HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ �" 1�' Permit Number:J _
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APR 1 1 2017
Building Permit Application
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: E HO`) or ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work o be peorme under this permit–check all that appy:
—Mechanical GTank Gas Piping Shutters _Windows/Doors
Electric :X- mbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ QI–g O Utilities: _Sewer ^Septic Building Height:
Name Name:
Address: e Company:
City: 4e farce- State: Address:
Zip Code: Fax: City: State:
Phone No. 7 7 �5��- Lf i 3 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page{if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
``` i iii i■
Planning&Development Services Departule-6 `
Building&Code Regulations
2300 Virginia Avenue APR 1 12017
Fort Pierce,MrWa 34982
(772)462-1553 PERM ITT iNG
OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT St. Lucie County, FL
F.S.489.103(7)EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even
though you do not have a license. You must provide direct,on-site supervision of the construction yourself. You
may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding$75,000.00 as long as it is for your own
use or occupancy.You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervising work to a icensed
contractor who is not licensed to perform the work being done. Your construction must comply with all pli to
laws,ordinances,building codes,and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on ho o t
the minimum code. Initial
I understand that as an owner-builder that any contract disputes with sub-contractors and I must handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial�—
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible and liabl�f the
cost of the license. Initial yyt��
I understand that if any person that is unlicensed and uninsured gets injured on my construction ject-
they may be entitled to workmen's compensation. I could be held liable for all doctor,lawyer and related
cost,which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/budder exemption shall be reported by the Building and
Zoning Department to a Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20
-f7-
owner/BuilcrefSignature
STATE OF FLO
COUNTY OF _
The f regoing ins ument was knowledged before me this 1 day of 20„(�,
by who is personally known to me,or who has
produced ,. as identification.
Signature o o �"—`
tary Type or Print Name of N� ' "'' (S E N S. �J I E L S EN
Title:Notary Public = c o�„�,
Commission Number 1S[ :__ =F F 15 s 3 7
q .6— Ml Cor: n rssron Exires
,tuns T 2,
2018'
SLCPDSD Revised 05/15/2014
Fart Pierce Utilities rE�VrEE •
206 S 6th Street
+art.—P'Terce, FL 34950 APR 1 1 2017 '
Telephone No. (772) 466-1600
04/10/17 4:39PM PERMITTING
St. Lucie county, FL `
Receipt #: 038170410000018 Phone(772)466-1600
Customer #: 244225 Fax (772)461-1938
Location #: 10006722
For: SAMUEL T DURHAM
Payment Received: 290.00fl
Amount Tendered - Check: 290.00
Check Number 108 1r,
Payment will be posted: 04-10-2017
Register: CASHIER 151 PREPARED BY:WARE
Thank you - Have a nice day.. .. ,T PIERCE FL USA 34982
NEW HOURS M-F 9AM - 5PM
DRIVE THRU BAM - 5PM
www.FPUA.com _„_ .� �" _.. � . _ Co,o
PF
t.
1 $250.00 $250.00
* Budget Billing Now Available * cusT $0.01 $40.00
$2sa.Oc
CUSTOMER COPY
Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater
Connection Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the
housebuilding is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health
Department must be obtained prior to initiating a septic tank abandonment. Contact the Health Department at (772)873-4931.
Construction cost estimates are based on current labor,equipment and material prices. Actual costs of construction will be determined at
the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse
weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the
customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the
customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authodty.All fees are due prior to any
construction.
Note: This Is only an estimate. A bill will be provided following acceptance of the Customer Invoice once signed and dated. Please
submit accepted Customer Invoice to Customer Service at 206 South 6th Street, Ft. Pierce, FL 34950 or call (772)466-1600 to setup an
Customer Signature: Date:
Printed Name:
PAGE 1 OF 1 PRINTED ON: 04/10/2017 AT 04:35 Pf
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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencirig work or recording your Notice of Commencement.
Signature dr6wneKeS'S6e/ContiicbYr as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID!�.. t, STATE OF FLORIDA
COUNTY OF A33 COUNTY OF
The f9rgoing instrutnent was acknowledged before me The forgoing instrument was acknowledged before me
this I I day of ,201-1 I
by this day of 20 by
&ftmue I C)Q aAQ4
(Name of person acknowledging) (Name of person acknowledging)
rrZ
(Signature of-14-otar-Y Public-State of Florida) (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification i./ Personally Known OR Produced Identification
Type of Identification _IUADL*ntification
Produced— cQ L ...... rg wed
KAREN S. �N, rg wed
c,,,miss,on # [F 115637
iss
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Commission No. r.4y Co1,,1,n,sionC-orAfflfssi No. (Seal)
jun
e 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
L