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HomeMy WebLinkAboutBuilding Permit Application All APPL C BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 2 Permit Number: 9VoLLCMCE' 1, Building Permit Application Planning and Development Services Building and Lode Regulation Division Commercial Residential_ 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding PERMIT APPLICATION FOR: 3 / r , PROPOSED IMPROVEMENT LO ATION: 1 Address: ( \ ' q Property Tax ID#: WtJ Lot No.—Er Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: V t 'split New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: 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 _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer Septic Building Height: O W N E RAESSE E: CONTRACTOR: Name, l' Name: rli( Address: kMicn Compan�y"" '� J City: I State. AddressU! ' T 70 Zip Code: ! V Fax: City. 'C State:' Phone No. 11 - E- Zip Code: Fax:.JJZ-6-7-3 Mail: Phone No 1 wo Fill in fee simple Title Holder on next page (if different E-MaiC ms( ( Q k� A Q Mq . Can from the Owner listed above) State or County Li ncd seC AC- 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. SUPPLE . BEN LIEN LAW INFORMATION: DESIGNER/ENGINEER: _Not 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 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 our Notice of Commencement. Signature wner/Lessee/Contractor as Agent for Owner STATE OF FLORID ' ,,\ COUNTY OF 1 Sworn o(or affir ed and sul d before me of Physical Presence or2LOnline Notarization this day ofI e 'scribe20U by rC2 I e_ Name of person making statement. Personally Known OR PfWuced Id itkification T of Identification Produced UJU LAZeYlao_ (Signature of Notary Public-State of Florida) Commission N 53'S(Seal) ,.^: ,, CATHERINE MILLER �b °%=State of Florida-Notary Public � - Commission#GG 273315 oar, My Commission Expires November 0l,2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev Eligible for Federal Tax Credit , Certificate of Product Ratings AHRI Certified Reference Number:9923016 Date: 11-23-2021 Model Status:Active AHRI Type:HRCU-A-CB(Split System:Heat Pump with Remote Outdoor Unit-Air-Source) Series:SILVER 15 Outdoor Unit Brand Name:AMERICAN STANDARD Outdoor Unit Model Number (Condenser or Single Package):4A61-150241-17 Indoor Unit Model Number(Evaporator and/or Air Handler):TEM4AOB24S21+TDR 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 R 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:23800 SEER: 15.00 EER(A2)-Single or High Stage(95F):12.50 Heating Capacity(H12)-Single or High Stage(47F):23000 HSPF(Region IV):8.50 f"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 alone with the previous(i.e.WAS)rating. DISCLAIMER AHRI does not endorse the products)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; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's Individual, AM personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information forwhe model cited on this certificate can be verified at www.ahrid Irectory.org,click on"Verify Certificate"link we 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. ©2021Air-Conditioning, Heating,and Refrigeration Institute CERTIFICATE NO.: 132821470243377078