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HomeMy WebLinkAboutgas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 0 [� e o Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce F� 34982 Phone: �772) 462-1553 Fax: (772) 462-1578 Commercial CBDG Funding Residential �` PERMIT APPLICATION FOR: ��j PROPOS+EDfI,tM�PROVEMENT LOCATfON: Address: `"1"l'"��j f r U�` /� � r�� PrapertyTax ID #: � 'L`. �' � -1 l ���V�IiJ � ��� �___ _ Lot No. Site Pian Name: Block No, Project Name: ���, C�CiI..�� DETAILED DESCRIPTION OF WORK: ( ���� �cV1a � a�,���� 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 _Pond Electric _Plumbing � Sprinklers _Generator _ Roaf Pitch Total Sq, Ft of Construction: 5q. Ft. of First Floor: �- � C5'J Cost of Construction: $ U11 � Utilities: _Sewer _ 5eptic Building Height: OWNER/LESSEE: CONTRACTOR: Name l�llGt Name: ��L_,V1C�,�9 �Gl.��.l() Address: ���� City: I"rlp State�t"� Zip Code: � l Fax: Phone No. E- Company:. 1( L. Address: �. City: � State Zip Code: r� � iFax: Phone No, �y �-C��Q L Mail: Fill in fee simple Title Holder on next page [if different from the Owner listed above] E-Mail State or County License [���� Sim, If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. If value of I1AVC is $7,500 or mare, a RECORDED Notice of Commencement is required. �i.�.�y:��u�. -w +.c�-�,«;.,=x.��mwan ;+��:-�.r¢ s.. , r Ewa '�-' ,SUPP�� P„TL��©N�SR��Z�E�~L�A���N �. {�r�'u4�^*�,. x � m - � y, x��©� � k��'�,,��� ,�v.���f��. DESIGNER/ENGINEER: Name: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: 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 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. Inconsideration 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 befor�@mmencing work or recording your Notice of Commencement. Signature of Own r/ L s e/Cop ractor as Agent for Owner STATE OF FLORID/ (/ CO U NTY O F �� f Sworn to (or affirmed an ubscribed before me of ��Physical Presence or Online Notarization this �� day of i� 20�[ by Name of person making statement. Personally Known, OR Produced Identification Identification Produce �T�ype�o`f -- �`-(3' nature of Notary Public- Sta f Floridal -.„_ �,� ���, UANIk1LRf�GNCALVES ���ea4 Commission No. MYCOMMISSIQNikGG232gA6 j__ EXPIRV-S: Jurre T7 2lt12 ��,,,'� Fsondal lhru NUUsrJ "ublirl�r'tlenud{era _s�mm-,$.�_..-.,.ate S&'n.�s�:ia.7Z'w.'v� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev *''i'reasu.re Coast 772-466-1 O�?5, �2�2 Ba���y .-t31vd, Port Pierce, FL, 34-981, Ftt� 7T?-� 1 i3-(b72� *Patin t3each Sb1-752_p� i ���, ?751i t)It9 Cil«�ch�l�ee Blvd, Suite [), West Pal�tj i�eacl., FL, 334(19�` '�5ebasdan 772-77$-0131, 725 Conlm�erpe CeuterDrive Sui�tc� ], Sebastian, PL 32�35$* ^Energized Electric l`itw 17epartnicnt 772-24I-�279 4258 F�ancly I�Jvd fioet Pierce FF 349u3 d` Proposal /Agreement Bill Tyler 4940 Tree Top TR Fort Pierce, FL 34951 772-979-2633 Btayler3@comcast. net September 16, 2021 i) Supply and install (1) customer owned 500 gallon underground L,P Tank with gas like to generator and final connect. 2) Price includes backfilling and removing dirt. 3) Obtain all permits & Inspections needed. 4� Price does NOT include filling the tank with propane, price per gallon will be based off Thompson Gas' market. prices. vr° the sure af.• $4,y9 ,00� TERMS; Charges &Payments: Charges are tlue in full at time services are rentleretl 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 allgwed rate by applicable law. Customer shall be responsible and agrees to payfor all charges billed, applicable taxes, applicable legal fees and other charges/fees. Customer shall be responsible for any stop payment, charge backs or returned cfiecks in the amount of $25.00 or 3% which ever is. greater. Grass will be replaced up to 1�0 squarefeek nr any fawn damage that may be caused due to excavation. Wilf repair any minor sewer or sprinkler line damage tlue. to excavation. ProposaljContract pricing good for 30 days from Proposal/Contract date $1,445.00 due @Signing $1,150.00 drfe @Gas Tank Inst�liation $1,15Q,00 due � Gas Line Connectian $300,00 due @Final Inspection We appreciate the opportunity you have extended us to quote on this work and would I[kt=_ to (hank you in advance for your consideration. iauthorized signature: Mike Fiaxman Acceptance of Pr000sal (printed Warne), authorize Energized Gas to complete the work in accordance with the above specifications and conditions. I agree to pay as per terms outlined shove. Date /� /` � c2 �r 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 agreoments: 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. Pale 2 of 3 CONTRACT TERMS AND CONDITIONS Installation will comply with all local and state regulations and be consiskent 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 HQA%POA approval. 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. ,� site survey of your property showing all property lines is required to pull a permit and can be submithed along with this signed prpp{�sat, $395.00 ofi 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 ABQVE TERM5 r l I i C�. M^ Z y�`�2 ✓` PRINTED NAME SIGNATURE /� / 2�i D_T� Pale 3 of 3