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HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: �. g Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 ✓/ Commercial Residential Phone: (772)462-1553 Fax: (772)462-1578 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: 2ga:3 30.'Me.5 g'& Goe`c_ "�+ lr_e_ Legal Description: Property Tax ID#: %dvt� ��bl 1e03 C)00 f 1 Lot No. 021 Block No. Imo_ Site Plan Name: Project Name: Right Side: 1 Setbacks Front 56.0 o Back: y.9�o Left Side: 1 y.9(a DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additionalworkto orme un er t is permit-c ec a app y: OHVAC F]Gas Tank ❑Gas Piping _Shutters Windows/Doors ZElectric 0 Plumbing Sprinklers Generator Roof Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction: $ 5Ca , Utilities:oSewer oSeptic Building Height: OWNER/LESSEE: CONTRACTOR: �- GICn a. Name: rands CO ar man Name ar man ectrlc Address: `13 JaY�rtic rih Company: ox rown City: ��p,rCG State: CitAddress: Indian own State: Zip Code: 3� I q . Fax: y: 597-46-95 Phone No. Zip Code: Fax: E-Mail: Phone No. Fill in fee simple Title Holder on next page ( if different E-Mail: Par mane ec rlc ao .com from the Owner listed above) State or County License: If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 j 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 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, r Signature of Owner/Agent/Lessee Signature of Contractor/License older STATE OF FLORID Q� STATE OF FLORIDA COUNTY OF ky'.\ COUNTY OF May-in The forgoing instrument was acknowledged before me The forgoing instrument was acknowledges before me this day of t'(1nr<t1 20 by this 2q day of 20_t2 by (Name of person acknowledging) (Name of person acknowledging) (Sign t re of Notary Public-Slate of Florida ) (Signature of Notary ublic-State of Florida) Personally Known `" OR Produced Identification Personally Known /"' OR Produced Identification Type of Identification Produced Type of Identification Produced CaC a'1a51 Laurie Berry Commission No R Lau 5ef� Commission No. or o NOTARY PUBLI o NO�ARY PUBLIC o STATE OF FLO IDAC s STATE OF FLORIDA om ', ? Comm*GG*72517 SINCE 19l0 Expires 2/13/2021 l� Expires 2113/2021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS I I/q zrrt, 00 Mpia B�Cgt(alL �ov R te. Zon BIEK tk 2- P�N� Lk ggtie. c�{2W ` C-�ecTaaLe- sk y I gee, t 7AUTHORIZED ODIYYYY) ACo CERTIFICATE OF LIABILITY INSURANCE /2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIER. CERTIFICATE DOES NOT AFFIRMATIVELY OR THIS NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURHORIZEDREPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION ISubject tothe terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does nohts to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME; Tami Karol FAXPHONE (772)781-7720 AIC No: (772)781-7820 Tami Karol Insurance c No,EYt E-NAIL taml tamlkar0llnSUCdnCe.COm 2440 SE Federal HWY Ste W ADDRESS: INSURER($)AFFORDING COVERAGE NAIC# Stuart FL 34994 INSURERA: AMTRUST INSURED INSURER S: Parkman Electric Inc INSURER C: 11415 SW Fox Brown Rd INSURER D INSURER E Indiantown FL 34956 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT I WHICH THIS CE RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.POLICY EXP LlMrrs INS_ N'R LIS B POLICY EFF TYPE OF INSURANCE I POLICY NUMBER MMIDD LTR EACH OCCURRENCE I$ COMMERCIAL GENERAL LIABILITY AMAG N 0 PREMISES Ea ocarrence $ CLAIMS-MADE OCCUR MED EXP(Any one per,cn) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO-����JECT _�LOC $ OTHER: COMBINED SINGLE LIMIT $ a acc dent) ------ AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE AUTOS AUTOS NON-OWNED $ Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR .AGGREGATE $ EXCESS LIAB CLAIMS-MADE I DIED - RETENTION S PER O - WORKERS COMPENSATION STATUTE I ER AND EMPLOYERS'UASILnY YIN E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA AWC1030347 02/06/2018 UZ/06/2019 A ",OFF ICERIMEMBEREXCLUDED? Y E.LDISEASE-EAEMPLOY $ SOO,000 (Mandatory in NH) E.L DISEASE-POLICY LIMIT 5 500,0 'f yes,describe under DESCRIPTION OF OPERATIONS below I I, i I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached rf more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Saint Lucie County Building Department 121 SW Port St Lucie Blvd AUTHORIZED REPRESENTATIVE Port St Lucie FL 34984 �� —� ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PARKE-1 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/Y1'YY)0 311 4/2 0 1 8 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements , PRODUCER 772-286-4334 NONTACT Cabot W. Lord, CIC. Stuart Insurance,Inc. PHONE 772-286-4334 FAX 772-286-9389 3070 S W Mapp (A)C,No,Ext: AIC,No Palm City,FL 34990 ADDRESS:clOrd@$tuartinsurance.net Cabot W.Lord,CIC. INSURER(SJ AFFORDING COVERAGE NAIC# INSURER A:Old Dominion Insurance Company 40231 INSURED Parkman Electric,Inc INSURER B: Mr Scott Parkman 11415 Sw Fox Brown Rd INSURER C: Indiantown,FL 34956 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUER. POLICY NUMBER POLICY EF F POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR MPG3189A 03/10/2018 03/10/2019 DAMAGE TO RENTED rj00,000 `J MED EXP(Any one erson 10,000 PERSONAL&ADV INJURY 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY F7 PECOT- 7 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 X ANY AUTO Bl G3189A 03/10/2018 03/10/2019 BODILY INJURY fPerPerson) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S —J AUTOS ONLY AUTOS ONE PeOr acudentDAMAGE 1,000,000 IOCCUR EACH EXCESS AB A X A CLAIMS-MADE CUG3189A 03/10/2018 03/10/2019 AGGREGATERRENCE DED X RETENTION S 100001 WORKERS COMPENSATION PER 7 OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE IS If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ELECTRICAL WIRING WITHIN BUILDINGS I STATE OF FLORIDA CERTIFICATE HOLDER CANCELLATION SLCCC-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. St. Lucie County Contractors Licensing 8r Certification 2300 Virginia Ave,#21 O AUTHORIZED REPRESENTATIVE Fort Pierce, FL 34982 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD