HomeMy WebLinkAboutgas app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91�. LfLCflV
.. �"`` ~; 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: l5•(' S-
PROPOSED IMPROVEMENT LOCATION:
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Address: � ��
Property Tax I D #: 1 � " Ln o - Lot No.�
Site Plan Name: (� Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
or.n.o cc r� -
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be perfor-med 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:
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Cost of Construction: $ �� �� Utilities: —Sewer —Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name
Name: �[Jl
Address: t� t—
Company:
Address: �q ,
City:' " State`
City: t!L e{�_�[� State:��.
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Zip Code: ' Fax:
Phone No. 0 E-
Zip Code: Fax:
Phone No
E-Mail QJ
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State: _
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not 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 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 jo ite before the first inspection. If you intend to obtain financing, consult
with lender or an attprney befqrSZornmencing work or recording your Notice of Commencement.
Signature of Owner/ Le e/Co ractor as Agent for Owner
STATE OF FLOR�
COUNTYOF )1) CA a
Sffir _d, and subscribed b r me of Physical Presence or Online Notarization
t is day of i;% 2 _ y
��rYi7�!CA m n
Name of person making statement.
Personally Known OR Produced Identification
Ty of Identificatio Pr duced
(Signature of Notary Public- State of Florida
cn'".?y'+. DANIELLE GONCALVL"S
f s- ac
Commission No. (Seal) MY COMMISSION 9 GG 232946
.:
EXPIRES: "cane 27, 2022 .
1landed 1 h, Notary PiNllc Underwriters
yyyOCYYi4 IIPi1deR,IW.'9{Iw4 v
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Now
*Treasure Coast 772-466-1 {195, 4252 Bandy Blvd, Fort Pierce. FL. 349N 1, Fax 772-318-6672*
*Pain] Beach 501-752-0214, 2758 Old Meechobee Blvd, Suite 9, West Palm Beach, H., 33409*
*Seta stiaii 772-778-0131, 725 Comrncrce Center Drive Suite J, Sebastian, FI- 3295i~*
*E ncruized Electric 6a5 Denartment 772-241-5279 -1'58 Bandv Blvd. Fort Pierce. FL, 349R I *
Gary Sofen
1816 Wildcat Cove Drive
Fort Pierce, EL 34949
(914) 420-6179
Ga[ySofen@gmaii.com
Proposal / Agreement
October 19, 2021
1) Supply and install (1) customer owned 500-gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes backfilling and removing dirt.
3) Obtain ail permits & inspections needed.
4) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
or the sum of., $4s795 -
TERMS -
Charges & 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 3% whichever is greater.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$1,995.00 due @ Signing
$1,2.50.00 due @ Gas Tana Installation
$1,250.00 clue @ Gas tine Connection
$300.00 due @b Gas 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.
Mike Flaxman
Acceptance of Proposal
�i_�✓L�__ _ _ (printed name), authorize Energized Gas to
complete the work In,accordance with the above speciflcations and conditions. I agree to pay as per
terms outned a ve. /-r
Date { [ 6 _J
Signaoire
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of tine
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.
Page 2 of3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent 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 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
P R I N T:N%E'�
}
1 r zj
SIGNATUR DATE
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