HomeMy WebLinkAboutCCF05262021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/26/2021 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) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION;
Address: 4695 ARCADIA AVE
Property Tax ID #: 1416-601-0043-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:'
LIKE FOR LIKE 3 TON 14 SEER SYSTEM WITH 10 KW HEATER
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
4chanical
_ Gas 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: $ 5250.00 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name GARY & MARY HUBBARD
Name: CURTIS SAMMONS
Address: 4695 ARCADIA AVE
Company: CUSTOM AIR SYSTEMS INC
City: FORT PIERCE State: J�--
Address: 1615 SE VILLAGE GREEN DR
Zip Code: 34946 Fax:
City: PORT SAINT LUCIE State. FL
Phone No. 772-519-2465
Zip Code: 34952 Fax: 772-335-1968
E-Mail:
Phone No 772-335-3232
Fill in fee simple Title Holder on next page ( if different
E-Mail CUSTAIRSYS@AOL.COM
from the Owner listed above)
State or County License CAC051810
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
► 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 before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S5-r L.UCle COUNTY OF fi-r L v t t -e
Swor,p to (or affirmed) and subscribed before me of
Physical Presence o, Online Notarization
this Ao day of ' �_k 0,A 2024 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this Z,(�g_ day of .. 202$ by
CLLr"-&LC �l4mrr ri� I Merits Jlllililrifdils
Name of person making statement. Name of person making statement.
Personally Known Y OR Produced Identification
Type of Identification
Produced
(Signature ofpi6tary Pules State of Florida )
!!// �'Ay r6 CHRISTINE B. ENGLIS
Commission No. 7a(
}Commission # HH 0693
�7w e� Expires April 4, 2025
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Not ry Pub ' - State of FWW a ) CMSTINE B. EWLI;
Commission No.h(j"d FU % * Seal°"#HH0693
> Ef'jox E4ires Apr# 4, 2025
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UPERVIS
S REVIIEWOR I REV EW ; VEGETATIE EWON I SEATURTREV EWLE I M EV EWVE
Hff_� EFREVEEERM t��GBMM e—a—Irm =_—.9mem
Custom Air Systems Inc.
12198 County Rd. 512 - Fellsmere, FL-32948
(772) 571-1080 - Fax ( 772) 571-9878
Proposal and Agreement-
Ustorn Name Go r Phone74... .... ...
Wdress e__ Job Address
_"ity, State, zip Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and
conditions outlined on this proposal.
Equipment Specifications
C harnQc)(A 2 f�r 3(0&jQ1 A-T"4v
vlake Model Number(s) 1 —1 1615�Qa —
;EER— EER_ AFUE_ Btuh Cooling— Btuh
Heating--- CFM---
nstallation shall include:
X in boxes = Yes
0 New Amp disconnect 0 Remove existing equipment from premises
0 New condensate drain system
D New Amp electric service 0 Install energy saving setback thermostat
0 New condensate pump
D New low voltage wiring 0 New copper wire from — to
D New weather resistant equipment stand El Make air tight plenum transition
[3 Install aux. condensate drain pan
0 New high efficiency air filter
1] New reinforced equipment pad 0 -- new supply diffuser(s)
0 New humidification system
L� New vibration isolation pads 0 Now duct run from — to
E New properly sized refrigerant lines 0 Noise reducing flexible duct connector
M New return air filter grill
L] Meet all code requirements
D New clean, dry ACR copper tubing 0 Balance for uniform supply air distribution
0 Insulate refrigerant suction lints) 0 Provide for external combustion air
0 Install refrigerant drier(s) D New gas piping from _ to to
U, Evacuate refrigerant system El New vent pipe and cap
C Charge to manufacturer's specs 0 Clean work area to customer's satisfaction
0 Cum fete system start up
1_L_0 year parts warranty
year labor warranty
year compressor warranty
L1 year service agreement
0 Meet all federal, state & local laws 0 Condensation overflow safety switch
E-1
I") Option (below) Cl Hurricane Fasteners for outdoor unit
L1
Total Investment
li
'Faxes
IbEal Amount Ll
F)own Payment
Balance Due
Terms:
Acceptance (Customer) Approval (Company)
By Date---,--,,. By
Date
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