HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 - _X' I Permit Number:
a
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 \
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION: I l —
Address: 5��
Property Tax ID #:
Site Plan Name:
Project Name:. rC T C
DETAILED DESCRIPTION OF WORK:
c rUw e'r
CONSTRUCTION INFORMATION:
Ft -
Cj5
Lot No. 'J-
Block No.
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: t
Cost of Construction: $ l UQ
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Weight:
OWNERAESSEE: ] CONTRACTOR:
Name l_A T L
Address: V L
City: __C- - i ie re.�. _ State:
Zip Code: '195 r Fax:
Phone No. -I q_(OCt 1
E-Mail: PeC.'rL. z_0D Jz_a , C` Nm
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: - 4 Cr T Zr(A i bra C. k
Company: f 01 r G�tl c. r N,4 S _....
Address: '(,L 3rxy I I to r__e C —
City: r r �l C (���,,,,,.•,_, Stater
Zip Code: 31(91RD Fax:'7.1 gb61 31 -
Phone No 7 D�Y ato63
E-Mail_[C1 SC fgrre. e rr O� '% G' Ci
••-
State or County License (. 0 5 6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State;
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 Horne 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 HOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee n ractor as gent for Owner
L
Signature of Cont r/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF S—r L'UCI -e. I COUNTY OF t't)c.1
The forgoing instrument was acknowledged before me
this day of U 20a[ by
tQober4 2_iQ4ic�c,k
Name of person making statement.
Personally Known 16 OR Produced Identification
Type of Identification
Produced
a '/6' \r:Jkr
(Signature of Notary u lic- State of Flori )
Commission Na.
a �5 (Seal)
REVIEWS I FRONT
COUNTER
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
thisb day of C^ f" 20QI by
P4bz r' [�f�c; �I C>'C' L
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Um�U-e
(Signature of Notary lic- State of Flori }
Commission No.0 aa�5
aR_ i Notary Public State of
y Commission GG S
VEGETATION SE T "Rt7PAfl�f34f;t9�ff
REVIEW I Rti
Peter Utz
Job Information
5207 Echo pines circle East
Fort Pierce, Florida 34951
Adding Battery Back-up only
1- Tesla Gateway connected as partial home backup
to a subpanel.
1-Tesla Power wall 2
Existing solar system on the roof
16 Panels Q-cell 340watt
with IQ 7 inverters
200-Amp main breaker on a 200-amp
SOLAR ENERGY SYSTEMS ESTIMATE and PROPOSAL
An gnergy Management Company
0 160 Smallwood Ave. Florida State Certified Solar Contractor 9CVC056637
Ft Pierce, Florida 34982 .Martin Co, Indian River Co. State
772-464-2663 772-288-0442 772-562-8999 1-800-330-7657 DATE— 20
NAME
PI IONE
CELL
E-MAIL
ADDRESS
CITY
STATE
�
SPECIFICATIONS: Solar Energy Systems offers to furnish and install: 0 BACK-UP GENERATOR
O SOLAR ELECTRIC SYSTEM
C3 Grid -Tie J-771 Grid -Tie wlback-up 171 Stand Alone
ELECTRICAL INFO
System Size KW
Location of Breaker Panel
Model # of Breakers
# of Empty Slots Available
Distance to Solar Array_. l t
AC Requirements: d 120 V .0 240 V C] 208 V 3PH
Array Mount Type: 0 Flush 0 Tilt
Roof Type: O Shingle i 3 Flat Tile 0 BBL Tile
I] Cedar Shake 1-7 Metal 13 Ground
Clear Attic Access: Ci Yes 0 No
C1 Single Story 0 2 Story 0 Lift Required
Name of Utility Company:
NOTES:
Sketch of Roof Area
NOTICE of CANCELLATION
You the buyer, may cancel this transaction at anytime prior to (midnight of the third business day after the date of this
transaction. Thereafter, this contract cannot be canceled and deposit will be forfeited. This contract constitutes the full
and only agreement between Parties, there being no promises, agreements or understandings, written or oral, except as
herein set forth. This contract is subject to acceptance or rejection by the management of SOLAR ENERGY SYSTEMS.
See the attached notice of cancellation form for an explanation of this right.
I HEREBY CANCEL THIS TRANSACTION
(DATE) (CUSTOMER'S SIGNATURE)
INSTALLATION
I understand that this is only an estimated date, and that I will be contacted prior tot" date to schedule actual
Submitted By:
DATE
installation.
Customer Can Buy At This Price Until: {DATE)
Building
ontact:
r
Phone #
Contractor:
We hereby propose to furnish labor & materials - Complete installation to existing premises in accordance with above specifications, for the sum of:
TO AL _ DCALARS$
With payments to be made as fallows O DEPOSIT $ 0 BALANCE $ O UPON COMPLETION O TO BE FINANCED
All system components meet FSEC standards. All wnrk is w br cumplelcd in a workmanlike manner according to standard prsdi,e,. Any alteration or deviation from above specifications irnoly kng mra casts, will be executed
only upon written orders, and will become an extra charge mer and above the estimate. All agreements are contingent upon strikes, accident% nr delays beyond our control.
The above prices, specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payment will be
made as outlined above.Payments not made upon completion subject to late fees after 10 days.
DATE (CUS i oMERS SIGNATURF) (SPOUSE'S STGNATURE)
FLA�C �
5 CliFE: OMElk: WHITE MEM9FR OFFICE PINK F1P�., INSTALLER -MANILLA FLORIDA
PARTICIPATING
INDEPENDENT c
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