HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAli APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: <R19I 1 Permit Number:
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1? 9 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 CBDG Funding
PERMIT APPLICATION FOR: �\ Q �_)C (��a
PROPOSED IMPROVEMENT LOCATION:
Address: '�� 1 R
Property Tax ID #: l7 q Lot No.
Site Plan Name: L `' C2V 1 Block No.
Project Name:
DETAILED DESCRIPTIONOFWORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
�
6vlechanicai — Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
07
Cost of Construction: $ 26W. Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name: ' ' Qv'
Address:
Company:
L t _c
City: State:
Addre s:
C
Zip Code: Fax:
City:
State:
Phone No. E-
Zip Code: 34351
Phone No i r a3
E-Mail ac, amCC- I
Fax: ��c�'���-� • I�(tL
s^ _ C9nTy-,
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
It Value oT construction is Z500 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 lender or an attornev before commencing work or recordine vour Notice of Commencement.
Signature of Owner/ L see/Contractor as Agent for Owner
STATE OF FL
COUNTY OF�ff(,,,,-4, r1
SwoM to (or affir d) and subscribed before me of Physical Presence or Online Notarization
this day of
..`
Name of person making statement.
Y ary.. LESLIE R. ZELAYA
Public - State of Floriday�
Personally Known OR Produced Identification
Identification Produced
= Notary
Commission M HH 00255E
my Comm. Expires Aug 6, 2024
3noai'ture
ed through National Notary Assn.
of Notary PP c- State Florida)
J
Commission NAAA lam' �.X..pSeal)
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WV DI cUl u
Eligible for Federal Tax Credit
Certificate of Product Ratings
AHRI Cerdfied Reference Number: 20//52973 Date: 08-31-2021 Model Status: Active
Old AHRI Reference Number: 7428126
AHRI Type: SP-A (Single -Package Air -Conditioner, Air -Cooled)
Series: GPC14
Outdoor Unit Brand Name: GOODMAN
Outdoor Unit Model Number (Condenser or Single Package) : GPCI44BH41 E'
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 GOODMAN product is responsible for the rating of this system combination.
Rated as follows in accordance with the latest edition of AHRI 2101240 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 : 46000
SEER: 14.00
EER (A2) - Single or High Stage (95F) : 12.00
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 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 CONDITIONSit
This Certificate and itsscontents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and
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confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced: copied; disseminated:
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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.ahridl►ectory.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.
9)2021 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132749152576884611