HomeMy WebLinkAboutBob Harsh 11995 S Indian River Dr. Jensen Beach 34957 permit dog �bmi�c��S L S�1cc� �or�
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L''),�0" '-Lo ;�-o Permit Number:
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 APPLICATION FOR: Boat Lift Power
PROPOSED IMPROVEMENT LOCATION:
Address: 11995 S Indian River Dr. Jensen Beach FI.
Property Tax ID #: 3532-802-0014-000/6
Site Plan Name:
Project Name: Clearview
Lot No.9
Block No. A
t DETAILED DESCRIPTION. OF WORK: �
Existing meter on east side of Indian River Dr, existing electric panel, existing T' conduit to end of dock. Pull new #8 Thhn through existing conduit.
install New 8 space 3R Subpanel, Install New 2 pole 15 Amp GFCI Circuit Breaker for Boat Lift Power, one point connection.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: N/A
Cost of Construction: $ $1900.00
Generator
Sq. Ft_ of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Bob Harsch
Name. -John Lotak
Address:11995 S_ Indian River Dr.
Company:John Lotak Electric Service LLC.
City: Jensen Beach State:
Zip Code: 34957 Fax:
Phone No.321-228-8892
Address:1161 SF Proctor Ln
City: Port St Lucie State: Fl
Zip Code: 34983 Fax:
Phone N0754-264-3089
E-MaiI: bobharsch@yahoo.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Maiijohnlotakelectdcservice@gmail.com
State or County License EC13008663 .3
if value of construction is 250U or more, a RECORDED Notice of Commencement is required.
if vainp of maVr is *%7 Snn nr mnrP n RFrnRnFn NntirP of rnmmanrPmant is rPnp4rM
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
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.
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/font actor as Agent for Owner
Signature of Contractor/Li ease Holder
STATE Of FLORIDA q
STATE OF FLORIDA
COUNTY OF S_V Live a
COUNTY OF Sk I 'U c , e.
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online Notarization
Physical Presence or Online Notarization
this � day of -Jane 2020 by
this day of X1 i 2020 by
Name of person making statement.
Name of person making statement.
Personally Known, OR Produced Identification
Personally Known lC' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Notary Public State d Ronda
N�6ta
Notary Public Stab of FW da
{signature of t 9112�
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(Signature of Notary ofllf GG 911278
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Commission No.
Commission No.
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU
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