HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLIC BL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ?11 Permit Number:
Budding Permit Application
Planning and Development Services
Buifdina and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial X Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION, -
Address: -
Property Tax ID #: - S11 U - 00 0 1-0 0-
Lot No.
Site Plan Name:
Project Name:�\Q, �-JaYQc V %VUg? Block No.
DETAILED DESCRIPTIONrOFWORK:
ft1w V1 / I n i e A 1- A
.,v • 11/Vve a "n - 1 "JAR `i /l'1 V V-vy
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping Shutters
-- _Windows/Doors
_ Electric _ Plumbing _ Sprinklers — Generator Roof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ `h % 01). 00 Utilities: —Sewer _Septic
OWNER/LESSEE: CONTRACTOR:
Name ' U, Name:
Address: 1 ® Company: n`�
City' State: MI Address:'u
Zip Code: LA Fax: City: �Q1
Phone No. _ 3 Zip Code: - - 04
E-Mail: - Y\ Phone No • U
Fill in fee simple Title older on next page (if different E-Mail N11i'l
from the Owner listed above) State or cr,— i
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.
Building Height:
r
Pond
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION°
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
City: State: _
Zip: — Phone
FEE SIMPLE TITLE HOLDER; Not Applicable
Name;
Address:
City.
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: — Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: _ phone
iNot Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkor installation has commenced prior to the issuance of a permit.
St.
is in conflict with anrepresentation
applicable' Home that
Association permit ules bylaws or and covenants holder to
mays estrict oJrproh bit 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 you o rty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and on t e jobsite before the first inspection. If you intend to obtain financing, consult
with lender or tto ne a re Commencingwork or recordingour Notice of Commencement.
Signature of Owner/
as Agent for Owner
STATE OF FLORIDA Ip
COUNTY OF � . V � it 4
5wor to (or afPir ) and scribed beforeme of Physical Presence or this day of 20 %1 by Online Notarization
Name of person making statement.
Personally Known uced Identification
Type of Identification Pr ucPri
(Signature of Notary
Commission No.
,c�-,o- State )
rR � � (seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
COMPLETED
ZONING
REVIEW
=o""IxY MARLENE LILT COLLADO
Commission # GG 171582
Expires April 25, 2022
9�F6PPbb� DOMtin NdgotNotary Servtces
UPERVIS
S REVIEWOR REVIEW VEGETATIEVIEWON I SEATURTREVIEWLE IGRO MRVVE
Unico Air Conditioning Company
1711 Sunset Isle Rd
Ft Pierce, FI 34949
Phone: (772) 678-6676 Fax: (772)647-7525
Billing Address
Unico Air Conditioning Company
1711 Sunset Isle Rd
Ft Pierce,Fl 34949
Shipping Address:
Terms of payment:
Term of delivery:
Equipment ready for pick up at HD Su
Contract
Document Number 51007510350
8/9/2021
Caroline Johnson
Pine Lakes Preserve
7595 Pine Lakes Blvd
Apt 7595
Port Saint Lucie
772-245-4530
Net 15 Days
ZOR(FOB Origin)
Item
Material/Description
Quantity
Unit Price
Amount
1
Install Indoor/Outdoor AC Unit
1
$2,200.00
$2,200.00
Int. Article No. 25937855
2 ton Tempstar 14 seer R410
Subtotal:
Tax -
Shipping. 0 �O`„ �� Shipping
Signature: 1� '11 Grand Total:
$2,200.00
.00
$2,20 .0
�:�i �ERTIFIEU
www.ahridirectory.argCertificate of Product Ratin
AHRI Certified Reference Number : 201852667 Date: 11-13-2018 Model Status: Active
AHRI Type: RCU-A-CB
Series : 14 SEER N SERIES R41 OA AC
Outdoor Unit Brand Name: TEMPSTAR
Outdoor Unit Model Number (Condenser or Single Package) . NXA424(A,G)KC**
Indoor Unit Model Number (Evaporator and/or Air Handler) : FMA4P24—AL'
Region : North (AK, CO, CT, ID, IL, IA, IN, KS, MA, ME, Mt, 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 TEMPSTAR product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2, 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
SEER : 14.00 1
EER (A2) - Single or High Stage (95F) - 11.50
f"Active" Model Status are those that an AHRI Certfication Program Participant is currently producing AND selling or offering for sale; OR new models that are being
rnarketeu 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.
RRatincrs that_are accompanied by WAS indicate an involuntary re -rate The new published ratino is shown along with the previous (i e WAS) rati to
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
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 n5er'5 individual, 'n it
PerFenot ana confidential ref—oncc.
CER TI RI COTE V ER IFI CAT1,oN x REFRIGERATION INSTITUTE The information for the model Cited 6h this certificate can be verified at www.ahrldirectory.or„ click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issuedwe make lire better*'
which Is listed above, and the Certificate No., which is listed at bottom right. , --- _
02018Air-Conditioning, Heating, and Refrigeration Institute !CERTIFICATE NO.: 131E6620o863162522