HomeMy WebLinkAboutBuilding Permit ApplicationAll 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) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 10701 S. Ocean Drive, Lot 848, Jensen Beach, FL 34957 - Venture Out at Indian River Inc. Lot 848 (OR 3391-2847)
Property Tax ID #: 4511-510-0049-000-2 _ Lot No.
Site Plan Name: Broome Block No.
Project Name: Broome
DETAILED DESCRIPTION OF WORK:
Remove existing Pedestal and replace with a Florida Approved 125 Amp Pedestal.
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 _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 2,200.00
OWNER/LESSEE:
NameTimothy Broome
Address:347 Birch Hill Road
City: New Durham, NH State:
Zip Code: 03855 Fax:n/a
Phone No.401-339-3621
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
E-Mail: kbroome1 @verizon.net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Pond
Pitch
CONTRACTOR:
Name:James D Brown
Company: Jim Brown Electric, LLC
Address:3352 NE Skyline Drive
City: Jensen Beach State: FL
Zip Code: 34957 Fax: Ofc#: 772-209-0280
Phone N0860-803-5333
E-Mailidb5333@gmail.com
State or County License SLC 30871
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: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address: _
City:
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone: -
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
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 your Notice of Commencement.
ure of Owner/ Lessee/,Gemtrac5-r as'
STATE OF FLORIDA
COUNTY OF AAA u- �- - i
Sworn ILofpr affirmed) and subscribed before me of
ysical Presence or Online Notarization
this `"day of 2020 by
of Contractor/License Holder
STATE OF-FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
�F�ysical Presence or Online Notarization
this 4 r` ay of 202� by
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Name of person making statement. Name of person making statement.
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Type of Identification Type of Identification
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