HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INI O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l� 4 T LPermit Number:
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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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �e
(� y
Property Tax ID #:L -V`' - 2— Lot No. �)
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed underthis permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
/
Cost of Construction: $
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: L 6
Xq
Compa y: u
City: f �'�O�' Stat : _
Addr'�/sS. U
Zip Coder.��yy Fax:
City: 1 2
State:
Phone No.�12��� CJ �` 11 E-
Zip Code:: t�1 Fax: 1ii- ? 3D U
Phone No l 1 � , lid
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail t H ,
1
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from the Owner listed above)
State or County Lf ense �- .
N 1 t
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
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 attorney before commencing work or recording your Notice of Commencement.
Signature of 0 n r/ Lessee/Contractor as Agent for Owner
STATE OF FLORID p
I9
COUNTY OF VVj
Swo n o (or affir nd _ ubscribed before me of Physical Presence or _
Online Notarization
this da^y/of 201Aby
AN
U l
Name of person making statement.
CATHERINE MILLER
State
of Florida -Notary Public
Personally Known OR ro uc Jdzen �6ication
T Identification Produced^ Ly
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4."'1
?`My
commission*GG273315
Commission Expires
e of
November0l, 2022
(Signature of Notary Public- of Florida)
State
Commission No �/ I (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev 5/20/21
Certificate of Product Ratinqs
AHRI Certified Reference Number: 7502871 Date : 08-23-2021 Model Status: Active
AHRI Type : RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower)
Series: SILVER 14
Outdoor Unit Brand Name: AMERICAN STANDARD
Outdoor Unit Model Number (Condenser or Single Package) : 4A7A4030L1
Indoor Unit Model Number (Evaporator and/or Air Handier): TEM4AOB3OS31+TDR
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, MI, 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 AMERICAN STANDARD 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 : 28600
SEER: 14.60
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) ratina.
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 products) 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;
µ�r +`I
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
ae 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.
02021Air-Conditioning, Heating, and Refrigeration Institute
CERTIFICATE NO.:
132742186065738068