HomeMy WebLinkAboutgas app, contract All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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IP .0 D 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:
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Address: FWQk�Y� Ck fl( �L-S� W(J4 A W-12
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project
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New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit-check all that apply:
—Mechanical '1'-6as Tank —Gas Piping Shutters —Windows/Doors Pond
—Electric —Plumbing Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction: Utilities: Sewer Septic Building Height:
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Name -IC4,(v cu! �p � re Name: K vy,F F�(Wrro(0
Address:- r-)��(A Rmo A YJV C— Company:1roov- v--u-r J(Ni
City: ;;i': Stater Address: VA\A
Zip Code' -�Awo Fax: City:L VNIZ W'f J StateIR—
Phone No. -)z E- Zip Code: 3MKJg( Fax:
Mail:— Phone No.(Y)-)-"-Ak A 0 VDA5
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Fill in fee simple Title Holder on next page(if different E-Mail'Q AC(-(A\ Q(A
from the Owner listed above) State or County'[!iccnse_�
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.
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DESIGNER/ENGINEER: _YNot 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 ranting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners%ssociation 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-res(dential use
l 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 th ' bsite before the first inspection. If you intend to obtain financing, consult
with lender or an tto ne a commencingwork or recordjn our Notice of Commencement.
Signature of OwnertAesseeeontractor as Agent for owner
STATE OF FLOR (I� ),
COUNTY OF
Sworn to(or affirmed)and si bscribed be re me of ,Physical Presence or_Online Notarization
thisgday of ai 'hr ,20 by
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Name of person making statement.
Personally Known < OR Produced Identification
Tof Identification Produced
(Signature of Notary Public-State of Florida)
Commission No. IS r1` �a4 DANIkLiLGpNCALVE+
My00MMISS'ON#GG2329463
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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*Treasure Coast 772-466-1095, 4252 Bandy Blvd,Foil Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214,2758 Old Okeechobee Blvd, Suite 9, West Palen Bead;, FL, 33409*
*Sebastian 772-778-0131, 725 Commerce Center Drive Suite 7, Sebastian, FL 32958*
*Energized Electric Gas Department 772-241-5279, 4258 Bandy Blvd, Fort Pierce,FL, 34981
Proposal / Agreement
Jane Carollo October 26tt', 2021
9669 Fairwood Ct
Port ST Lucie, FL, 34986
303-907-7331
L.ololane333@gmail.com
1) Supply and install (1) customer owned 1,000 gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes extended gas line through landscaping, and trees. This will cause
of some the small shrubs to be removed and Energized will not be able to put
them back
3) Obtain all permits & inspections needed.
4) Price includes backfilling and removing dirt.
5) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
or the sum of., $9,295-0
Licensed & Insured *LQ31756
Email: Eneraizedaeneratorscaiamail.corn website: www.Enerai zed generators.com
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of installation*. This includes but is not
limited to; damaged/broken sprinkler lines and/or damaged/broken water or sewer lines.
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 HOA/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.
A site survey of your property showing all property lines is required to pull a permit and can be submitted
along with this signed proposal.
$395.00 of 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 ABOVE TERMS
rr (_0f�) I � '
PRINTED NAME
Nuo
SIGNATURE DATE
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TERMS:
Charges iL Payments: Charges are due in full at time services are rendered 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 allowed rate by
applicable law. Customer shall be responsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees and
other charges/fees. Customer shall be responsible for any stop payment, charge backs or returned checks in the amount of
$25.00 or 311/o whichever is greater.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$1,995.00 due @ Signing
$3,500.00 due @ Gas Tank Installation
$3,500.00 due @ Gas Line Connection
300.00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
Michael Haman
Acceptance of Proposal
I, (printed name), authorize Energized Gas to
com Iete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
MEC (am'D Date 1 4
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 agreements: 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.
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