HomeMy WebLinkAboutchange of contratorPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
• R I • A Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed by the property owner, and the new contractor of record for the
current permit. A new permit application must also be completed with new contractor information,
signature, and transfer fee. A new Notice of Commencement must be filed in the new contractor's
name for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 1512D2-1
Site Address: 1 1 VJ Ouf u In C Ig r`
Permit Number:
r
5 State License L�LiSS� ( SLC License --nmized Ng
Original eneral Contractor (or Subcontractor)
p
L L c- State License SLC License
New Gene Contractor (or Subcontractor)
Reason for Change
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed. / , 1
SIGNATURE OF OWNER (or owner! uil er)
PRINT NAME YAC110 T aLWWti IZVIA1 !4 .M.
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1S"day oft VU! 2031, by�H01 Dk 0
�k (n(lCU VJ(Jr who is personally know tome
or who has produced n , /as^ 1D.
�Ih 4n�X.t e�Q�t�
Signature of Notary Date
SIGNATURE OF� N� EA&QENER�L �C-O—tNTRACTOR
PRINT NAME t"11L ilf I 4(AXM
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1 S� day of ��!A
�A 20-1 , b C.t;i
12C,I)MAn o is personally kno to me
o ho has procluced
U�Q
r
Signature of Notary Date a, is 12�
*Only signature eciuired.. Wr ontractor jo' ?y c DANIELtEGONCAIVES
�;s'v v II- DANIELLE GONCALVES MY COMMISSION # GG 232946
Revised 0 7 / 21 / 19 MY COMMISSION # GG 232946 EXPIRES: Juna 27, 2022
x
* "= `. r, °P Bonded Thru Notary Public Underwriters
EXPIRES: Juno 27, 2022 __. `,"
OF��`' Bonded Thru Notary Public Underwriters •�
_ ._-
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 116 Queen Christina CT Hutchinson Island, FL 34949
Property Tax ID #: 1414-702-0008-000-5
Site Plan Name:
Project Name: Brandenburg
DETAILED DESCRIPTION OF WORK:
Lot No. H
Block No. 21
SUPPLY AND INSTALL 500 GALLON UNDERGROUND LP TANK WITH GAS LINE TO GENERATOR AND RANGE AND FINAL CONNECT.
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
Total Sq. Ft of Construction: _
Cost of Construction: $ 5664.00
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Harold T Brandenburg Jr
Name: Michael Flaxman
Address:116 Queen Christina CT
Company: Energized Electric
City: Hutchinson Island State:—
Zip Code: 34949 Fax:
Phone No. (703) 855-4604
Address:4252 Bandy Blvd
City: Ft pierce State: FL
Zip Code: 34981 Fax: 7723186672
Phone No7724661095
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 License LQ31756
If value of construction is 2500 or more, a RECORDED Notice of commencement is requirea.
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:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 befoCg4ommencing work or recording our Notic9 of Co ncement.
Signature of Owfierla ee/C tractor as Agent for Owner
Signature of Contr t r/Lic se Holder
STATE OF FLORID
OF FLORIDA—
ASTATE
COUNTY COUNTY OF S ) C�
COUNTY OF�.4 k i a
Sworn to (or affirmed) and subscribed before me of
�S
Swor to (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
_ Physical Pre ence or Online Notarization
R day HCIMn by
this L day of 202t by
thy) of 1202$
Name of person making statement.
Name of person making statement.
Personally Known /< OR Produced Identification
Personally Known N_ OR Produced Identification
Type of Identification
Type of Identification
Pr uced
Ain I
Produced
0-P IV I -J—P r(-,)
(Signature of N
ry Public--'Nfatp(Signature
R
Commission No
Sr;Yo DANIELLEGONCALVES
=' `' ° = MMISSIA 232946
"�? `: DANIELLEGONCALVES
Commissio g} '*= MYCOMMISSION#Gt 6
a o EXPIRES: June 27, 2022
%?rF.• ..pQ;•
% FqF Fto` : Bonded PIRES; June 27, 2022
ded ThN NO
Ilers
ZONING
REVIEWS FRONT
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/2O