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Home My WebLink AboutRollins Permit App, Sub & Check List•ARD OF COUNTY WNP• WATJ Lei Was . 4 11 M1 Building & Code Regulation Proiect Location:10851 S OCEAN DR LOT 143 ROLLINS Date: Permit Number: Technician: ' �r •r 1'r r Application completely filled out wish Notarized Signatures .................... . toot... Yes �No N/A Sub Agreements with Notarized Signatures (prior to issuance) .......................... YesVNo N/A Owner /Builder Affidavit (signed in office) ........................... Yes No N/A Filled Land Affidavit (prior to issuance) ............................................ $toll .. Yes No N/AV Recar�ded Warranty Deed, if applicable ......................................................Yes No _ N/A Recorded Notice of Commencement (prior to issuance or inspection) ..... . ........... Yes No N/A Utility Agreement or Payment Receipt (prior to issuance).................................Yes No N/A Vegetation Removal Application with copy of survey, . . 4 1 . 0 0 a 9 0 4 4 1 YesNo N/A Landscaping and Parking plan (under 6,000 sgft)04994 4*1 040#04A104 Yes No N/A Approved Site Plans....... Ies.No N/A Sealed Survey with Dimensions, Finished floor...... . ......... Yes No N/A Elevations and Setbacks., Yes No N/A Not plan with Setbacks, . a 4 1 a I a # & & 4 4 4 0 0 a a * # 4 4 9 0 1 0 4 1 0 0 & & 6 6 6 a 2 0 a a % a I I A A a 6 4 a 0 0 8 0 0 9 6 6 a a 1 6 * Yes No ®N/A Health Department approval stamped on survey and floor plan, . a a & 6 0 a a 6 a 6 1 t 6 a a a 9 a 4 A 4 . YesNo N/A Health Department Food Establishment Permit stamped on floor plan ... . . . ........ . . Yes No N/A Manual "J" or Manual "N" Calculations,.* 4 4 of 0 V so 0 a 0 0*600 t 0 6 oi so 6*04 6 60 1 a & I t6osoo of so It Yes No N/A V Signed Energy Calculations (l .set original signatures & signed in 2 spots).........., .Yes No N/A Sealed Wind Load Compliance Certification ............................................... Yes�No N/A Product Review Affidavit ................... . .......... . ......................................Yes No N/A Excavating a pond for fill: Site plan showing 25�foot(minimum) set back from all property boundaries, size, Yes® No N/A� shape, location and quantities of proposed excavation and fill areas Side slopes not to exceed 4 to 1 to a minimum of 3 feet below water Level, .. , ..... Yes No,� N/A ®they: Health Department Permit Paperwork. so to so 091.4 Yes No N/A V CD for IN Department if commercial or multi -family ... . ............ . .... . . . ........ . .. no No N/A DEP, SFWMD or Army Corp of Engineers (dock, seawall, SF on beach),,,,,, , . , . , . Yes VNo.NIA. Pool Barrier Affidavit, losses 66648 . .. . . ..... soots Yes No N/A Ground Sign Landscape Affidavit (signs) ............... . . . .................. . ... . ... . ...... Yes No N/A V Burn Rate for Sign Cabinets............ $$0414tool............................................ Yes No N/A VI RV and Mobile Home Tie - Down mr, k2 copies) Permit Worksheet (Tie -Down Diagram) ...... . .............................. . .... . ........ Yes No N/A Manufacture Set -Up and Installation Manual......... ... too 166. 81004 too 0*41*1686 66000#4... Yes No N/A Manufacture Blocking Documents .................... . .. . ................ . .... . ........ . . .. Yes No N/A Signed Penetrometer Test (1 copy) ................. . ............... . ............ . ..... . . . .. Yes No N/A Vol StairDetails......................................................... . .......................... Yes No N/A Mobile Home Inspection Report for Relocation (used only) ................ . .... . ..... Yes No N/A Copy of Title for Relocation (used only) .............:.......................... . ..... . ... es o Private Property not in a mobile home park Class "A" Approval from Planning or file # ................................................ Yes No Revised 10/15/1� ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Name: DANIELPAULRETHERFORD Address: 1402 HARTMAN RD City: FORT PIERCE Zip: 34947 Ph one: 772-zza-sszs FEE SIMPLE TITLE HOLDER: Name: Address: city: Zip: Phone. _ State: FL Name: _ Address: city: Phone: X Not Applicable State: X Not Applicable I BONDING COMPANY: _Not Applicable Name: _ Address: City:_ I certify that no work or installation has commenced prior to the issuance of a permit. Phone: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attorney before commencing work or recordj.agyqur Notice of Commencement. ,nature of Owner/Lessee/Contkctora1@r Owner Signature of Contra Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF Ji �� COUNTY OF 1..,�1 The forgoing instru gent was acknowled, efore me this � day of 20 y (Name of person acknowledging ) (Signature of Notary�Pu/bl'ic- State of hlorloa � Personally Known ✓ OR Produced Identification Type of Identification Produced Commission No. Revised 07/15/20 The forgoing inst this � day of _ was acknowled ed before me �c ]I 20D1J by (Name of person acknowledging ) (Signature of NotaryPub/tic- State of Florida ) Personally Known ✓ OR Produced Identification Type of Identification Produced DA'(�131�ZC6Rr�l_D .��n�iF��•., Commission No. DAV1rN I-Il'ZG RALD 1=;(FIRES: ClecernDer 17, 2021 _.,;�-�,} ��= MY COMMISSION fl GG 1623A8 Banded'lhru Notary Public Undermilars r =;, •1�_v; s:' 7% :% : eCem er _1 disisO _ "',[; ; ' Bonded Thru Notary Pubiic Underxrilers REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV IEW DATE COMPLETE INITIALS PERMIT # ISSUE DATE � rs COUNTY PLANNING & DEVELOPMENT SERVICES Building & Code Compliance DlIvIlsion ��rGf✓f G Name(Individual Name) t�UIILDING 6'EIdMIT 51J11]-COI ITRACTOR AGR EEI`ViENrl' Sck�y H G �1'. have agreed to be the ELFCTRICAI Sub -contractor for WILCO CONSTRUC I ION INC. (Type of Trade) (Primary Contractor) Fol• the pt•oject located at 10851 S OCEAN DR LOT 143 (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Cha ffSub-conh•actor notice. C:ONTRAC.1'OR 51 R013CRT WILLIAMS I'RIN'1' NAMIE 29115 couN•ry crR•nplc.,\'r1oN N ShUc of IrinriJn, canna• of ST LUCIE The furegohrg Inslrumenl wns signed before me 161s! (lay of _, 21p, byQJ'� u i L � ��(�,S who is persounlly knoWnV or tons produced n ne IdenliRcnlian. :iil;nnhu•e of Nolory 1'ubbc I Nnrne ';;�!:"''`?'��•,. DAWN i=I I1.(�FP,aL D _ �• ,�y 'c„= MY COMMISSION lr` G„ 162348 =` EXPIRES: December 17, 2021 `•'; F Bonded Thru Notary Public Underwriters Revised I 511R- NTRACI'OR SIGNATURE (Qunlilier) 3 0L %Z Lbw PRINT NAMIE j 9�3� couN I V crR'rlrlcA NON NUMBER Slnle or Irloridu, County of \JIJL� The rarcgolug hrslrumenl wns signed before no• Ihls —L dny of ' '2uq,y 0T.Ohn L&,A) rvho Is personniky known %00/411a has produced it ns IdenllRcnlian, Signohu'e of Nnlnry Public awn T Le- Prhrl Name of Nolary Public S"I'A MI I' ;�:YN%%•,, DAwN `1Tzc1=P,a�D �';; MYCOMMISSION EGG 162348 �= EXPIRES: December 17, 2021 Bonded Thru Notary Pubic Unden'Riters