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HomeMy WebLinkAboutPERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Permit Number: Building Permit Application Residential y Commercial CBDG Funding PROPOSED IMPROVEMENT LOCATION: " Address: /L,2 C j � - /�DcS Lot No. Property Tax ID #: �5%� %D / ' C� 00 - Block No. / Site Plan Name: Project Name: DETAILED DESCRIPTION OF WORK: AJ/ New Electrical Meter Second Electrical Meter (Affidavit required) /- e CONSTRUCTION INFORMATION: Addit=echanical ork to be performed under this permit -check all that apply: _ — Gas Tank —Gas Piping Windows/Doors Pond _ Shutters — _ Electric — Plumbing — Sprinklers — Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ 7 ��//l — — Utilities: Sewer Septic Building Height: � ° OWNER/LESSEE: Name Address: //Dw S aa2� a City: ; ,� %� State-1 Zip Code: y95`7 Fax: Phone No. -7 3 Z % E- Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) CONTRACTOR: Name: C Company: Jic'A Address 3 City:/'�`����� f��� State: Zip Code:- 77 Fax: Phone Now E-Maillf� ©1r7 �7,/di/�O•arc State or County License al fs� �G '7-- 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. F1SUPPLEMENTAL CONSTRUCTIO�RN LAW INFORMATION: DESIGNER/ENGINEER: ` Not Applicable MORTGAGE COMPANY: i Not Applicable Name: Name: Address: Address: City: State: City: State: Phone - Zip: Phone: - FEE SIMPLE TITLE HOLDER: L�Not Applicable Name: BONDING COMPANY: �,`ot 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. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie nrs!scatnu,lanpcvansttasttbrbitsc1whlcicoriwih yplcbeomeOweasoiAssociation resbyawsordoenthamyrericoprohiuh 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 YOUR 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 ANCING, CONSULT WITH YOUR LENDER O AN ATT NEY BEFORE RECORDING YOUR NOTICE OF COMMEN ME ." Signature of Owner Lessee/Contractoras Agent fo wner ! Signature of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA / f / COUNTY OF /3� /t-COUNTY OF The fog ing instrLtm nt was acknowledged before me The forgoing instr mg'n� was acknowledged. before me this�� day of _0(. �L� iJp� 20 � by this day of � ; ILO _� 20 _ by D.e,-� M� �' � G Q vj Name of person making sta ment. Name of person making st ement. Personally Known �R Produced Identification Personally Known :OR Produced Identification I Type of Identification Type of Identification _ Py uced _ ZPduced I r, (Sig, ature of Nota y Public- State of Florida (Sign ture of Notary ublic- State of Florida ) Com issio o., V: I_ I,SWE`r (Seal Com ssion .,? . rotary pubic State of Florida KELUE J. SWEET t� Commission = GG 3t5166 ?�1 .` Notari Public - State of Florida REVIEW My Lorrm. c • `gh �i ires y�73-2II23- ` Assn. SUPERVISOR PLANS ;:' P: EGET�ST,I�dtlhoto 3ra�=-U(, JIT ECx�/�uesI�023 gt�st[UTf ssn. - MANGROVE COUNTER REVIEW REVIEW - REVIEW REVIEW DATE - RECEIVED DATE — COMPLETED Rev. CERTIFIED° www.ahridirectory.org AHRI Certified Reference Number: 9287346 Date : 11-11-2021 Model Status: Active AHRI Type: RCU-A-CB (Split System: Air -Cooled Condensing Unit, Coil with Blower) Series: COASTAL 14 SEER AC Outdoor Unit Brand Name: ARCOAIRE Outdoor Unit Model Number (Condenser or Single Package) : N4A424CKA** Indoor Unit Model Number (Evaporator and/or Air Handler) : FEM4P24**AL 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. Region 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 ARCOAIRE 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 : 23200 SEER: 14.00 EER (A2) - Single or High Stage (95F) : 11.50 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 those that an AHRI Certification Program Participant is no longer producing BUT is still marketed but are not yet being produced."Production Stopped" Model Status are selling or offering for sale. Ratings that are accom anied b WAS indicate an involuntaryre-rate. The new published ratingis shown alongwith 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 or. 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.ahrldirectory.org. TERMS AND CONDITIONSand This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal in AM confidential reference purposes. The contents of this Certificate may not, In whole or in part, be reproduced; copied; disseminated; AIR-CONDITIONING, HEATING, r manner or by any means, except for the user's individual, entered into a computer database; or otherwise utilized, in any form oAA REFRIGERATION INSTITUTE personal and confidential reference. CERTIFICATE VERIFICATION c n,.,l:e lilr hrrtcr" The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link and enter the AHRI Certified Reference Number and the date on which the certificate was issued, 132811227751332649 which is listed above, and the Certificate No., which is listed at bottom right. CERTIFICATE NO.: ©2021 Air -Conditioning, Heating, and Refrigeration Institute