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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED - Dater 1�•�l n�'� Permit Number: c ��.��',� � a{.'gra � �1.I71 � xv�♦Q:y 6�:"r . _ r JUL 2 6 20136' Building Permit Application Planning and Development Services FERi",Al,_TING Building and Code Regulation Division 54. Lucie County, FL 2300 Virginia Avenue,Fort Pierce FL 34982 j Phone: (772)462-1553 Fax: (772)46271578 Commercial Residential `" PERMIT APPLICATION FOR: (3 Address: -S-3 © qAll T Legal Description: Property Tax ID#: b " lJ 'dam Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Additional work to be performed un er t is permit-c ec a t at app y: _Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator —Roof . Pitch Total.Sq. Ft of Construction: Sq. Ft.of First.Floor: Cost of Construction:$ /. -2 SJ Utilities: —Sewer —Septic Building Height: Name,4'l( 14 t JA A)t Z)S Name: Address: S3 o M .4 TL 4 Company: City: lL i At State:- Address: Zip Code: 3 Y 7 V Z Fax: — City: State: Phone No. 7 7 Z - S'4.S' - 9 z i y 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. 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 commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA• STATE OF FLORIDA COUNTY OFA' COUNTY OF The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me this day of 20 by this day of ,20_ by �Yljqg'juia, kt4�os (Name of person acknowledging (Name of person acknowledging') (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification Type of Iden ation Type of Identification Produced , ; Produced < REN S. NIELSEI Commission No. ,�P °< (Sglat Seo mission No. (Seal) of mission R FF 1156 My Commission Expir is 12, pn W REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW. DATE RECEIVED DATE COMPLETED ev. ST LUCIE UTILITIES DEP i ST LUCIE COUNTY UTILITIES P O:BOX 728;TT FIERCE;FL 34982 j 2300 VIRGINA AVE FORT PIERCE,FL 34982 NAME x 4 (� - 07/26/2017 } ti 08:06:35 l jr r CREDIT CARD VISA SALE x � 3 P, SERVICE ADDRESS { �x 3 !t Card# f0000000L000(8476 Chip Card, f VISA CREDIT1. .,,, `_ _; fc11 .�T e1 _ 3 ,�l `L—. .. AID: A000000O031010 ATC: 0006 SUBDIVISION LOT BLOCK_ E 'TC: 72BA2085DCDA2A25 ! 4 Y SEQ#: 1L BILLINGADDRE6S Batch#: n r 694 1 INVOICE ` x 1 v i Approval Code: , r x 06132C EntryMethod: Chip Read �; IN/CLOSING DATE J Y�' y ^ - Mode: Issuer r This application herebyrequest and'authonzes the Utility to render water and/or sewage disposal SALE AMOUNT sevices to-the prerhises described,above m accordance with the Uttirties present or future rates, $52125 rules and regulations,whicfi by reference are made apart of flus contract Applicant agrees to pay ; v the Utility promptl 1fr I such se rvices m accordance with the established rules andkreguIahons CUSTOMERS DEPOSITS'ARE NON NEGOTIABLE OR _ _ .,_. ..�_� ..... .�_�z. _ t._. ,<; _ SFERABLE SOCIAL`SEC/ " CUSTOMER COPY a ��SPOUSE SkOCIAL SEC - , ' } Y Y � 3E ONLY JUL 6 20V PERM iTING St. Lucie County, FL 0 "St Lucie County Building Department Plumbing Inspections It shall be the responsibility of the permit holder to schedule all inspections.,-The Following items will be checked in one final inspection for water meter hook up and plumbing to the homes in Indian River Estates: w 1) Type and size of plumbing (3/4 inch minimum); 2) All cement (glue)joints must have purple primer on them; 3) Connection at the meter and check valve; 4) Pipe must'be 12 inches-deep (minimum); 5) Pipe must not run through or under drain fields or septic systems and must be a mimmum of 10 feet horizontally from them; 6) All pumps and filters/softe4ers must be disconnected; 7) A shutoff valve of the same size as the piping must be installed up at the dwelling; 8) A leak test will be performed from the meter.to the.shut off valve. The home owner or-plumbing ' will be responsible for turning the shutoff valve to the on position' and letting water into the dwelling. These items-must be ready when the inspector arrives on site or a rejection will be issued. Please be advised that there will be a $7�10 reinspection fee if additional inspections are required for-failure to comply with any of the above items. Please note that if a homeowner pulls a plumbing permit as Owner/Builder, it is required to have an affidavit*signed and notarized at the time of application accepting the terms of the permit and homeowner may do the work or hire a licensed plumbing contractor to do the work. 7/25/2007 H:n Lucie County Building Department.doc J Planning.&Development Services DepartmepK Building&Code Regulations "�L .a,�,� t ' o 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 JUL `A 6 201 \ OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT PEFqfeiliMPdG F.S.489.103(7)EXEMPTIONS St. Lucie Counhj, FL 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 licensed contractor who is not licensed to perform the work being done. Your construction must comply with all applicable 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 how to meet the minimum code. Initial mil I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial 7�7 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 liable for the cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my`construction project- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical 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/builder exemption shall be reported by the Building and Zoning Department to the Florida State Department of Professional-Regulation. Signed and acknowledged on this day of J70 L y of 20 . Owner/Builder Signature STATE OF FLOD COUNTY OF • The foregoing instrument wa acknowledged before me this day of � ,20 , by Mh (�(��, f✓,Vds� who is personally known to me,or who has produced as identification. K LL vv_ dle,63,d Signature of Notary Type or Print Name of NotF. r (Seal) Title:Notary Public Commission Number 15 �•_ m KAREN S. NIELSEI�I _¢ *_ Commissio'L;. FF 1JJ 5637 SLCPDSD Revised 05/15/2014 - My Commission Expires June. 12, 2018