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HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:��l / — Permit Number: p Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residentialy 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding PERMIT APPLICATION FOR: PROPOSED IMPROVMM Address: (_D J i Property Tax IC Site Plan Name Project Name: DETAILED DESCRIPTION OF WORK i A Ate- c--c I sz. IFI VI New Electrical Meter Second Electrical Meter (Affidavit required) CONSTRUCTION INFORMATION: !SI Additional work to be performed under this permit- check all that apply: V 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: $ 12.) 14 5 Utilities: _ Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name I ficcxi VIC'\ h s Name: i r _; O �h' "l ; G. Address: ,n ss:- C) IC_cti - l.liC ( City:t' I t'iQcC�Q__ State: Zip Code: 3y01 5 I Fax: Phone No.1q-(y q !RCo _ OaaS E- Company: vc\ �rts Address: (9(.0 )+hA v - City: Q.rk State: EL Zip Code: �'�4 c Fax: Phone No Z' .l 13 - _) D E-Mail ; c)) + 1 fi ^� �l I SC'�CX SGC State or County License oL1 2-914 Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney_ before commencing work or recording vour Notice of Commencement. Sign atur o ont or - wner Builder as applicable ST E OF FLORIDA COUNTY OF �ic9 Zt440P4V_CA-1'_ Sworn to (or affir e ) and subscribed before me of ✓ Physical Presence or Online Notarization this $ day of /2022by Name of person making statement. Personally Kn ✓ OR Produced Identii+iciZtion Type of Iden fica n Produced \MINI of (Signature of Not Commission No. (S Z N1left 2 REVIEWS FI{ . S J bA SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COON 4 W REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10/12/21 Certificate of Product Ratings AHRI Certified Reference Number: 206971743 Date : 01-03-2022 Model Status : Active AHRI Type : HRCU-A-CB (Split System: Heat Pump with Remote Outdoor Unit -Air -Source) Series: HMH7 Outdoor Unit Brand Name: CHAMPION HEATING AND COOLING Outdoor Unit Model Number (Condenser or Single Package) : HMH72B481 Indoor Unit Model Number (Evaporator and/or Air Handler) : AVC60DX21+TXV The manufacturer of this CHAMPION HEATING AND COOLING product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of AHRI 210/240 - 2017 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 : 48000 SEER : 17.50 EER (A2) - Single or High Stage (95F) : 9.75 Heating Capacity (H12) - Single or High Stage (47F) : 47500 HSPF (Region IV) : 9.30 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 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 Oublished rating is shown along with theviious (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 for, 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.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 AM 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, personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridlrectory.org, click on "Verify Certificate' link we make lihi hewer'° 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. ©2022Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 132857230364873085