HomeMy WebLinkAboutBuilding Permit Package All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c� ss��u
Date: '� Permit Number: clo l aq
O
-17" o n JUL ® 6 2020
--Y Building Permit Application
Planning and Development Services SF. Lucie County, P• mitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: �U �
PROPOSED t�. PR'OUEMENT LOCAT)ON'
Address:
Property Tax ID#: coo aoz; ann . 0 Lot No.
Site Plan Name: Block No.
Project Name:
D1=TAILED �006RIPTtON OF WORK:
v A
i-k3ti te- u P -AD qv� UJ a�-g
New Electrical Meter Second Electrical Meter
'CONSTRUCTION I I N 9,R7W1ATI'ON:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
e
Cost of Construction: $ b h Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CfJNIT,6 R:
Name . Tzp6 Name:
Address: 2103 �Cll �g�1(A pub Company:
City: State:E(., Address:
Zip Code: 3U��2 Fax: City: State:
Phone No. Zip Code: Fax: .
E-Mail: (e)k Phone N'o-
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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CC)NSTRUCTiG)N LI N LAW IN FOR'MA.TjOR
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 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 attorney before commencing work or recording our Notice of Commencement.
��tl`1�Ca
Signature caner /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF l• COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
thishysical Prese ce or Online Notarization Physical Presence or Online Notarization
day of �J 2020 by this day of 12020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced in _ Produced
(Signature of Notary Public-State'of Florida/) (Signature of Notary Public-State of Florida )
Commission Commission No. (Seal)
pY111" KAREN S. NIELSEN
State of Florida-Notary Public
'- Commission # GG 20484
REVIEWS TMy d 'I 022 i�P VISOR PLANS VEGETATION SEA TURTLE MANGROVE
EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Fort Pierce Utiiatiss Authority
"Committed To Quality"
JUL 0 6 2020
Water/Wastewater Engineering ST. Lucie County, Permitting '" •
206 South 6th Street
Ft. Pierce, FL 34950 Phone(772)466-1600
Fax (772)461-1938
tUSTOMtkklNVOICE,IiESTIMATE ONLY); '
QUOTE-FOR KARLA FRAGA
.JLOB„DESCRIPTION INSTALL(,1.).518 X3/4,WATER METER ONLY, NO.SEWER: a
INVOICE NO: SORD00003977516 PREPARED BY:JOHNSONCH
LOCATION ID: 10008121
ADDRESS: 2103 ELIZABETH AVE FORT PIERCE FL USA 34982
ADDITIONAL_INFO:
TASKS ?,DESCRIPTION 1j _ :_ T COUNTi __ w ;UNI OST CHARGE$'I
W-CAP IM CHG WATER CAPITAL IMPROVE CHARGE $0.01.L� $1,850.00 .
W-CON FEE NEW WATER CONNECT FEE NEW COST $0.01 $40.00
DEPOSIT INVOICE DEPOSIT FOR INVOICE NEW CUST $0.01 $60.00
TOTAL CHARGE $1,950.00
Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater
Connection Charge is paid - whichever is first . The cost of the service line from the point of delivery at the property line to the
house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit•from the Health
Department must be obtained prior to initiating a septic tank abandonment.Contact the Health Department at (772)873-4931.
Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at
the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse
weather conditions and construction conflicts , the customer will be responsible for increased costs . Additional costs incurred by the
customer shall not exceed fifteen ( 15 ) percent of the total estimated construction costs shown above . Estimated costs paid by the
customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority All fees are due prior to any
construction.
Note: This is only an estimate. A bill will be provided following acceptance of the Customer Invoice once signed and dated. Please
submit accepted Customer Invoice to Customer Service at 206 South 6th Street,-Ft.Pierce;FL 34950 or call(772)466-1600 to setup an
WtAGL
Customer Signature: t'�t"S? Date:
Printed Name:
PAGE 1 OF 1 PRINTED ON: 05/27/2020 AT 08:05 AM
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Planning&Development 9etvkas Online address:httplvA ..sUucleco.orGVplanning/permit6ng.htm
Oulck Links:
Building&Code Regulation Division Permit Status Lookup
2300 Virginia Avenue Online Building Inspection System
Fort Pierce,FL 34962
Phone:17 7 214 6 2-217 2 Fex:(772)462.6W
Date: 7/1/2020 Receipt no: M202001723
Received by: humphreya Total paid: $25.00
Paid by: QUALITY RESEARCH Payment type: CHECK `
a
Issued to: QUALITY RESEARCH Check/Credit card no: 1105 i I
Address: City:
State&ZIP
r�
® Planning&Development Services Di partme&EGEIVtt0
Building&Code Regulation
° G3 1D 2300 Virginia Avenue JUL 0 6 20?0
� Fort Pierce,Florida 34982
(772)462-1553
ST. Lucie County, Permitting J
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.
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,building codes,
and zoning regulations. Initial V__P
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 L F-7—
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 relat d edical
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 Depart ent to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20
� l
Owner/Builder Signature
STATE OF FLORI
COUNTY OF
The fore ping instrument was acknowledged before me this�_day of 20,30 ,
b who is personally known to me,or who has
produced as identification.
i
Signature of Notary a or Print Name of Notary (Seal)
Title:Notary Public 1PpYPjBi KAREN S. TTNdW mber
SLCPDSD Revised 02/7 W41, :State of Florida-Notary Public
Commission # GG 207484
= My Commission Expires
June 12, 2022