HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/21/2022 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Port Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 3728 SLEEPY HOLLOW
Property Tax ID #: 3425-705-0013-000-2
Lot No.
Site Plan Name:
Block No.
Project Name:
01 �s r
✓/ sb
LIKE FOR LIKE 3.5 TON 14 SEER PACKAGE UNIT WITH 10 KW HEATER
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit —check all that apply:
x 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: $ 5295.00 Utilities: —Sewer _ Septic Building Height:
Name JEAN & SUZANNE CLOUTIER, BEVERLY BOYER Name; CURTIS SAMMONS
Address: 1055 SR THOMAS ROAD
Company: CUSTOM AIR SYSTEMS INC
City: EMBRUN ON KOA 1 WO CANADA
y State: Address: 1615 SE VIILAGE GREEN DR
_
Zip Code: Fax: City: PORT SAINT LUCIE
State: FL
Phone No. 772-262-2443 E- Zip Code: 34952 Fax:
Mail: Phone No 772-335-3232
Fill In fee simple Title Holder on next page (if different E-Mail CUSTAIRSYS@AOL.COM
from the Owner listed above) State or County License CAC051810
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_.- _---.. _ _ _.......... ._..............._
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.
Name:
Address:
City-, State:
Zip: Phone-_
11_1.__. ... . .... ...
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
COMPANY: Not Applicable
Name:
Address:
City, State:
Zip: Phone:
. ... .. ....... .... ..... . .
BONDING COMPANY:
Name,,
Address:
uty:
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 g a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners 21"noclial!on rules, bylaws cirand covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
__ _,Not Applicable
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,
accessary structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to anothar 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 tender or an attorney before commencinia work or recordine vour Notice of Commencement.
Signature of Cantrawt-o-r - o---r 6wn'e—r Builder'as--a-p-p-li-c—ab—le
STATE OF FLORIDA
COUNTY
Sworn to (or affirmed) and subscribed before me of —_-_Physical Presence or,.--, Online Notarization
this _a.1 day of 20.rli)�Iy
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification lroduced
(Signature of'Notary Public- State- of Florida)
U)mmission No. Seal)
RONALDLAUCH
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COMmission # HH 067257
14,
Expires Novembor ^ 2024
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bw4ed Mr. &Aj*1 %owy 1k L.
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION $
EA TURTLE I MANGROVE
COUNTER REVIEW REVIEW 1 R�VIEW 1REVIEW REVIEW REVIEW
Customer Name
Address
City, State, Zip
Custom Air Systems Inc. 1 ;
1615 SE Village Green Drive • Port St. Lucie, FL 34952 T' 0
(772) 335-3232 • Fax ( 772) 335-1968�—
Proposal and Agreement
Phone ift Date.3 4-21C$
Job Address
fl�L Work Phone(s)
We will furnish, install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make '7 Model Number(s) PA Z/�a�' ?6 `)o —71'
SEER EER AFUE Btuh Cooling Yl. dd Btuh Heating CFM
❑ New Amp disconnect
❑ Remove existing equipment from premises
❑ New Amp electric service
❑ Install energy saving setback thermostat
❑ New low voltage wiring
❑ New copper wire from to
❑ New weather resistant equipment stand
❑ Make air tight plenum transition
❑ New reinforced equipment pad
❑ new supply diffuser(s)
❑ New vibration isolation pads
❑ New duct run from to
❑ New properly sized refrigerant lines
❑ Noise reducing flexible duct connector
❑ New clean, dry ACR copper tubing
❑ Balance for uniform supply air distribution
❑ Insulate refrigerant suction line(s)
❑ Provide for external combustion air
❑ Install refrigerant drier(s)
❑ New gas piping from to
❑ Evacuate refrigerant system
❑ New vent pipe and cap
❑ Charge to manufacturer's specs
❑ Clean work area to customer's satisfaction
all federal, state & local laws
❑ Condensation overflow safety switch
�[]�Mee
❑ Hurricane Fasteners for outdoor unit
Option (below)
❑
Terms
Acceptance (Customer)
By
Approval
Date By _
X in boxes = Yes
❑ New condensate drain system
❑ New condensate pump
❑ Install aux. condensate drain pan
❑ New high efficiency air filter
❑ New humidification system
❑ New return air filter grill
❑ Meet all code requirements
❑ Complete system start up
❑ year parts warranty
❑ ^� year labor warranty
❑ 1sZ year compressor warranty
❑ __ /— year servi5e agreement
Total Investment $
Taxes $
Total Amount $
Down Payment $
Balance Due $