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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: BUilding Permit Application li tion Planning and Development Services Building and Code Regulation Division Commercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 PERMIT APPLICATION FOR: Fg4oIJ PROPO$ - N: Address: Property Tax ID#: '?> l o -- 5O$ - 0�)-4(0 - 0c:>0 - 3 Lot No. Site Plan Name:'tgo?P cAkl_ tst.g& (OV_ a'I$b- --1\b3) LkVJ►T l - lS Block No. Project Name: %Y\ DETAILED DESCRIPTION OF WORK: Li 1Ltc V P-C S`ls"C \ CA Wr'r:6'1�, OUT m o 8t k_� iikolnn lii� PA-CX.14- u to LZ" New Electrical Meter Second Electrical Meter (Affidavit required) LCONSTRUCTION INFORMATION: 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: Sq. Ft. of First Floor: Cost of Construction: $ 6 S O 0' 00 Utilities: —Sewer —Septic Building Height: Name Fe.Pr1JK Iy(k'C1At,�T) W\kwgIZ Name: SA-YYNz-C-> -6. C*y9_12• Address: 3g4 5 T02- Company:C0VY\ply COWY\RW_T I W.)Cf City: rT PtC-V-C'V Stater-- Address:Vg�kA Q 12.iC. 1.,1J S fit" 4 Zip Code: 34C1S�, Fax: VR 0, City: ;wPa 1 5v- State: P, Phone No.3<9a6-'S86'$1 (O� Zip Code: _J3gS13 Fax: I E-Mail: Phone No r✓10 5 AC1 -(0 abzr*t Fill in fee simple Title Holder on next page(if different E-Mail 1 IY� CO -dYh from the Owner listed above) State or County I icen a 0 V I I O g 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 jobsite before the first inspection. If you intend to obtain financing, consult with len or an attorney.J;Ieforg commencing work or recording our Notice of Commencement. Si atur of Owner/Lessee/Contractor as Agent for Owner S E OF FLORIDA COUNTY OF PALM BEACH COUNTY Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization this 16 day of JULY 12091 by Name of person making statement. Personally Known X OR Produced Identification Type f entification P uce (5-ig`n—aturd of Notary Pu ic-State of orida ) •DIY P(, _ LORI E.CYRAN Commission No. (Seal) = MY COMMISSION#HH 032452 ExPIRES:August 16,2024 Bonded Thru Notary Publ'r undenvr9ters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev IM9 nall CERTIFIED www.ahridirectory.org Certificate of Product Ratings AHRI Certified Reference Number:202717826 Date:07-16-2021 Model Status:Active AHRI Type:SP-A(Single-Package Air-Conditioner,Air-Cooled) Outdoor Unit Brand Name:BRYANT HEATING AND COOLING SYSTEMS Outdoor Unit Model Number (Condenser or Single Package): PA4ZNB030" Region : All(AK,AL,AR,AZ,CA,CO, CT, DC, DE, FL, GA,HI, ID, IL, IA, IN, KS,KY, LA, MA, MD, ME,MI,MN, MO, MS, MT, NC,ND,NE, NH, NJ, NM, NV, NY,OH,OK,OR, PA, RI,SC,SD,TN,TX,UT,VA,VT,WA,WV,WI,WY. U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1,2015 are eligible to be installed in all regions until June 30,2016.Beginning July 1,2016 central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. The manufacturer of this BRYANT HEATING AND COOLING SYSTEMS product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of AHRI 210/240 with Addendum 1,Performance Rating of Unitary Air-Conditioning &Air-Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored,independent,third party testing: Cooling Capacity(A2)-Single or High Stage(95F),btuh:28600 SEER: 14.00 EER(A2)-Single or High Stage(95F) : 11.50 C PLETE COMFORT INC. ames B Carr Cert # CAC01108 t"Active"Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale:OR new models that are being marketed but are not yet being produced."Production Stopped"Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratings that are accompanied by WAS indicate an involuntary re-rate. The new published ratinq is shown along with the previous(i.e.WAS)rating. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations.warranties or guarantees as to,and assumes no responsibility for. the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS it "12, This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced:copied:disseminated: .■ ILO into a computer database;or otherwise utilized,in any form or manner or by any means.except for the user's individual, N%mpersonal and confidential reference. AIR-CONDITIONING.HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org.click on"Verify Certificate"link we make life better"' and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. ©2021 Air-Conditioning. Heating,and Refrigeration Institute CERTIFICATE NO.: 132709124709587931 DATE: l J S INVOICE: COMPLETE COME RT NAME: FfAk1� �— y. Air Cond'+°ding&Heating �� STREET: tSZ=� 7?_764 - P.O Box 1311 •Jupiter,FL 33468 CITY. ra (ea'lr___ ZIP: Phone: (561)529-6262 License#CAC011108 PHONE: 36go-ST:go -,f74$'_MAH.: www.mycompletecomfort.com COMFORT ❑ Vertical Air Handler Refrigerant Locking Caps ❑ New Duct System ❑ Surge Protector ❑ Condenser on Ground b3:�' Hurricane Tie Down Straps ❑ New A/H Platform/Stand ❑ Horizontal to Vertical Package Unit on Ground Ifilf-Vibration Proof Isolation Pads �iew Concrete Slab [I Time Delay ❑ Attic Air Handler ❑ Reconnect to Existing Ref.Lines /❑ Emergency Flood Cut Off Switch ❑ I lard Start Kit ❑ Condenser on Roof Reconnect to Existing Electrical ❑ New Roof Stand ❑ Line Cover ❑ Package Unit on Roof ❑ Filters ❑ New Emergency Drain Pan ❑ Mastic Seal All Duct Joints Remove Existing Equipment ❑ Standard / ❑ New Refrigerant Lines ❑ New A/H Plenum from Premises size Quantity ❑ Liquid Line Size Return Supply ❑ Crane Service ❑ New Duct Work Connect to ❑ Suction Line Size $ Permit Included ❑ Add New Supply Duct Existing Cans&Grilles ❑ Insulate Suction Line /❑ New Programmable Thermostat Reconnect to Existing Ductwork ❑ Air Filtration System ❑ Reconnect to Existing Drain Line New Digital Thermostat /❑ Balance Air Flow ❑ Remove Old A/H Stand ❑ New Condensate Pump ❑ New Humidistat ❑ New Return Grill Install Pan&Stand to Code 115v 240v ❑ New STD Thermostat ❑ Add New Return Duct ❑ New Drain Line ❑ Refrigerant Line Flush ❑ Drop Cloths Used ❑ ❑ New Control Wire ❑ New Disconnect Box OPTION 1 OPTION 2 OPTION 3 MANUFACTURER tV 044 TONNAGE Z'S SEER ,LUG OUTDOOR UNIT Ll Z A/S 1?30 QC-U INDOOR UNIT HEAT(KW) SYSTEM PRICE INSTALL PRICE ADDITIONAL OPTIONS TOTAL INVESTMENT O C) 4 _YEAR(S)PARTS YEAR(S)PARTS YEAR(S)PARTS WARRANTYYEAR LABOR YEAR LABOR YEAR LABOR �)YEAR COMPRESSOR YEAR COMPRESSOR YEAR COMPRESSOR U YEAR INDOOR COIL YEAR INDOOR COIL YEAR INDOOR COIL _YEAR OUTDOOR COIL YEAR OUTDOOR COIL YEAR OUTDOOR COIL ONE YEAR COMFORT CLUB MEMBERSHIP INCLUDED WITH EVERY INSTALL(VALUE OF$239A0) 1 EQUIPMENT BEING REPLACED INVESTMENT OUTDOOR UNIT BEING REPLACED INDOOR UNIT BEING REPLACED Investment MODEL# 2 iZ d 30k4n MODEL# $ S Oy • UC.� SERIAL# k7L/YO Y o/03 SERIAL# -�✓_, LOCATION 6 n ". LOCATION Deposit ❑ CASH ❑CHECK❑FINANCING ❑CREDIT CARD INFORMATION(cH cxoNe) ❑ Visa ❑ Mastercard ❑ Discover ❑ American Express BALANCE DUE UPON COMPLETION Aect# I I I I I I I I I I I I I I I I I $ �r Q Q Exp.Date: Mo. Yr. Security Code: Client ACCEPTANCE OF PROPOSAL Complete Comfort 1 / THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND Date Acceptance Z ARE HEREBY ACCEPTED. YOU ARE AUMORIZED TO DO THE WORK AS Install Date SPFCTFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE.