HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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V414,04 - 1
4 'A I 4 K� 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
PERM IT APPLICATION FOR:GAS
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Address: 7822 Long Cove WAY Port Saint Lucie, FL 34986
Property Tax ID#: 3321-803-0083-000-5 Lot No.79
Site Plan Name: Block No.
Project Name: Pierce gen
Install gas line to generator and final connect
New Electrical Meter Second Electrical Meter
ONSTRUCTIONfJ,.,, W&
Additional work to be performed under this permit—check all that apply:
—Mechanical _Gas Tank 1,115'as Piping Shutters —Windows/Doors Pond
_Electric _Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 595-00 Utilities: _Sewer _Septic Building Height:
5
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Name Brent Pierce Name:Michael Flaxman
Address:7822 Long Cove WAY Company:Energized Electric
City: Port ST Lucie State:�J— Address:4252 Bandy Blvd
Zip Code: 34986 Fax: City: Ft Pierce State:FL
Phone No.3347826829 Zip Code: 34981 Fax:
E-Mail: Phone N07724661095
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
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.
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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 publIpeecords of St.
Lucie County and posted on the jo 'te before the first inspection. If you intend to obtaitpoffhancing, consult
with lender or an attorneybef
9MKommencing work or recording our Nptice_gf Co encement.
Signature of Ow er/ s e/Conk actor as Agent for Owner Signature of C trg tor/ cense Holder
STATE OF FLORID STATE OF FLORIDA c
COUNTY OF d A COUNTY OF ) )C-.,—
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr sence or Online Notarization YPhysical Pre ce or Online Notarization
this day of 202t by this day of en 202t by
L kl p Ce�C Mri vl I al`r1-�P l t.x A
Name of person making statement. Name of person making statement.
Personally Known- 11�-OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
P uced Pr uced
mere'
(Sig natu YRv4i��ki (Signatur gf;'T kf
�' as? FJIPIRE3:J4hte 27,2>� e? oY June b2L�
Commis�..�{ ' ;°•' eondeetnruu�roNpublkU Commissi �` • a..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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*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, Srute 9, West Patin Beach, FL, 33409*
Proposal / Agreement
Pam Wascom April 26, 2021
Brent Pierce
7822 Long Cove Way
Port St. Lucie, Florida 34986
334-782-6829
pbrentpierce@gmail.com
1) Run new gas lines from existing LP tank to generator and final connect.
2) Obtain all permits & inspections needed.
or the sum of, $595•00
TERMS:
Charges 0 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. due @ Signing /�U®lo
100.00 d Final Inspection
We appreciate the opportunity you have extended us to to on this work and would
like to thank you in advance for your consideration.
Authorized signature:
i e Flax an
Acceptance of Proposal
(printed name), authorize Energized Gas to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
ter� lined above.
`"%V`' Date
Signature
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.
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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
PR NiED7AAME
SIGNATURE DATE
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