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HomeMy WebLinkAboutChange of Contractor RECEIVED PLANNING & DEVELOPMENT SERVICES U1 7JR 5R_ - ``1v." BUILDING & ZONING DIVISION JUL 0 2 2019 2300 VIRGINIA AVE sT. Lucie county, Permitting -- _ � 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, nd the new contractor 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: v 2-0 1 Permit Number: SiteAddress: State License . SLC License Original GC,subcontr ctor r owner/bui der C `� 40 A State License SLC License e GC,subcontrac or Reason for Cancellation The unders' ed does hereby agree to i demnify and hold harmless St Lucie County,its officers,agents and employees from all costs,Be o d ages arising om an d all claims of action for any reason,which may arise as a result of this change of C on ctor/ ontractor c cel permit.A permit cannot be cancelled if work has been performed. 1 SIGNA OWNER Oro er/but SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable) P NT NAME o� PRINT NAME State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following i strument was acknowledged before me this The following instrument was acknowledged before me this day of 201 Ll by day of 20_,by, is personally known to me who is personally known to who has rodu as ID. me or who has produced as ID. Signature of Notary UWS.M Signature of Notary Date ,.��`... KAREN S. NIELSEN CSP l �a �sState of Florida-Notary Public Revised 04/15/16 'c Commission #GG 207484 '.�rFOF'F`o`c My Commission Expires June 12, 2022 i i I i I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1 L'4 Permit Number: i RECEIVED v m... ..__ �:.- Building Permit Application JUL 0 2 2019 Planning and Development Services Building and Code Regulation Division ST. Lucie County, Permittin 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT TYPE: PROPOS N[PROVE'ME NT-p6CATION, , Address: Property Tax lD#: l ' ©�' on Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRI,PTION.OF,WO'RK r s, 6vC-At v' \ ►�� 2. g-4 cAk 1771—77 : ONSTRU&ION IIVFORMATIOIV 3 '' 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: 'F4 Sq. Ft. of First Floor: Cost of Construction:$ c -D Utilities: —Sewer _Septic Building Height: OWNER/CESS,EE CONTRAC,TO R < Name Name: Address: �O['� EL n1�� V-Apany City: ( State:fL' ,Address: Zip Code: Fax: City: State: Phone No. 7 �7 3'.7�7 - 3���- .Zip_Code: _ !_ .Fax E-Mailc) Phone No�:,... r_.:...::... 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. i SUPPLEMER;TAL 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 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 subjectstructure 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,_CONSULT OUR LENDER OR A ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." l Si a ure of Owner Less e/contra&orasAgedt for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrme t was acknowledge before me The forgoing instrument was acknowledged before me hi I day of 20 by this day of 20_ by Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identifi ' n Type of Identification Produced Produced kLQ (Si nature of No ary Pu - Signature of Notary Public-State of Florida) .,"�Pj�, KAREN S. NIELSEN ..� �B Commission No. =_° `�sStat1orida-Notary Publi ommission No. (Seal) Colmistion # GG 207484 My Commission Expires REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 11 Planning&Development Services Department---- Building&Code Regulations, RECEIVE) 2300 Virginia Avenue Fort Pierce,Florida 34982 i {772}462-155.3 JUL 0 2 2019 OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT ST. Lucie County, Permitting 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 constructiony ourself. 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 applicabke laws,ordinances,building codes,and zoning regulations. Initial I I understand that the building official and inspectors are not there to design or give advice on how to me t the minimum code. Initial A. 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 A. f 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 t cost of the license. Initial- At 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 medic I cost,which could include loss of wages during recovery from their injury. Initial 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 Departineri%to the Florida St to Department of Professional Regulation. Signed and acknowledged on this day of-At I IN of 20 OW6e /Builder Si-gnat'ure STATE OF FLOgLA COUNTY OF Th ore g ing insRm as acknowledged before me this ca day of �0��q 20 1A, _who is personally known to me,or who has produced as identification. C::�kg/11_A Signature of N—otary Type or Print Name of Notary (Seal) Title:Notary Public -19a, I KAME018� :N State of Florida-Notary Public SLCPDSD Revised 06/13/2014 0 Commissionfl, GG 207484 My Commission Expires June 12, 2022