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HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / - p'/ Permit Number: Date: • Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Residential Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERMIT TYPE: HVAC Equipment ChangeOut Address: Property Tax ID # Site Plan Name: Project Name: _ Like for like AC replacement 1-5-7 lw 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: l/ 1141-r`a Sq. Ft. of First Floor: _ Cost of Construction: $ i Utilities: _Sewer _Septic Name Address: � City: / o�T %�l�'r/ State: Zip Code: Fax: Phone No. E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Lot No. Block No. Windows/Doors Roof Pitch Building Height: Name: Steve Smith ,,,. Steve Smith Air Conditioning A,4,a,.p«.8001 Eden Road City: Fort Pierce State: FL Zip Code: 34951 Fax: 772-461-2036 Phone N0772-461-1425 E-M ail stevesmithac@aol.com State or County License CAC1813454 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. ��" r �' � ' s.. . l..ti. { Y, n' ,.�.�, `w`.� .. �? .,,.' A9y..u�s..... J7 � rr �.S�k.;�.53x ✓„i,3d � ,. i. ,..:.x MORTGAGE COMPANY: _ Not Applicable DESIGNER/ENGINEER: ^ 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 maicaMu, 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 structure. with w thpyoiurHlome Owners Association andrreview bylaws ur deed for any restrthat ct ons which maor aprohibit such 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 IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON PE JOBSM BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y LENDF,ICR AN ATTORNEY BEFORE RECORDING YOUR NOTICEA� COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Hol STATE OF FLORIDA I STATE OF FLORID S COUNTY OF -r COUNTY OF .I,Lor Le The forgoing instrument was acknowledged before me this Lyday of t A a L-g 20ja by <<&VEN '�;l'A %-T4 Name of person making statement. Personally Known OR Produced Identification_ Type of Identification Produced DR\VER- �-I L�'`'sE ignat a of ota Public- State of Florid ChristopherJ. NOTARY Pl Commission No. 22212 STATE OF I Comm GG: REVIEWS FRONT I ZONING COUNTER REVIEW DATE RECEIVED DATE COMPLETED ev. Z7T%f9 The forgoing instrument was acknowledged before me this day of ICI (.��= 20- j by Sf xyn S►� r i4 Name of person making statement. Personally Known OR Produced Identification k' Type of Identification u Produced �— ure V Notary Public- State of Flo { Jiepnano ' NOTARY P ssion No. FF 9Y 7 e a STATE OF W ? Comm# FF SUPERVISOR PLANS VEGETATION I SEA TURTLE I MANGROVE REVIEW REVIEW REVIEW REVIEW REVIEW This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between 1/1/2015 and 12/31/2020. Certificate of Product Rao'Ns AHRI Certified Reference Number: 9141217 Date : 02-10-2021 Model Status : Active AHRI Type : HRCU-A-CB (Split System: Heat Pump with Remote Outdoor Unit -Air -Source) Series: LX SERIES Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : TH4B3021 Indoor Unit Model Number (Evaporator and/or Air Handler) : AE30BX21+TXV The manufacturer of this CHAMPION HEATING AND COOLING product is responsible for the rating of this system combination. 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 produced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings 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 I confidential reference purposes. The contents of this Certificate may not, in whole or in part. be reproduced; copied; disseminated;Armo entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual. AIR-CONDITIONING. HEATING, personal and confidential reference. & REFRIGERATION INSTITUTE CERTIFICATE VERIFICATION The Information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" Ilnk we rnake Iifebetter, and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which Is listed above, and the Certificate No., which Is Ilsted at bottom right 132574422416155861 ©2021 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: