HomeMy WebLinkAboutGas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ST L(.iC1E
C®U<NT�Y
L O R 1 D
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: /Z5UL LUiNA3 UUVL WAY, HURT ST LUCIE, FL 34986
Property Tax ID #: 3321-803-0088-000-0
Site Plan Name:
Project Name: Wllkerson gas
DETAILED DESCRIPTION OF WORK:
install gas line to generator and final connect
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential X
Lot No.84
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:
Cost of Construction: $ 1295.00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name David Wilkerson
Name: Michael Flaxman
Address:209 Truitt AVE
Company: Energized Electric
City: Milford State: _
Zip Code: 19963 Fax:
Phone No.3022283419
Address:4252 Bandy
City: Ft Pierce State: FL
Zip Code: 34981 Fax:
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 / L145030
--•-- -• •� a nLI, WnULIJ wuuLe vi wmmencement 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: Applicable
Name:
_Not
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 at orne b re commencing work or recording our Notice of Commencement.
Signature of 0 er/ Lesseer ntractor as Agent for Owner Signature of C t for/Lic se Holder
STATE OF FLORID STATE OF FLORI
COUNTY OF_�tTy t COUNTY OF �(
Sworn to (or affirmed) and subscribed before me of S rn to (or affirmed) and subscribed before me of
Pre
ysical nce or Online NotarizationP}Yslcal Prese ce or Online Notarization
this ( day of 1 2021 by this - J' day of , 202k by
Name of person making statement. Name of person making statement.
Personally Known k
OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pq0Xced P 8-64.j c e d
(Signature f ublic �' 'qs a� e irdXG're o CkEPd i A o rids )
*: MY CO@hMiSSION #, GG 232946 I� von ''t ' # GG 2.'32945
tv'Y cOMM➢SS➢ON I
Commissio �p7 GAF EXPIRES: June 216gll)jro tlis<4on N (Seal)ES:Jun,27,2022 �r C,., nt e ru otan� Publio Uncienvriters ;°
w� —��
f 8cnded Thru Notar Pub ie n P 1U(➢➢Gt3
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5
i
-�
01
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-02.14, 1700 Latham Rd, Suite 2, West Palm Beach. FL. 33409*
David Wilkerson
7802 Long Cove Way
Port St Lucie, FL 34986
dawiIkerson verizon.net
Proposal / Agreement
1) Energized Electric to reconnect and disconnect existing Gas Lines to Generator
and demo existing lines.
2) Install new gas line from new Generator location to existing LP Tank
underground.
3) Obtain all permits & inspections needed
or the sumo : $1295.00
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
$995.00 is due @ Signing
$150.00 is due @ Gas Lire Installation
$150.00 is due @ Completion
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:
John Maruri
Acceptance of Proposal
I' - ayi d,--. -..A- � Xv ' � )K5- t3 62� (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.
Signature
Date -4 - 6 _
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
Installation will comply with aCON7'aRAC nd a eE RMS'oAND d QNDITIONSns be consistent th standard ind
ustry 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
SIGNATURE
+�-e� "?-.. �
DATE
Page 3 of 3