HomeMy WebLinkAboutBuilding Permit Application 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 X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-'1S78
PERMIT APPLICATION FOR:GAS TANK
PROPOSED IMPROVEMENT LOCATION:
Address: 8307 Kenwood Rd Fort Pierce, IFL 34951
Property Tax ID#: 1301-605-0319-000-3 Lot No.28
Site Plan Name: Block No. 53
Project Name: Irving gas
DETAILED DESCRIPTION OF WORK:
Install 500 gallon underground gas tank with line to generator
New Electrical Meter Second Electrical Meter
EcO:N:S:TRUCT�ONNFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical dGas 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: $ 4295.00 Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Everett Irving Name:Michael Flaxman
Address:8307 Kenwood Rd Company:Energized Electric
City: Ft Pierce State: Address:4252 Bandy Blvd
Zip Code: 34951 Fax: City: Ft Pierce State:FL
Phone No.7723328472 Zip Code: 34981 Fax:
E-Mail: Phone No7724661095
Fill in fee simple Title Holder on next page(if different E-Mail energizedgenerators@gmail.com
from the Owner listed above) State or County License LQ31756/L145030
If value of construction is 2500 or more,a RECORDED Notice of Commencement 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 lopsite before the first inspection. If you intend to ob in financing, consult
with lender or an tore b commencin work or recordingour oti e of encement.
Signature of Owner/ see/ ntractor as Agent for Owner Signature of Cont for/Li ense Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF C A A COUNTY OF (a
TPSwo to(or affirmed)and subscribed before me of SK to(or affirmed)and subscribed before me of
hxsical Pres ce or Online Notarization IS P�Pical Presepce or Online Notarization
this�day of IT— 202A by this day of n 202J by
Name of person making statement. Name of person makin tatement.
Personally Known /�- OR Produced Identification Personally Known OR Produced identification
Type of Identification Type of Identification
uced Pr ced
(Signa r °b bury P i a ICE Ia ) (Signat te.06iotgry PubRN481M.GM( )
. : *" PAY CQPAMISSlQfd#GG 232946�� 3o_ .c�3 •': :_ PAY COPvEPtIiSSIQfJ�GG 2..,�946
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o n/ u51ic Undenvre;s Fu%rF;°` Bonded 7h,PMary Public Underwrters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
t
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 2758 Old Okeechobee Blvd, Suite 9, West Patin Beach, FL, 33409*
Proposal / Agreement
Everett Irving April 6, 2021
Darlene Gordon
8307 Kenwood Road
Fort Pierce, FL 34951
772-332-8472
Rosern0l@aol.com
1) Supply and install (1) customer owned 500 gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes backfilling and removing dirt.
3) Obtain all permits & inspections needed.
4) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
or the sum of: $49295•0
TERMS:
Charges a Payments: Charges are due in full at time services are rendered unless otherwise stated below. Contractor may
:harge 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
$ rOOO.0 } due @ Signing(paild 4/6/2021
997.50 due @ Gas Tank Installation
997.50 due @ Gas Line Connection
+ IDO due @ Final Ins -, ction
°e appreciate the opportunity you have extended us to quote on this work and would
ke to thank you in advance for your consideration,
ithorized signature:
Jofin Maruri 772-626-4691
Acceptance of Proposal
(printed name), authorize Energized Gas to
nplete the work in accordance with the above specifications and conditions. I agree to pay as per
-Is outlined above.
d Date a
mature
Merit shall be construed under the taws of the State of Florida. This agreement contains the entire understanding of the
I supersedes all previous verbal or written agreements, there are no other agreements, representations or warranties not
rein. 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.
CONTRACT TERMS AND CONDITIONS
Installation will comply with all Ducal 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,wat r or sewer-lies.
This contract pace does NOT include bonding gas lanes, 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 QA/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
.4 a `- � ;`°� ,;a`�: e"flex
PRINTED NAME
SIGNATURE DATE
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