HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/20/2021 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 4 SANTA FE
Property Tax ID #: 3427-111-002-000-5
Site Plan Name:
Project Name:
Ut I AlLtU U.t5CRJPTION OF WORK:
LIKE FORE LIKE 3 TON 14 SEER PACKAGE UNIT WITH 10KW HEAT
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential X
Lot No.
Block No.
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: $ 4350 Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name HARRY & PEGGY POTTS
Name: CURTIS SAMMONS
Address: 4 SANTA FE
Company: CUSTOM AIR SYSTEMS INC
City: PORT SAINT LUCIE State: _
Zip Code: 34952 Fax:
Phone No. 772-344-5954
Address: 1615 SE VILLAGE GREEN DR
City: PORT SAINT LUCIE State: FL
Zip Code: 34952 Fax: 772-335-1968
Phone No 772-335-3232
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CUSTAIRSYS@AOL.COM
State or County License CAC051810
- -- ----••--•- •• •� ... a nLlW"UCIJ iwuce or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: i
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
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 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
COUNTY OF Sf 46
STATE OF FLORIDA
e/ �
COUNTY OF
Swofn 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 2Z day of 2020 by
this Zt) day of _ �ac,4�aL.t=L-, 2021 by
�ur- ',S k.r,MOr b
LVN-NMo��
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,i blic- St,/ of Florida)
(Signature of Notary Public- Stat f Florida )
VI Sa ,5 �t PUe�� CHRISTINE B ENGLIS
Commission No. *,nal)MYCOMMISSION#GG05
n _ �p&0: 'Zl , CHRISTINE B ENW
545ommission No. `Jr rn d 5 ►��� * *aJ)MyCOMMISSIONGGEXPIRES:
'aa�
April 4, 2021
EXPIRES: AP04, V,
F� fronded ® et Nola Se
a EO o� 8"ed Thru 8-fae
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
0 Custom Air Systems Inc.
1615 SE Village Green Drive • Port St. Lucie, FL 34952
(772) 335-3232 • Fax( 772) 335-1968
0 Proposal and Agreement
Customer Name ao Phone 3� ° ` S ` Date
(� Address sQ -- e- C-;P— Job Address
City, State, Zip P 51 —,� 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
Make �Qf f�.l'�— Model Number(s) P 6193 693 (D
SEER EER AFUE Btuh Cooling Btuh Heating CFM
❑ New Amp disconnect
❑ New Amp electric service
❑ New low voltage wiring
❑ New weather resistant equipment stand
New reinforced equipment pad
❑ New vibration isolation pads
❑ New properly sized refrigerant lines
❑ New clean, dry ACR copper tubing
❑ Insulate refrigerant suction line(s)
❑ Install refrigerant drier(s)
i Evacuate refrigerant system
Charge to manufacturer's specs
fG Meet all federal, state & local laws
❑ Option (below)
<�- W (I +,*,K
5 lb o zF
,e1 Remove existing equipment from premises
❑ Install energy saving setback thermostat
❑ New copper wire from to
❑ Make air tight plenum transition
❑ new supply diffuser(s)
❑ New duct run from to
❑ Noise reducing flexible duct connector
❑ Balance for uniform supply air distribution
❑ Provide for external combustion air
❑ New gas piping from to
❑ New vent pipe and cap
X Clean work area to customer's satisfaction
❑ Condensation overflow safety switch
Hurricane Fasteners for outdoor unit
V�
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ New return air filter grill
Meet all code requirements
Complete system start up
year parts warranty
year labor warranty
❑ year compressor warranty
❑ year service agreement
El
Total Investment $ q t -,� 50
5'l19 .- a I , 91
Taxes $
Total Amount $ r �� • 5
G�J'� b 1 Down Payment $
Balance Due
Terms: �t✓ R:Jn�' P M
Acceptan a (Customer) Approv(Cojany)
l a y at
By � Date '� a B Date__��t='_