HomeMy WebLinkAboutbuilding permitPlanning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 402-1553
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 vou, 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.
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. Initial
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. Initial
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 applicable laws, ordinances, buildj�g,�odes,
and zoning regulations. Initial — �Z 44, —,
I understand that the building official and inspectors are not there to design or give advice on how to meet
the minitnum code. Initial - C �L�
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 dei,artment will not mitigate any contract disputes.
initial
1 understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for same reason they do not possess a license, I may be responsible and liable f,Qr the
cost of the Iicense. Initial _
I understand that if any person that is unlicc:,.sed 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_
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 1 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. Sir and acknowledged on this
day of _ YU f�1,t✓ of 20
Owner/ udder Signature
STATE OF FLORIDA
COUNTY OF i 1 y-\ reg 1{l 1
The fomg inst-ume t wa�acknowledged before me this � day of
by 6 �j� '40` i S who is personally known to me, or who has
l Y�
produced- as identificati(o/+Jn..1j
-' - �l l • ,My"4
' 1 EARLpESi1A CROSbAt.f
Signature of o#ary Type or Print Name of Notary (('�� « w Notary Public - State of Florida
Title: Notary Public Commission Number " 1 Commission GG 04ii917
My Comm. Expires Nov 14, 2020
SI.CPDSD Revised 02f 20
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
E ILI �
Building Permit Application
Planning and Development Services l
Building and Code Regulation Division Commercial Residential V/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #: 7i-000 Lot No.11
Site Plan Name: Block No. _�G1
Project Name:
DETAILED DESCRIPTION OF WORK:,...-;
vt4 ) 0-r• `^,64,
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors ` Pond
Electric 4 Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�-a
Cost of Construction: $ � Utilities: Sewer septic Building Height-.
-_....-_...__._
_.., ....
OWNER/LESSEE:
_. ,::.:
CONTRA v :
Name vR�
Name:
Address:
Compeny.
City: ► State:
Address ' `x
Zip Code: Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.