HomeMy WebLinkAboutROOF PERMIT APP and OWNER AFFAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR: KI RBY BLACK
PROPOSED IMPROVEMENT LOCATION:
Address: 701 Ramie Ct
Property Tax ID #: 3419-515-0081-00017
Site Plan Name:
Project Name: Roof Replacement
DETAILED DESCRIPTION OF WORK:
Remove and replace existing flat roof with polyglass base sheet and cap sheet over entire roof deck.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.17
Block No. 22
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 01I2- Pitch
Total Sq. Ft of Construction:-.�GdlG Sq. Ft. of First Floor:
Cost of Construction: $ $12,000.00 Utilities: —Sewer _ Septic Building Height: 14 ft
OWNER/LESSEE:
CONTRACTOR:
Name Kirby Black
Name:N/A
Address:701 Ramie Ct
Company:
Address:
City: Port St Lucie State: E."
Zip Code: 34952 Fax:
Phone No.772-446-4126
City: State:
Zip Code: Fax:
Phone No
E-Mail:kirby@blackfireprotection.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: xNot 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 attorne before commencing work or recording our Notice of Commencement.
Si nature of O ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Y Physical Presence or Online Notarization
Physical Presence or Online Notarization
this lb day of ee, 2024 by
this day of 2020 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
Produced
(Sig t.4tp1W;Notary tibliL-�S i' ri�l�
o
(Signature of Notary Public- State of Florida )
;s: , ; uuiii;v Put)hc• laic G
^. .�•: Corn mission # GG 284093
(Seal)
Co m sr „A,,rQMM S� Qn c.cni3Oe
Commission No.
becembe, 13, 2022
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS FRONT ZONING SUPERVISOR
REVIEW
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
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 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 Here.
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 Here.
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 Here.
I understand that the building official and inspectors are not there to design or give advice on how to me �t�
Here
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. �j
Initial Here.
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 t�
license. Initial Here. /
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 related medical cost, whit
could include loss of wages during recovery from their injury. Initial Here
To qualify for this exemption under this subsection, an owner must personally appear, 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 owneribuilder exemption shall be report the Buildi nd Zoning
Department to he Florida State Department of Professional Regulation. Si a ed is
day of of 202/.�
Owner uildersignature
STATE OF FLORIDA
COUNTY OF
The foregoing instrument w knowI dged before me this day of , 20 ,
b who is personally known , ,
y {iYPG/i/ ' LLEN VAUGHN
produced �` C� L as identifi t m,= g
fate of Florida -Notary Public
QF Commission # GG 270079
oPp` My Commission Expires
%� OF FL �
/"""`` -- r 22, 2022
Signature of Notary Type or rtnt Name o Not — — - - -
Title: Notary Public Commission Number