HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/04/17 Permit Number:
_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT.. PPLICATION FOR: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 10975 S OCEAN DR
12 37 41 FROM SW COR OF SEC RUN N 89 DEG 55 MIN 41 SEC E ALG S LI OF SEC 720.19 FT TO WLY W W AIA, TH N 23
Legal Description: .�
DEG 49 MIN 31 SEC W ALG SD RIW 566.32 FT FOR POB,
SEC W 199.44 FT, TH S 89 DEG 56 MIN 22 SEC W 273.2 FT, TH S 23 DEG 49 MIN 31 SEC E 199.44 FT, TH N 89 DEG 56 MIN 22 SEC
E 27320 FT TOPOB (1.14 AC) (OR 240-698) '
Property Tax ID #: 4512-323-0026-000-4
Lot No.
Site Plan Name:
Block No.
Pr ject Name: CUMBERLAND FARMS, Inc.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 3 i'
AFTER THE FACT EMERGENCY CANOPY REMOVAL
(ENTIRE.CANOPY STRUCTURE WAS UNSAFE AND'HAZARDOUS TO
PUBLIC)
CONSTRUCTION INFORMATION:
orme un er t Is.permit —c ec a appy:
Additional work to El
HVAC Gas Tank ❑Gas Piping _ Shutters
.ElElectric 0 Plumbing ❑Sprinklers F]Generator
❑ Windows/Doors
❑_ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ ✓�%, ��. = Utilities: Sewer Ll Septic
Building Height:
OWNERAESSEE:
CONTRACTOR: .
Name CUMBERLAND. FARMS, INC
Name: STEVEN M. NALE
Address:- 165 Flanders Rd.Company:
GREAT DANEIPETROLEUM
CONTRACTORS
AVE
City: WESTBORO State: MA
Address: 1330 S.. ANDREWS
Zip Code: 01.581 Fax:
City: POMPANO=BEACH
I State: FL'
Phone No. 508-270-1.400
Zip Code: 33069
I Fax:
E-Mail:ibohn@cumberlandfarms.com
Phone No. 954-214-40871
Fill in fee simple Title Holder on next page ( if different
E -Mail: mario@greatdan'epetroleum.com
I CBC045595
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
.1
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY- _ Not Applicable
Name: JASON WAYNE SHORT
Name:
Address: 800 EIGHTH STREET
Address:
City: VERO BEACH - State: FL
City: State:
Zip: 32982 Phone: 72-228-7282
Zip: Phone'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: I
City:
City:
Zip: Phone:
Zip: Phone:
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 resects, 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
commencing work or recording vour Notice of Commencement.
��GZ,�tJn1�12 ��Lli1c1✓
Signature of Owner/Lessee/Contractor as Agent for Owner
Cumberland Farms, Inc., Kathleen Sousa, Sr. Pipeline Mgr
STATE OF Ft DA Massachusetts
COUNTY OF Worcester
The fUgoing instrument. was acknowledged before me
I� '
this day of 20 L-Lby
CLn)n i fel M. Su red,
(Name of person acknowl ging )
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
l
Thefor ing instru
this )day of _
STEVEN M.NALE
(Name of person
edged before me
201 by
ng) `
(Signature of Notary Public- State of F1sfl#a) (Signature of Notary Pu is State of Florida)
Massachusetts
Personally Known X OR Produced Identification Personally Known OR Produced Identification
Type of Identificatiori_-., .ape of Identification Produced
Commission No.
Revised 07/15/2014
UUNNIENI. SYREi<%
(Sed otary Pudic jornmission No.
COM&TONWEALTH OF MASS'ACHUSET
Nty Commission Expires
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW,
REVIEW
REVIEW
DATE
COMPLETE
INITIALS