HomeMy WebLinkAboutWilliams gas app, contractAll 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: GAS
PROPOSED IMPROVEMENT LOCATION:
Address: j 1e isiana uunes Uv Jensen Beach, FL 34957
Property Tax I D #: 3534-503-0006-000-5
Site Plan Name:
Project Name: Williams gas
DETAILED DESCRIPTION OF WORK:
disconnect existing generator, reconnect line to new generator
Residential X
Lot No.5
Block No.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank X' 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: $ 995.00 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Roy Williams
Name: Michael Flaxman
Address:116 Island Dunes Cv
Company: Energized Electric
City: Jensen Beach State
Zip Code: 34957 Fax:
Phone No.7724850503
Address:4252 bandy Blvd
City: Fort Pierce State -FL
Zip Code: 34981 Fax:
Phone No 7724661095
E-Mail: Roy748Roy@aol.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Ir.._1.._ -t------
E-Mail energizedgenerators@gmail.com
State or County License LQ31756
-- -•--••--•---• •• •.,, ���a v Uv " ivUuLe ui %_urnmencemem: 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 tain financing, consult
with lender or an attor before commencingwork or recordingyourNotice ommencement.
Signature of er/ ssee/Contractor as Agent for Owner
Signatur of Contractor/License Holder
STATE OF FLOR
STATE OF FLORID
COUNTY OF �(,L�
COUNTY OF__ Sfi A 4
S or to (or affirmed) and subscribed before me of
SwVfil to (or affirmed) and subscribed before me of
ysical Presence or Online Notarization
�('
this day of — f� 202p by
Physical Presence or Online Notarization
this day of (tf , 202t 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
Pr duced
Pr uced
t
(Sig �► "�ydAtary l i ES %ptm4rida
; r.• ;
nature of N
DANIELLE GON ALVES
Commission No.
�' MY COMMISSI G 232946
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=.• ; �: MY COMMISSION ry GG 232946
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- 4 EXPIRES: June 2022
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Bonded Rru Notary Public Undenwdters
Bonded ihru Notary a m Underwriters
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-31.8-6672*
*Pahn Beach 561-752-0214, 1700 Latham Rd, Suite 2, Vest Palm Beach, FL, 33409*
Roy Williams
116 Island Dunes Cove
Jensen Beach, Florida 34957
772-485-0503
roy748rov@aol.com
Proposal j Agreement
March 10, 2021
1) Energized Electric to disconnect existing Gasline gtrom existing generator and
reroute to new generator amd final connect.
2) Install new regulators.
3) Obtain all permits & inspections needed
For • sum r ',9•
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 due @ Signing
$ 300.00 due @ Gas Line Installation
200.00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
complete t work in
terms outline above.
Signature
Mi
Brian Orr 772-353-8734
Acceptance of Proposal
(printed name), authorize Energized Gas to
accordance with the above specifications and conditions. I agree to pay as per
'h -��I r l
Date Mu2.1
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
�Ro,I:rI,,);1l1r�mc?
PRINTJED NAME
SIGNATU
414k:�A 1� zc;w
DATE
Page 3 of 3