latham Rd, Suite 2, West Palm Beach, FL, 33409*
Proposal / Agreement
Howard Darnold August 31, 2020
5303 Indian Bend Lane
Fort Pierce, FL Florida 34951
772-332-6812
Skip669@yahoo.com
1) Disconnect and reconnect gas line to new generator and final connect
2) Price includes all labor, material and permits
For the sum of.- $495.00
TERMS:
Charges & Payments: Charges are due in full at time services are rendered unless 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 Proposal/Contract date
$495.00 is due @ completion
vve appreciate me opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
John Maruri
********************************************************************
Acceptance of Proposal
I, (printed name), authorize Energized Gas to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date i
Signature
ar �
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of the
parties and supersedes all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or written, the
typed or written language shall govern.
Page 2 of 3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of installation*. This includes but is not
limited to; damaged/broken sprinkler lines and/or damaged/broken water or sewer lines.
This contract price does NOT include bonding gas lines, converting outlets, 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. Installer is 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
PRINTED NAME
S GNATURE DATE
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