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HomeMy WebLinkAboutChange of Contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: `� � �9 Permit Number: �� - RECEP "V ED " JUN 4 2019 Building Permit Applic tion Planning and Development Services Permitting Department Building and Code Regulation Division St. Lucie unty FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res-Rd en Ia PERMIT TYPE: PRaPOSED UMPR01/EMENT LOCATION: Address: 0 Property Tax I #: p� L7 ' Lot No. Site Plan Name: Block No. Project Name: DETAILED DEzSCRdPTI©N OF W@RK: D CONSTRUCTIdN INiFORMATI©N: Additional work to be performed under this permit—check all that apply: _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:$ ) (0 A t Utilities: —Sewer —Septic Building Height: OWNEJRAN— @ 11001NTRACTQR: Name f\u M,Ifer Name: Address: NOJ IM y. C'ompa,ny,;. City: f• reef c State: -F - Address•:,., Zip Code: .���1' Fax: City: State: Phone No. 77,9 E-Mail: erf%rn%Jl--P_V- Uft90 cJ c^ i.Cv 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. If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INfiORMATION: 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 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 "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 JOB 5_5I EFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 19COUNTY OF The forgoing ins nt was acknowledged�efore me The forgoing instrument was acknowledged before me 4,9qthis V day of 20 1'.. by this day of 20_ by Name of person—making statement. Name of person making statement. PersonaVrK own OR Produced Identification Personally Known OR Produced Identification Type of Identif a ion Type of Identification Produced /� Produced (Signature of Not Public-State of Florida (Signature of Notary Public-State of Florida) Commission No. ='`• A`�_1 irCO `bHN#GGR300817 Commission No. (Seal) :o EXPIRES:March 6,2023 P F", REVIEWS FR ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. Planning&Development Services Department Building&Code Regulations ° _ 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 OWNER/BUILDER 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 with all appwable 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 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 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_ r--PA 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 Depart t to the Florida State Department of Professional Regulation. Signed arid_ackhowdged o3ehis �rll day o� of 20-7-. O er ild ure STATE OF FLORIDA �A COUNTY OF (iCrC� The fqF5gomg instrument was acknowledgee4before me this 7' day of ,20� by who is personally knob to me,or who has prod ed , - as de tification. _ ° Signato ure of Typ Print Name of Notary (Seal) Title:Notary Publ' Commission Number SLCPDSD Revised 05/15/2014 AUDREY B.HUMPHREY MY COMMISSION#GG 30081 T rho EXPIRES ,. .�March 6,2023 '.�OF FM�. SQIKJBd Tlvu Notary POW Und"Milers PLANNING & DEVELOPMENT SERVICES t — ` BUILDING & ZONING DIVISION o 2300 VIRGINIA AVE _ ww FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner, an tew he ncontractor of record for the current permit. A new permit application must also be completed with new contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to commencing any work.There is a$50.00 fee for the Change of Contractor. CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor. The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub- Contractor. CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: �"' J Permit Number: 0 Site Address: �� , }t✓ �� r �- go IV PL- State License,` SLC License eo vc)­Y Original GC,subcontractor or owner/builder �' 77 s ©c,C/ State License /1[ YJ SLC License New GC,subcontractor Reason for Cancellation 1jeto a j—r The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all costs,fees or dgmages-ari"singfidm any and all claims of action for any reason,which may arise as a result of this change of contrac rtsubcontractyr-ofcancellation of permit.A permit cannot be cancelled if work has been performed. "�GN"A'RURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) PRINT NAME t�7,C—)_ PRINT NAME State of Florida,County of St.Lucie County State ofFl Florida,County tyofSt.Lucie County The following i ment was acknowledged before me this The following instrument was acknowledged before me this day o 20A/ b,, M m/ ) � day of 20_ by who is personally known to me who is personally known to P Y P Y or whoroduced asZH' L me or who has produced as ID.71 Signature of Notary Date Signature of Notary Date Revised 04/15/16 AUDREY B.HUMPHREY MY�C�OMeMIISSION#GQG/�3�0007 �•A ��`� EXPIRES.March 6,2023 '.FOF f�,�•' Bow Thin Notary Public ur�twNrs PLANNING AND DEVELOPMENT SERVICES DEPARTMENT - BUILDING AND CODE REGULATIONS DIVISION 2300 VIRGINIA AVE FORT PIERCE,FL 34982 (772)462-1553 Fax(772)462-1578 PERMIT RENEWAL REQUEST PERMIT NUMBER: �Uy OADDRESS: � 3rJ j r f- d r,cc V14, I, `�&Y\ M 71�i� ,am requesting that the above permit be renewed. I understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a passing inspection during any six month period during the renewal period. Justification Cj-,anof c,+ n w n--f S yX - O LDR OR CONTRACTOR SIGNATURE DATE 'Evan M,,c Y Print Name STATE OF FLORIDA ` COUNTY OF ACKNO EDGED BEFOR,yEyME THIS DAY OF 20 BY V !/ 1 elWHO IS E ONALLY KNOWN TO ME OR l HAS PROVIDED AS IDENTIFICATION. STA OF FLORIDA,Coqnty of SlbgAAFrARY " ' Ali?iq AUDREY 8.HUMPHREY MY COMMISSION#GG 300817 Qo`,e EXP{RES:March 6,2023 -----------_------------------------------------------ --1 �.`.°�-_�gpTbru dotary Public Underwriters - FOR OFFICE USE ONLY: Number of Open Inspections: Total Inspections: (Divide open by total to get%of open inspections) Percentage: Original permit fee: x%open = $ Renewal fee Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee) Revised 7/21/2014 Planning&DevelopmOnt Services ASBESTOS NOTICE TO OWNER/BUILDER Building&Code Regulation Division 2300%firginla Avenue Fort Pierce,FL U982 June 04, 2OYG RE: Building Permit Number Disclosure Statement: State law requires asbestos abatement bzbadone bvUmanaadcontractors. You have oppUedfor o �u��on�m�����|m� T�����aU �� y��tho'mwner of your p ^ you own asbestos abatement contractor even tho h donohave mlicense. You nluotsupervise t ' construction ns- - 'u�� oryourae/[ You may move, remove, or dispose ofasbestos containing materials onoresidential building where the ou/m/nQondtkoUV||U|ng |� notfnr�a|�or|�oaoorthabui|din i� fa outbuilding ' ' ^ . g o rmou u n0onyourpnopo�y. |fyou sell orlease such building within one year after the asbestos abatement is complete the lawwill presume that you intended tosell or lease the propodx�tthoUm�th�vvorkvmasdonowhi � i / {sdi of�hi ~ o �ovo on this exemption. You may not hire anunlicensed person asyour contractor. Your work must be done according to all local state and federal laws and regulations which apply toasbestos abatement projects. |tioyour FaeponaibiUtvtonoUfvtheOepo�n}antofEnvironnnanta| Protection of your inbanbonboremove asbestos. |tisyour nespunoibi|ib/ ~m�kesure that the people employed bvyou hovmlicenses required bvstate law and bycounty ormunicipal licensing ' ordinances. ^ ____~ �_~---- Oxxnor"Gi�natuma & Date . 6/4/20188:2313AM ' / .