HomeMy WebLinkAboutBUILDING PERMIT•ARD OF
COUNTY
MMM it
A 1 • .
Building & Code Regulation
Project Location: 10701 S OCEAN DR LOT 637 - MEDINA Date:
Permit Number: Technician:
Application completely filled out with Notarized Signatures . . . . ...... . .. . ...... . . . ..... Yes � No N/A
Sub Agreements with Notarized Signatures (prior to issuance), ............. . . . at .. . .... Yes No N/A
Owner / Builder Affidavit (signed in office),, . ............ . ... . so ...... it 0404 . . ..... . ....... Yes No N/A
Recorded Warranty Deed, if applicable ....... . .................... . . .......... . . ...... . .....Yes No � N/!-�
Utility
Vegetation Removal Application with copy of survey, ....................................Yes No N/A V
Landscaping and Parking plan (under 6,000 sgft). .. . ........... . ............. . . . . . ....... Yes No N/A
ApprovedSite Plans, . ... . . ........................................... . ................... Yes No N/A
Sealed Survey with Dimensions, Finished floor,,,,,, . . . ... . ..... . . . . . ....... Yes No N/A
Elevations and Setbacks, 0 0 * 0 4 0 a a t 6 9 0 o 0 0 & 1 0 4 0 9 1 * 4 a 4 0 a 6 1 6 4 1 4 9 a 1 0 4 6 a 4 & 4 9 0 * 0 1 0 0 9 t N 1 0 6 4 N 16 Yes No N/A
Plot plan with Setbacks............................................................... Yes No � N/A
Health Department approval stamped on survey and floor plan, . 0 4 * 4 1 0 6 6 # a a I a . ...... . . YesNo N/A
Health Department Food Establishment Permit stamped on floor plan... *9 so *a so Yes No N/A V
Manual "J" or Manual "N" Calculations .............. . ........ . ... . ....... . . ... . ..... . .... . Yes No N/A
Signed Energy Calculations (1 set original signatures & signed in 2 spots), ..... , , ....Yes No N/A
Sealed Wind Load Compliance Certification .. . .. . ....... . .... . .. . ..... . ...... . .. . .. . . . .... Yes No N/A
ProductReview 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
Health Depat�hnent Permit Paperwork .................................................... . .. Yes No N/A
CD for Fire Department if commercial or multi -family ... . ............ . .. . . . . . ........... Yes No N/A
DEP, SFWMD or Army Corp of Engineers (dock, seawall, SF on beach). , .... , ..... Yes VNo N/A
Pool Barrier Affidavit............................................................. . ....... . .... Yes No N/A
Ground Sign Landscape Affidavit (signs) ................................................... Yes No N/A
Burn Rate for Sign Cabinets..........., Isss. . . . . . Otto ....... Yes No N/A
RV and Mobile Home Tie - Down On1Y(2 copies)
Yes No N/A
Manufacture Seto*Upand Installation Manual. ,,,,,,,,,,,,,,,, else ,,,,,,,;,,,,,,, befog ,,,,,Yes No N/A
ManufactureBlocking Documents ................. . .. . . . . .......... . .............of 00 , , . Yes No N/A
Signed Penetrometer Test (1 copy)......................................................... Yes No N/A
We
StairDetails......................................................... . ..................... . .... YesNo N/A
Mobile Home Inspection Report for Relocation (used only) , , , , , , , , , , , , , , , , , , , , , , , , , , , Yes No N/A
Copy of Title for Relocation (used only) ............................................... . . .. Yes No N/Av
Private Property not in a mobile home park
Class "A" Approval from Planning or file #......... ....................................... Yes No N/A
Revised 10/15/18
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
i J -'
>��DOC���U�i "enF[cla'H f�J�p)��Ce R00lr�
Planning and Development Services
Building and Code (regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial _ Residevii:iDl X
PERMIT APPLICATION FOR: BeeWSeawall
PROPOSED IMPROVEMENT LOCATION:
Address: 10701 S OCEAN DR LOT 637
I_e�al Description: VENTURE OUT - SECTION C - LD 13t3
I'ro l m r i:y I a x I D #: 4511-805-0038-000-7
Si�c� Plan Name: MEDINA
Project Name: MEDINA -SEAWALL
Sc�i:backs Front
Back:
Right Side: _ — Lein Side:
f3locl< No.
INSTALL UP TO 35 L. FT. OF SEAWALL WATERWAR® OF EXISTING USING DATTER &
KING PILES.
� :I ►I�l'I Itl I.:I II ►l�l II�II t,i�MATION:
lditional work to be ertormed under this permit e cneci< a
�HVAC Gas Tank ❑Gas Piping
Electric El Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 18,000.00
�_ Shutters Q Windows/Doors
Generator Roof Roof pitch
S Ft. of First Floor:
Utilities: Sewer . Septic
Building Height:
OWNER/LESSEE.
If
CONTRACTOR:
Name MEDINA, DAISY & NELSON
Name: ROBERT WILLIAMS
Company: WILCO CONSTRUCTION INC
Address:16227 NW 12TH STREET
City: HOLLYWOOD State: FL
Zip Code: 33028 Fax: N/A
Phone No. 305498-3965
E-Mail: N/A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: 10751 ORANGE AVE
City: FORT PIERCE State: FL
Zip Code: 34945 Fax: 772460-6929
Phone No. 772-460-6928
E-Mall: WILCOINC c@BELLSOUTH.NET
State or County License: SCC131151026 29115
vo-ilnn of construction is $2500 or more, a RECORDED Notice of Commencement is rc^rinired.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW
INFORMATION:
DESIGNER/ENGINEER: _ Not
Name: DANIEL PAUL RETHERFORD
Applicable
MORTGAGE COMPANY:
Name:
X Not Applicable
Address: 1402 HARTMAN RD
Address:
City: FORT PIERCE
Zip: 34947 Phone: 772-224-9826
State: FL
City*
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: X Not
Name:
Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature
ntractor as Agent for Owner
STATE OF FLORIDA �
COUNTY OF
The f r
oing instru ent wa ackn wledge before me
this � day of 20 y
(Name of person acknowledging )
(Signature of Notary Public- State o�lorida )
Personally Known v OR Produced Identification
Type of Iden�ifj�a_�Pi+�6��-:��-� �-�•�-
f ,•�:.11„ - DAWPI1=11LG�:Ltr\LD
Commis igi1``Nd,`< r�rvcoMMISSIONRGG'I4�I)
F-APIRLS; December 17, 2021
'' ` 12 ,nd«i Thni N0tLIN Public Underwriters
Revised 07/15/2014
Signature of Contractor/License Ho
TE OF FLORIDA
STA
COUNTY OF S-t-
The forgoing Instrument was acknowledefore me
thisay of 2 by
�.
(Name of person acknowledging
(Signature of Notary PubliE/State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
DAWN FITZGERALD
:,� LJtPIR[S: December
17, 2021
;;;;i<� 13unded Thru D!olary Pubiic UndenRitars
al)
E
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS