HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Permit Number: 0(00C
_. _.._.....W,.___..__" 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 TYPE:
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Address: 5701 Buchanan DR Fort Pierce, FL 34982-3253
Property Tax ID #: 3402-603-0005-000-9
Site Plan Name:
Project Name:
Changeout A/C
(Previously installed by old
BcE—' 3 wo-'�
'L
FF 3
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
`XMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 0920-0
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
'
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CO1tl�TRACTOR
DOWNER/L€SSEE ,x' t
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Name Robert Dumont
Name:
Company:
Address: 5701 Buchanan DR
City: Fort Pierce, FL State:
Address:
City: State:
Zip Code: 34982 Fax:
Phone No. 7.723706308
Zip Code: Fax:
E-Mail: bdumont63@gmail.com
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
1f value of construction is $2500 or more,.a RECORDED Notice of Commencementis requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLERlIEIVTALCONSTRUC�ION=LIEIV LAW INFORMATION' f� '
it�� '` r:^� : _ i „1, / s L ..''..tE tir 1. { tip — F.. ��t.� - f y 1 xv1,,, ✓.: stwl h Ay z t _ . _.
DESIGNER/ENGINEER: x
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENWR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
Signa re of Owner/ Lessee/CoNiractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI A
!
STATE OF FLORIDA
COUNTY OF V. kubif'
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day o 20W by
this day of , 20_ by
Name of person making statement.
Name of person making statement.
Personally Known lko OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Karen DesNOTARY
P
BUC
(Signature of Notary Publ State of FlonSTATE OF
*(All
L ure of Notary Public- State of FloridaCommit:
GG
li5 1
Commission No.�' M15W Expires 3
IdMission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 217/19
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 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 with all a able
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 ho o eet
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 SKI
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 I r the
cost of the license. Initia
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 relate cal
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. ed and kno ed on this
day of 441r of 20 'b.
wnerBuild:sr Signature
STATE OF FLORID
COUNTY OF LC
Tli strum t was ac owledged before me this dayof
by who is personally known to me, or who has
Idu6et. as identifcation.
ore of Notary Type or Print Name of Notary (Seal)
Title: Nptga Public Commission Number
SLCPDSD Revised 05/15/2014 LASHAHNAINGRAM•RAHMING
W COMMISSION # GO 276060
EXPIRES: December 20, 2022
t Bonded TW Notary Public Uadw Atm'