HomeMy WebLinkAboutRobinson gas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
O
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Residential `>
Property Tax ID #: 33C� (g�)a l .wl{ ' (YOD o Lot No.
Site Plan Name: Block No.
Project Name: a r\&cS\ 061 11
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank -<Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: r'
Cost of Construction: $ 1 �"11�
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
t R/LE$SR`"
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CQNTRACTOR Y
Name f)S0
Name: l
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Address:
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City:
Zip Code: Fax:
Phone No. �}1� ' O --AmW,
State: r-t—
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Address: 1 n a l l
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City:
Zip Code: Fax:
Phone No --7 Di-q( O A 5i
State:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License1 `13
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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.
SUPRLMEN�L CONT[tITIQN LIENLU1/If�FOfI/I���Na
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
_
Address:
Address:
City:
Zip: Phone
State:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 th�ee��j1obsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney beWf�'i-e commencing work or recording your Notice of Commencement.
Signature
STATE OF FL
COUNTY OF
as Agent for Owner
Sworm To or affirmed) and subscribed b re me of
this 21day of] \ iA 2b ( by
Name of person making statement.
Personally Known )� OR Produced Identification
Physical Presence or Online Notarization
Commission No. (Seal) ��s+?uc, DANIeLleuVrv�w.vw
,. MY COMMISSION # GG 2329"
EXPIRES: June 27, 2022
'"".� b•bCoP' n,,,,dad 7hru Notary Public Undciwrite,
REVIEWS
RECEIVED
COMPLETED
FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
*Treas«re Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981. Fax 772-318-6672*
*Palle Beach 561-752-0214. 2758 Old Okeechobee Blvd. Suite 9, West Palm Beach, FL, 33409*
*Sebastian 772-778-0131. 725 Commerce Center Drive Suite !, Sebastian. FL 32958*
*Energized Electric Gas Department 772-241-5279. 4258 handy Blvd, Fort Pierce. IT, 34981
Proposal / Agreement
Chrysantha & Gary Robinson June 30, 2021
4951 11 Mile Road
Fort Pierce, FL 34945
772-460-4602
glr482(ftellsouth. net
1) Energized Electric to intall underground gas line to generator from existing
propane tank and final connect.
2) Obtain all permits & inspections needed.
For the sum of., h 395.00
TERMS:
Charges & 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. Customer shali be responsible for any stop payment, charge backs or returned checks in the amount of
$25.00 or 3% whichever is greater.
Grass will be replaced up to 100 square feet or any lawn damage that may be caused due to excavation. Will repair any minor
sewer or sprinkler line damage due to excavation.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$ 495.00 due @ Signing
$ 700.00 due @ Gas Line Installation
$200.00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
John Maruri 772-626-4691
Acceptance of Proposal
(printed name), authorize Energized Gas to
complete t9 work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above. A
Date Z 2
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.
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 approva4. 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,
$395.00 of the initial deposit is NON REFUNDABLE if customer cancels after signing this contract
or makes a deposit for any reason. No refunds will be given at all after permits have been
applied for or installation begins
*To include sod replacement a charge of $395 applies
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
PRINTED- AME
SIGNATU
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