HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE f LO ryyoff COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: St.h Permit Number:� — P(0
Permitting �
A
Building Permit Application
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 7 )e;jWCC& lG 1i e
Property Tax ID#: 3"1 } '1'-7 O`- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
;CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
DIMechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Ponds.
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ oo o,0 6 Utilities: —Sewer _Septic Building Height:
;.OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: - r✓ Company: 't-1 C, \A4rZ_ -vim
City: Gr1r S�- jut, Stater Address:I/
Zip Code: Fax:. City. 1 �
�. State:
Phone No. -L3(.4 5�-S 5)- Zip Code: csj 1 ( 5g � ' � 'Fax:
E-Mail: Phone Not& !Y1/6-15E611—
Fill in fee simple Title Holder on next page(if different E-Mail M%- ,JW7.
from the Owner listed above) State or County License ac
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.
' 1U Tt _N ALOM T R N—A-W.'IN FUR-MAT
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: —NotApplicable 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 ancovenants 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,nr.,ming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO.0 Your failure to Record a Notice of Commencementmay e ult in paying twice for
improv
e
_r�ts your p
I s F_ property. A Notice of Commencement mu e eorded in the public records of St.
LucieC ri;t�y/ncl posted on the jobsite before the first inspection. uhhtend to obtain financing, consult
V ;�de r an attorney before commencing work or recording y rffoticeof Commencement.
may must
,/fbe
r 0
Sign tu#(qfOwner/Lessee/Contractor as Agent for Owner Signature of 111oull or/License Holder
STATE OF FLORIDA STATE 0 ORIDA
COUNTY OF COUNTYliF( �_A'amj --
Savor (or affirmed)and subscribed before me of Sworn to or affirmed)and subscribed before me of
'c Ph I Presence or Online Notarization sical Presence or Online Notarization
ysi a
this�2q day of 2020 by thi 2 day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi to Type of Identification
Produce Produced—
-e
ZTSig 'ISI—gnature of Notary Public-State of Florida
pot&e of Notary Public-State Florida
Com i 1 0 Seal) Commissi Seal)
IVETTE LORENZO 1VETrE LORENZO
Notary Public-state
2_7 Notary Public-State of Florida �1
o Commission#GG 230691 m, ion#GG23069j
QF M Co m. X -
Seal)
7�7
Lom
RE My flires Jun 20—IQ SUPERVISOR PLANS V969AUR L11W A112RE62 MANGROVE
d q
=�onai I o gh atl
REVIEW REVIEW ssn, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 0
CERTIFIED
www.ahrld.lrecto�y.org
uertificate of 'Product Ratings
AHRI Certified Reference Number:8215497 Date:07-08-2021 Model Status:Active
AHRI Type:SP-A(Single-Package Air-Conditioner,Air-Cooled)
Series:R410A AC SPP
Outdoor Unit Brand Name:BRYANT HEATING AND COOLING SYSTEMS
Outdoor Unit Model Number (Condenser or Single Package):PA4ZNA042000—""
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 wltti the latest edltlonwof AHR1,210/240 with Aiide6 urn 1,P.erformance Rating of Unitary Air Condltlonirig
&Air-Source Heat Pump`,,,Equipment and subject to rating accuracy by-AHRI sponsored,_independent,third:party testing
Cooling Capacity(A2} Single or High-Stage(OF)-btuh 41000
SEER.'14 50
EER(A2); Singlebr High Stage,(95F) 11.50
p
4 2
o'
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 rating 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-responsi6ltity 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
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;
entered Into a computer database;or otherwise utilized,In any form or manner or by any means,except for the user's Individual,_
personal 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,_cllgli orL"Verify Certificate"link-- - -wc make life betwe-
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.
02021 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 132702374413578209