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HomeMy WebLinkAboutHenderson Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date Permit Number: SI wm.I11L C' Building Permit Application Planning and Development Services �✓' Building and Code Regulation Division Commercial Residential l/ 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: j N ty1 {! �(��' � j' �- I rk"Q� 't, `�1` ko Address: Property Tax ID #: 2- �� ! J �t`� Lot No. Site Plan Name: i Block No. Project Name: DETAILED DESCRIPTION OF WORK: P New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION: Additional work to be performed under this permit - check all that apply: w echanical _ Gas Tank _ Gas Piping _ Shutters C (Affidavit required) Electric _ Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Cost of Construction: $ ]� 000 Sq. Ft. of First Floor: Windows/Doors _ Pond Roof Pitch Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Li'i . "� ,n Name: Address: Nl-, f- Company: City: r( jState: _fA, Zip Code: s'tcl � Fax: Phone No. I-L-Al 9&-1 0 1(C12- E- Address: City:�'"es�UL� - C,,-A7 �. � Z Zip Code--3q ` 2— Fax: Phone No 9 1 State:V(-., Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail )� I � e deby ,,�d CCU tU� I C ry State or County License C-ACj1,,sI (-v 157z? If value of construction is 2500 or more, a RECORUEU Notice oT 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: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Name: _ Address: City: 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 of Contractor - or - Owner Builder as applicable STATE OF FLORIDA COUNTY OF S�- 1 ✓LrF Sworn to (or affirmed) and subscribed before me of iC Physical Presence or Online Notarization this Ib day of I,-/i-n C­, 20 tLby 'SO 4r4 P4r' C'4"7-L_ Name of person making statement. Personally Known X OR Produced Identification Type of Identification Produced (Signature of Notary Public- State of Florida) Commission No. If 14)(p5i �y (Seal) LENAc DEwlcry �uolic State of loritaommission Eo""'RONNI »HH 165134omm. Expires Dec 10, 2025rough rational Notary Assn• REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10112721 AHRI Certified Reference Number : 206020185 Date : 03-10-2022 Model Status : Active AHRI Type : SP-A (Single -Package Air -Conditioner, Air -Cooled) Series: LX SERIES Outdoor Unit Brand Name : YORK Outdoor Unit Model Number (Condenser or Single Package) : PCE4A4224 Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. 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 YORK 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 : 41500 SEER: 14.00 EER (A2) - Single or High Stage (9517) : 11.20 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 prod uced."Prod uction Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratin s that are accom anied bx WAS indicate an involunta re -rate. The new Dublished rating is shown along with 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 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.a4ridi ectory.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, 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.ahrldlrectoi,y.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. -___-_.__ ©2022Air-Conditioning, Heating, and Refrigeration Institute Mail Lien Satisfaction to: Dept of Highway Safety and Motor Vehicles, Neil Kirkman Building, Tallahassee, FL 32399-0500 Identification Number Registerc(1 Owrior: LEWIS E HENDERSON OR LIANE M HENDERSON PO BOX 188 BRADLEY ME 04411-0188 Mail ':I:'o: ,F Year — Make — Body — UUT-L-BHP — Vessel Regis. No. — Title Number 1981 BROA HS 60' 1929538 Date of Issue 02/01/2016 LEWIS E HENDERSON PO BOX 188 BRADLEY ME 04411-0188 Ill����l��l�l��ltotllttlllllt�drttlll�tltltpl� ��II�I Odometer Status;tir Vessel. Manufacturer or bH use':: e Lien Release Interest in the described vehicle is hereby released IMPORTANT INFORMATION 1. When ownership of the vehicle described herein is transferred, the seller MUST complete in full the Transfer of Title by Seller section at the bottom of the certificate of title. 2. Upon sale of this vehicle, the seller must complete the notice of sale on the reverse side of this form. 3. Remove your license plate from the vehicle. 4. See the web address below for more information and the appropriate forms required for the purchaser to title and register the vehicle, mobile home or vessel: http:/fwww.fihsmv.gov/htmi/titlinf.htmi a2/a1/2o1s Rtllsi.4sreill wrT r LEWTS E I�ENDER5UIV OR LIANE M HENDERSON PO Box .168: BRADLEY ME 04411-0188 1 st: J JdArollder I: NONE v. i DIVISION OF MOTORIST SERVICES TALLAHASSEEFLORIDA EPARTME T P N RHIGHUIt AY SA 410�110Q FEl`Y AND,MOTbR VEHIGLEu (, ' /✓ �'J ��(,�'� H a�aydn(nh ltilinmanl?u n r� �I ^ :. Robert R. ICynarh Terry L. Rhodes Director'Executive Dire TRANSFER OF TITLE BY SELLER. ;(This section must be completed at the time'of safe ) Fedor.d mlcLor Mite Inw require Ihnt IL¢ i,el I erstate Ili¢ mllow,, pinch isol nonny.sclling priac Ro(I dole sold m ¢onneetmn will, IllpIrhnyfer n£own ership. 1• oilure to Onnplcte of providing a £nlsL shduin�rltnurl ,Lyn)yln tmcs and/ipr imprisrinme116 '1'hi's true is wnrrvrtat to be tree from anylict cxcepF. xs nulerl ml`tie foo¢ of Kia ccrti cnle`rmrl the elotdr vohiale or'."v¢sscl d¢geridlcd is hcrehy=lronsfar7¢d to. .: -;Seller Most kale),PurehnEer'r. Name Arltlress;:' - - _ SLIILr MuvtL;nferSelliugl>ric¢ - SellorMn'stFntutlldte.Snld t llwchtot¢thudlhns 4nr (idrglt,1)donmt¢ritowrendsl .I:I .,. ❑ ❑ .. _ . ,, _I I II_I, )l l (rw tgntbs) rndLs tlRkL r LMI .W and I herebS cLrtlfy flint the best of my knowl¢dgy!dno n(loo10or rerultng 1. acfluots A(1'1'UAt MII F;A(SF.. n2 isjNE CF.S§ OF 115 MFI(aiA1VI(A[, 11MI1S. � .{. ih NQ1 IFIF'AC;TtTAl, Ib1T1FAC;F;. UNDER PENALTIIEs OF PERJURY, l DECLARE THAT I HAVE READ THE FOREGOING DpCUMENT ANQ THAT THE FACTS STATE$1 IN tT ARE TRUE. ru I.V.R Mnhl (:n-SFi,1,F.}i Mn51 Sign N¢re._' Jet Printl [ar¢F . Int .. .. S¢II lag Ilyaler s LiceI'ok No -- !\nctionNainLtc¢nsotVwptYL, . )aTJk( 5Mt Mnst (() P, U[i( HIISJ+R 3ufugi Print }{LfL NOTICE :PENALTY IS REQUIRED BY LAW IF NOT SUBMITTED,F(iR TRgNSFER WITFItN 30 L1A1 S AFiEFC.DgTE OF PIIkCHpSE � \F Al