HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Y � L- �L .
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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: C�?b O 5 I ( C 1 U
Property Tax ID#: // S I Cp Lot No.
Site Plan Name: ..PA/I 7C ( U mod^ C S' Block No..
Project Name:a(2,a
DETAILED DESCRIPTION OF WORK:
z I/i
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
1--f echanical _Gas Tank —Gas Piping Shutters _Windows/Doors ^Pond
Electric _Plumbing _Sprinklers —Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
C�
Cost of Construction: $ s Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name CC /1 Name: ki (�t�� �ej 7� a4 A.D
Address:3 -? S Gr1 Q.tiltI nc L l Company: -c7 t J� 1r,L 'ZI" �_ _
City:PodC � State: Address '►n 5� � �
Zip Code. q ni L") Fax: City:114 a L / Stater
Phone No.`7�_z 7 S- Ce �5 Zip Code: C f Fax:
E-Mail: Phone Now
Fill in fee simple Title Holder on next page if different E-Mail / S
from the Owner listed above) State or County License-(
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 CONSTRUCTIOY-CAN LAW INFORMATION: 1
DESIGNER/ENGINEER. J Not Applicable MORTGAGE COMPANY- `f,Not Applicable
Name: iName:
Address: Address:
City: State: City: State:
Phone Zip: Phone: f
f
FEE SIMPLE TITLE HOLDER: v"Not Applicable BONDING COMPANY: `1Vot Applicable
Name; Name:
Address: Address:
1 City: ' City:
i 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(-tome Owners Association rules,bylavis 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,
PPP' 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST iNSPECTION. IF YOU INTEND TO OBTAIN EINANCING, CONSULT
WITH YOUR LENDER O AN ATT Y BEFORE RECORDING YOUR NOTICFjOF COMMEK ME s'
Signature of Owner Lessee/Contractor as Agent fo wner Signature of Contractor/License Holder
STATE OF FLORIDA i STATE OF FLORIDA
COUNTY OF /}f I-1�'�_f COUNTY OF
The for-ging rostrum nt was acknowledged before me i The forgoing instrurnr was acknowledged before me
this�'�'j day of 0(_ ts,.� 20�`Z by this day of Cc t),y 20 `by
_v,� ,Q
1 Name of person making sta ment.� Name of person making st ement.
Personally Known OR Produced Identification l Personally Known I OR Produced identification
Type of identification 'i Type of identification
Pr duced ! P� used
l (Sig, attire of Nota Public-State of Florida) (Sign Lure of Notary ublia-State of Florida)
\ l
4 Com issio o., �.+,,. sws_ (Seal Coal ssion
.s. st
xy Ke:a If
P0+1, State 4t Florida
I a f>Y«_ CQmmissivn=GG 3 t 5a66 � tarp Public State of F!arida
I}— 4.r CoMir.:x tr2s. y 23-ZQi3 s t r:- p
^, �� Assn. nrci� MvCcm Exaues 023
REVIEW s SUPtRVISOR PLANS E6ET�s�dQ {hrc gtZlX;l� ssn. II�IANGROVE
COUNTER i REVIEW REVIEW REVIEW _ REVIEW
— �
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DATE I 44
RECEIVED I
DATE
CaMPLETED
Rev. 9 �_
iailF 7
Certifk_-e- °; ■
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AHRI Certified Reference Number:201298963 Date:07-23-2021 Model Status:Active
Old AHRI Reference Number:7984199
AHRI Type: RCU-A-CB(Split System:Air-Cooled Condensing Unit,Coil with Blower)
Series:GSX14
Outdoor Unit Brand Name: GOODMAN
Outdoor Unit Model Number (Condenser or Single Package):GSX140421 K*
Indoor Unit Model Number(Evaporator and/or Air Handler):ARUF47D14A*
Region: Southeast and North(AL,AR,DC,DE, FL,GA, HI, KY,LA,MD,MS,NC, OK,SC,TN,TX,VA,AK,CO, CT,ID, IL,
IA,IN,KS,MA, ME,full, MN,MO,MT,ND, NE,NH,NJ,NY,OH, OR,PA,RI,SD, UT,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 GOODMAN 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:37600
SEER: 14.00
EER(A2)-Single or High Stage(95F) :11.50
$"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 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
directoryat 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,click on-Verify Certificate"link we make bvt
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. 132715315605291565
(02021 Air-Conditioning, Heating,and Refrigeration institute I CERTIFICATE NO.: