HomeMy WebLinkAboutScanAll 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: demolition
PROPOSED IMPROVEMENT LOCATION:
Address: 10701 S oCean Dr Lot 880 Jensen Beach FL 34957
Property Tax i D #: 4511-510-0081-000-8
Site Plan Name:
Project Name:
X
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
-t%�Lk lie
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 Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0(4 oo' Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
Name Marry Block & Susan Neal
CONTRACTOR:
Name:James Newman
Address:10701 S oCean Dr. #880
Company:JWN Builders, LLC
City: Jensen Beach State: E L
Zip Code: 34957 Fax:
Phone No. 772-418-5709
E-Mail: hblock1212@yahoo.com
Address:1701 SE Carvalho St.
City: Fort. St. Lucie State: FI
Zip Code: 34983 Fax: 772-871-9500
Phone No772-871-9500
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailjwnconstruction@comcast.net
State or County LicenseCRC1328282
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: T 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
swhich is in tructure. Please consult any applicable
Home Owners Asswners ociation on andciation rre�iew your dbylaws eed or any re tr ct o s ts that which may strict alprohibit such
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 commencin work or r ardin our Notice of Commencement.
as Agent or Owner t ' n ture of Contraclor(License Holder
STATE OF FLO r STATE OF FLOI
COUNTY OF COUNTY OF
Swpt t to (or affirmed) and subscribed before me of
✓✓ e s al Pre g e�or Online Notarization
thi % of ` '�� 2020 by
1
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*ameperso making statem nt.
Personally Known OR Produced Identification
Type of Identification
Swor to (or affirmed) and subscribed before me of
Phi al Pre n e or Online Notarization
thistw,v�\d•�y of 2020 by
'TAVV&,�� K V- cl (A
Name of person m70atement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Sig tore of Notary Public- State of Florida (Signature of Notary Public- State of Florida)
1ARIAH 1v US ,•y RkA �11�Ls
Commission No. Curnmissl49lM)1o0722 Commission No. `' '' 1 �on # GG 100722
Expires June 3, 2D21 : Expires June 3, 2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
4 �
f
Venture.Out at.lndian River, Inc., 107015 Ocean Dr, Jensen Beach, FL 34957
Phone. (772) 229-2333 Fax: (772) 229-5559 it -mail: V3office@V3assoc,com
FORM 101- APPLICATION FOR BUILDING COMMITTEE APPROVAL
INSTRUCTIOi3S:'ro process this Form 101, the following items must be submitted either In person, by emall, or fax, to the
Venture Out at Indian River, Inc. office as listed above, at least 5 business days prior to commencement of any work:
1. This completed appi€cation.
2. Site Plan Submission to Include the type of work, location, materlals, color, design, dimensions, plans, survey, pictures and
other Informatlon as maybe pertinent to complete your request. See Venture out at Indian River, Inc. Rules For a complete
description of the Site Plan Submission requirements for new home construction.
3. Fully executed Venture Three f Venture Out at Indian River, Inc. indemnif€cation Agreement. it must be signed by the
commercial contractor and owner, or Just the owner If the work will be done by the owner.
To: Venture Out at Indian River, inc. Building Committee
Lot it
From: e' Owners Namj �t_P �/ L� � G�-
Property Address: 10'7 0 I �'. C3C&X01 rt ✓ C1� (� 7 J�
Email:
I/We are hereby requesting to make the following modifications as described below (check all that apply):
Painting
Roof
Doors ❑
Windows Shutters El
Landscaping Feature
Pavers
Sea Wall
Boat Lift ❑
Dock Awnings 0 Ext Stairs/Landing
A/c F]
Plumbing ❑
Electrical
Concrete Lighting other
Description of work (attach requ€req documytatlon).
Commercial Contractor Information. E]No commercial contractor/lay owner
If work is being done by the owner, leave this section blank and mark box no commercial contractor/by owner.
ny name:
Address:
Phone:
Contact:
By stabmitting this Form.101, we agree to the following terms and conditions as described below:
1. Do not commence any work until written approval is granted. if work begins prior to being authorized, owner will be In
violation of The Rules of Venture Out at Indian River, Inc. Rules and subject to the fining process.
2. Abide with the Association's authorized days and hours for construction and ail Assoc€at€on and Venture Three Rules.
3. All commercial contractors must be properly licensed and Insured for liability. The Venture Three and Association
Indemnification Agreement Is REQUIRED to be signed and on file at the Venture Three office priorto the commencement of any
work.
4. Any approval granted herein is only valid if owner obtains neccessary permits as required from St Lucie County, In accordance
with the local codes, laws and ordinances, prior to the commencement of work. It is the owner's responsibility to provide any
required permits to validate the Building mm€ttee "proval. 1
Signature of Owners or Agent
Far Building Committee Use Only:
U
Date (9 O a �
Date Application Received: -5— j S — Z i Date of Disposition A`
Approval Granted: X Approval Denied: Comments
Bufldfnq Committee Member Signatures i
Signature: yQ Printed game: a IV >�Lb 10-�-f �'/a
Signature:^ Printed Name: J I .
4M-h-- /Jl%�...G ,... Printed Narne: �1�:llf to . 1 Ai'An OV11 ,,.
15
FORM 101 - STIPULATION -RELEASE INDEMNIFICATION
AND HOLD -HARMLESS AGREEMENT
THIS STIPULATION -RELEASE, INDEMNIFICATION AND HOLD -HARMLESS
AGREEMENT (Hereinafter "Agreement") is made and entered into by.and between all record
title holders Apv_,.e- �M oe,and
(hereinafter "Owner(s)') who own the property where the Owner(s) intend to make
improvements and/or perform construction work to tyhhe� Property located at
(hereinafter "Property") and Venture Three, Inc. (hereinafter "Manager") and the designated
Association, Venture Out at St. Lucie, Inc. or Venture Out at Indian River, Inc or
Venture Harbour, Inc. (hereinafter the "Association") and/or the
Committee including the Committee members (hereinafter
"Committee") - (all collectively are hereinafter "the Parties" or singularly "the Party")
STIPULATIONS:
A. WHEREAS, The Owner(s) is making certain improvements and/or construction
work to the Property which is located within the community served by Venture Three, Inc., the
Manager, and within the Association designated herein and;
B. WHEREAS, the Owner(s), to achieve such improvements and/or construction
work to the Property, has or will hire a licensed builder/contractor or the Owner(s) will do the
improvements themselves or with unlicensed workers and;
C. WHEREAS, the Owners plan to achieve the improvement and/or construction work
to the Property as outlined in Form 101 and presented before the designated Committee and;
D. WHEREAS, as a result of the improvements and/or construction work to the
Property, the Owner(s), through their licensed builder/contractor, unlicensed workers or the
Owner(s) themselves will be using some of the common elements/facilities, including but not
limited to roads and water and sewer lines owned and maintained by the Manager and/or the
Association named herein, and;
E. WHEREAS, as a result of the improvements and/or construction work to the
Property, the Owner(s), through their licensed builder/contractor, unlicensed workers or the
Owner(s) themselves may cause damage to the common elements/facilities, including but not
limited to roads and water and sewer lines owned and maintained by the Manager and/or the
Association named herein, and;
c. DAMAGE OR INJURY TO PASSERSBY OR ANY PERSON DAMAGE TO
VEHICLES INCLUDING BUT NOT LIMITED TO PASSENGER VEHICLES BOATS, ETC.
The Owner(s) agree that in the event a licensed builder/contractor, unlicensed workers or the
Owner(s) themselves, or any agent, sub -agent, subcontractor, material supplier, guest,
servant, employee, independent worker, performing said improvements and/or construction
work on behalf of the Owner(s) cause damage or injury to passers-by, or any person,
damage to vehicles, including but not limited to passenger vehicles, boats, etc. the Owner(s)
are completely responsible for any and all injury to passers-by, damage to vehicles, including
but not limited to passenger vehicles, boats, etc.;
d. INSURANCES LICENSES PLANS SURVEYS PERMITS SETBACKS LOCAL
COUNTYAND STATE REQUIREMENTS INCLUDING BUT NOT LIMITED TO
ENVIRONMENTAL REQUIREMENTS INSPECTIONS: The Owner(s) warrant to the
Manager and Association that either the Owner(s), their licensed builder/contractor,
unlicensed contractors who are performing the work on said improvement and/or construction
work on behalf of the Owner(s) carry all proper and required insurances to protect and hold
harmless the Manager, Association named herein, and for any damages to person or thing,
obtain all licenses and permits, plans and surveys, adhere to all setbacks, follow all local,
county and State requirements, including but not limited to environmental requirements and
inspections that are required to perform said improvements and/or construction work on
behalf of the Owner(s) and be financially responsible for same;
e. PROVIDE PROOF OF INSURANCES, LICENSES, AND OTHER DOCUMENTS
TO THE COMMITTEE: The Owner(s) shall, upon request, provide proof of insurances,
including but not limited to, liability insurance, personal injury insurance, medical insurance,
worker's compensation insurance, licenses, permits, surveys, plans and results of inspections
and the Owner(s) warrants that all insurances, licenses and permits will be kept current
throughout the course of the improvement and/or construction work performed by a licensed
builder/contractor, unlicensed workers or the Owner(s) themselves, or any agent, sub -agent,
subcontractor, material supplier, guest, servant, employee, independent worker, performing
said improvements and/or construction work on behalf of the Owner(s) and that all work shall
be finally inspected by the appropriate agency;
J. WHEREAS, the Owner(s), does hereby waive, remise, release, holds harmless
and forever discharge the Manager, the Association, and the Committee and all directors or
unit owners of the Manager, Association and Committee, heirs and assigns, of, from any and
all responsibility and liability and against any and all manner of actions and causes of action,
suits of any kind including but not limited to civil or appellate suits, complaints to
administrative agencies, debts, accounts, bonds, covenants, contracts, agreements,
judgments, claims and demands whatsoever in law and in equity, arising out of or relating to
the improvement and/or construction work done on behalf of the Owner(s) and for any and all
damages to the common elements/facilities, personal injury to passersby or any person;
damage to neighbors or adjacent properties; damage to any vehicles, boats, etc.;
5. Entire Agreement and Successors in Interest. This Agreement and its exhibits
constitutes the entire understanding of the Parties hereto, and no modifications,
amendments, or other statements to this Agreement shall be binding on the Parties
unless executed in writing and signed by the Party to be bound by such instrument. If any
provision of this Agreement is held invalid or unenforceable, such invalidity or
unenforceability shall not affect the other provisions of this Agreement and, to that extent,
the provisions of this Agreement are intended to be and shall be deemed to be severable.
6. Waiver. No delay or failure by either Party to exercise any right hereunder, and no
partial or single exercise of such right, shall constitute a waiver of that or any other right,
unless otherwise expressly provided herein.
7. Effectiveness. This Agreement shall become effective on the date of the signature of
the last party to execution the Agreement.
8. Counterparts. The Parties may;'siqn this°Agreement in„counterparts and faxed oremailed
copy shall be treated as originals admissible as evidence in any administrative or judicial
proceeding.
INTENTIONALLY LEFT BLANK.
ACKNOWLEDGMENTS:
J. , Date;
R AT1VE N B HALF OF MANAGER
- e '7--- 1-- ,
��YL Ce Y Date: r `"
REPRESENTATIVE ON HALF OF ASSOCIATION
Date;
4—
REPRESENTATIVE O BEHALF OF COMMITTEE
PERMIT # ISSUE nDATE
PLANNING & DEVELOPMENT SERVICES
_ -� = Building & Code Compliance Division
LW-61419.1
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
R. Thompson Electric, LLC have agreed to he
(Company Naineindividuai Name)
the Electric Sub -contractor for JWN Builders, LLC
(Type of Trade) --� — (Primary Contractor)
For the project located at�___.__
(project Street Address or property Tax I #)
it is understood that, if there is any chance of status regarding our participation with the above mention,
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
failing of a Change of Sub -contractor notice.
qNWQ0142S1:C_1_t
t liF ( as idler)
James Newman
PRINT ti AME
t q I'S_
COUNTY Y CERTIFICATION 4liV18ER
state ar Florida, Cumnty ar ,��
"lice romping instrument was signed before me this of
Hhn is prM:nowaor aprducd _oa
as idenlirjration.
STA?I ,
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Print asue of o .
FW?fin., tAARIAH MILLS
Commission # GG 109722
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t ,•' Bond;tl The 4oy Fain Insaance 8fl0aBST6?9
Revised IIIIW24ih
(Quatittcr)
Robert Thompson
EC13007306
,,oUN-n1 CERTIFIC-NTION NUMBEI
stale o€ Florida, Count-, of St Lucie
'I'he forrgoinp instrument was signed dxforc me this 25 i)4` of
May zo# by Robert Thompson
11
who is persanatly known J�or has produced a
as identification. t• l J
1 1A ti7� ft E` wr ti,dd
SlgiTurc or'Notary Public
Melissa L Butterfield
1tiat Name ttr S1ilan Puhtic
rQ,YT MN NOWY ?vabkc State c
Melissa L Bulls fu
MY CO?MIMan G 3r3Zv65.
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the
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Name/individual Name)
(Type of Trade)
For the project located at
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
I
Sub -contractor for
(Primary Contractor)
have agreed to be
�Sq(�5-7
(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 Change of Sub -contractor notice.
TCOUNTY ICA' NNUMBER
State of Florida, County of h
The foregoing instrument was signedbefore me thissue day of
2t, by,
who is personally known�_Xr has produced a
as identification.
: al "
STAMP
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Print Name of Notary Public }a,q,d p+;_C5
":%4 GIG 104722
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[tevised 11/16/2016
SUB CONTRA6®R,GNATURE (Qualif;er)
PRINT NAME
COUNTY CERTIFICATION NUMBER(
state of Florida, County #��,
The foregoing instrument was signed before me thi" day of
1G 20 }�y L�?[
Who is personally known _�r has produced a
as identification.
STAMP
4igpatof Notary Pu lic
Print Name of Notary Public
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