HomeMy WebLinkAboutProduct Approval r
Planning&Development Services Department
i Building&Code Regulations
t�o 0 2300 Virginia Avenue
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Fort Pierce,Florida 34982
(77 2)462-1553
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT
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 licensed
contractor who is not licensed to perform the work being done. Your construction must comply wi;mu
all i able
laws,ordinances,building codes,and zoning regulations. Ini
I understand that the building official and inspectors are not there to design or give advice eet
the minimum code. Ini
I understand that as an owner-builder that any contract disputes with sub-contractors and I be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract dispute .
Init
I understand that if I compensate any person or company for work performed they arni � be
licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsiblethe
cost of the license. In
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 ate di 1
cost,which could include loss of wages during recovery from their injury. In 1
To qualify for this exemption under this subsection,an owner must personally appear and sign th 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
ing Depa me to Florida Separtment of Professional Regulation. Signed and a knowledged on this
day o of 20
&Vd
40 Builder Signature
STATE OF FLORJPjk
COUNTY OF ,.
The Pegoing instrument was acknowledged before me this day of 20 n ,
by who is personally known to me,or who has
du ed 1Q as identification.
y P
t„RY���., L SHAHNA IN(iRA1N
A�aturefNotary Type or Print Name of otary ,lk ;�S gya�ublic-State of Florida
Title:Notary Public Commission NumberMy Comm.Expires Dec 20,2010
iN
COmmission#FF 177249
SLCPDSD Revised 05/15/2014 BrAw through National Notary Assn.
Fort Pierce Utilities Authority '
"Committed To Quality" !, ;
Ls
Water/Wastewater Engineering
206 South 6th Street Phone(772)466-1600
Ft. Pierce, FL 34950 C) ,Gb" Fax (772)461-1938
...i �.I tx�"i X�
s �rF r r CUSTOMER INVOICEJ EST�IMATI ANLY) 9� rffil k ,s
�.a"�� j<5'1' Ja�' Hof .i- �k Y�L 4�...'l '. �^ _a7 s' a "2` .�._ C
ha>r..r` fr v"t- s ..3 a s'-a}.- w. ,
�tQUOTE FOIZ�k LINDA7BROOME
- � °Y�' �` � JOB:DESCRIPTION�INSTALL NEW 5/8 x 3/4VV�TER MTR/SVGS NO SEWERS��w � ���
�7 � r ?`<r ..,�, .4.3 '2�. 4 i �4� Z ,r- � 's o� `° ;y,' .y.ack '�"• �,'�a'w�'�--�rt�a- � y s �`
E�"x�.�'� -�.�......,r ..c +.�x�.,=3,:,,�u�.�:�_.a-.,ztua�...�"..,s...�.uu L.,-�.�tc�... ^,� _.,�y�ia.."' £..='r�.f....A��?�.a..s.,�az:u.w»._�.,.. w�.u,.�;u`.a:.....•�.:�..._...�r � ."v}'.:.'�..a..�-r..._.�__I
INVOICE NO: SORD00003334408 PREPARED BY:WARE
LOCATION ID: 10007301
ADDRESS: 3418 SUNRISE BLVD FORT PIERCE FL USA 34982-611:
ADDITIONAL INFO: , (772)201-7440
TASKS{ rDESC31PTIONb �R ' - _`. r,z� CuY __ UNIT CO&TCHARGE�S
W-3/4 M/SVC U/G WATER 3/4 METER/SERVICE U/G 1 u $800.00 $800.00
W-CAP IM CHG WATER CAPITAL IMPROVE CHARGE $0.01 $920.50
W-CON FEE NEW WATER CONNECT FEE NEW CUST $0.01 $40.00
DEPOSIT INVOICE DEPOSIT FOR INVOICE NEW CUST $0.01 $60.00
W-LIEN FEE WATER LIEN FEE CIC $0.01 $120.50
W-FEES PAID WATER FEES PAID - $0.00 $0.00
$1;941 OC
TOTAL-CHARGE.
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-Z whichever is first. The cost of the service line from the point of delivery at the property line to the
house/building 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.
i
Cpnstruction-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 Authority.All fees are due prior-to any
construction``r5.
Note: This his onl' n 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
l Customer Signature: Date:
Printed Name:
PAGE 1 OF 1 PRINTED ON: 09/01/2017 AT 11:46 At
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1�1�• �J�_)��
s
Yn
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 Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 8809 One Putt PL
Legal Description: POD 33 AT THE RESERVE PHASE 1 KINGSMILL LOT 80 (OR 1691-2104;3120-602)
Property Tax ID#: 3334-500-0091-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL"ED-D.ESCRIPTION-',C+F..WORK. , ,
&o& -A G Cha�7 cxA-1- 1 .5 rls S in)
CONSTRUCTION INFORMATION.
Additional work toe e Orme under this permit—check a appy:
HVAC E] Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 4841 Utilities:[]Sewer Septic Building Height:
OWNER/L§6- EE: f CONTRACTOR
Name Sherwin P Bostick Carisa A Bostick Name: RICHARD LEVINSON
Address: 8809 One Putt PL Company: SERVICE AMERICA
City: Port St Lucie State:FL. Address: 2755 NW 63RD CT
Zip Code:;34986 Fax: City: FT LAUDERDALE State:FL
Phone No.772-466-9944 Zip Code: 33309 Fax: 954-977-3591'
E-Mail: Phone No. 954-979-1100
Fill in fee simple Title Holder on next page(if different E-Mail: EPERMITSGROUP@SERVICEAMERICA.COM
from,the Owner listed above) State or County License: CAC014619
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU°PP.LEMENTAL CONSTRUCTION LIENwLAV1/ INFORMATION:
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:
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 thepermit 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
WARnme
OWNER:Your failure to Record a Notice of Commence n re ult in your paying twice for
imprtoy ur property. A Notice of Commencement m t b re r and posted on the jobsite
befor p ction. If you intend to obtain financing, con ult ith n r an attorney before
commr o rec m' our Notice of Commencement.
s
Signatur Lessee C ntractor as Agent for Owner Signature Con for/Licens Holder
STATE OF FLORJPA 1 STATE OF FLO ID
COUNTY OF ID MuQ(A COUNTY OF K) uJQrd
The forgoing instrument was acknowledged before me
:The forgoing instrum nt was acknowledged before me g g� !nA g
this__day of_�C �P 2 20 aby this 3 day of MAD" 20 LAL by
Leoiwspll ki clNorA Leu►nsairi
(Name of person acknowledging) (Name of person acknowledging)
{a'i P4 Debbie Jeffries
aP e�'o Notary Public-State of Florid
Commission#GG70668 '' r P Debbie Jeffries
(Signature of Not ubli - rida)EXPires Signature of b 5k°4WE1uPl6Yi !eo ori a
FOFFL Nr Jc Commission#GG 70668
Personally Known OR Produced Identification Personally Kno n", CoQ' OR PruFd 898?RM!cation
Type of Identification Produced Type of Identifi
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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DATE
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[INITIALS