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Home My WebLink AboutBuilding Permit APP, St. Lucie Co. Annual Lowvoltage Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 7/6/2021 Permit Number: 85vo acui o Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial x Residential 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: Multiple St Lucie Co. Buildings / Projects- Low Voltage Work Property Tax ID #: Site Plan Name: Project Name: Annual Pemit of Low Voltage Work DETAILED DESCRIPTION OF WORK: Lot No. Block No, Annual Permit for Low Voltage work for St. Lucie County IT projects 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 Electric _ Plumbing ( SW Voltage) Total Sq. Ft of Construction: Cost of Construction: $ 50,000.00 Sprinklers (Affidavit required) _ Shutters _ Windows/Doors _ Pond Generator _ Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: Mark Vanson Address: Company: Universal Cabling Systems, Inc. City: State: _ Zip Code: Fax: Phone No. Address: 914 Fern Street City: West Palm Beach State: FT. Zip Code: 33401 Fax: 561-659-6308 Phone No 561-659-6224 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail ryan@ucscable.com or info@ucscable.com State or County License ES12000228 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 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 which is in co 1 ict 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 prope . A Notice of Commencement must be recorded in the public records of St. Lucie County and posted on a jobsite before the first inspection. If you intend to obtain financing, consult with lender or an tto efore commencing work or recording our Notice of Commencement. j Mark Vanson Signature of Own r/ Lessee/Contractor as Agent for Owner STATE OF FLORIDA COUNTY OF Palm Reach Sworn to (or affirmed) and subscribed before me of X Physical Presence or _ Online Notarization this 6th day of July 2021 by Mark Vanson Name of person making statement. Personally Kno OR Produced Identification nti n Produced ;Pre of Notary Public- State o .. Pubevin of Florida (Seal) Commission No. GC249463 o to Mc M 1A My Commission mission y : p My Commission GG 249463 �q M1d Expires 1211412022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev ACORIY CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD YYY) 12/30/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kathleen Bruno NAME: Brown& Brown of Florida, Inc. AHC NNO Ext: (561)686-2266 FFIL,No: (561)686-2313 E-MAIL kbruno@bb-wpb.com ADDRESS: 1661 Worthington Rd Ste 175 INSURER(S) AFFORDING COVERAGE NAICIf INSURERA: Sirius America Insurance Company 38776 West Palm Beach FL 33409 INSURED INSURER B INSURER C Universal Cabling Systems, Inc. INSURER D 914 Fern St INSURER E : INSURER F: West Palm Beach FL 33401 COVERAGES CERTIFICATE NUMBER: Master WC 21-22 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE ADDLSUBR INSD MD POLICYNUMBER EFF MMIDDYIYYYY EXP MM/ODY/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one Person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY EJECT El LOC PRODUCTS COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accitlent $ BODILY INJURY (Per person) It ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accitlent) $ PROPERTY DAMAGE Per accitlent $ HIRED NON -OWNED AUTOS ONLY AUTOSONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYCERIMEETOREXCLUDED? CUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A WC84135 Oi/01/2021 01/01/2022 X STPTUTE ER E.L. EACH ACCIDENT $ 1,000,000 EL. DISEASE - EA EMPLOYEE g 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000.000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN St. Lucie County Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Ave AUTHORIZED REPRESENTATIVE Q Ft. Pierce FL 34982 CORPORATION. All dahts reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� b CERTIFICATE OF LIABILITY INSURANCE DATE(MMDOY YY) 05/10/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sara Douglas NAME: Lassiter -Ware Insurance AICNNo El : (800) 845-8437 AX, No): (888) 883-8680 2701 Maitland Center Parkway E-MAIL Saml)@lassilerware.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAICk Suite 125 INSURERA: National Trust Insurance Co. 20141 Maitland FL 32751 INSURED INSURER B: Owners Insurance Company 32700 INSURER C: North River Insurance Company 21105 Universal Cabling Systems, Inc. INSURER D: FCCI Insurance Company 10178 914 Fern Street INSURER E IN,URERF: West Palm Beach FL 33401 COVERAGES CERTIFICATE NUMBER: 21-22 P&C Rnwl No WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVO POLICY NUMBER P FF MMIDDIYYYY POLICYEXP MMIDDM'YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMSMADE 7x OCCUR R PREMISES Eaoc.mmee 800,aoo MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 A GLI00042196-03 05/11/2021 05/11/2022 GEN'LAGGREGATE UMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 PRODUCTS COMP/OPAGG $ 2,000,000 POLICY [g PRI LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY I NJURY(Per parson) $ X ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY HAUTOS ONLY 95-433044-02 05/11/2021 05/11/2022 BODILY INJURY IPer accident) $ PROPERTY DAMAGE Peraccident $ PIP $ 10,000 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4.000,000 AGGREGATE $ 4.000,000 C X EXCESS LIAB CLAIMS -MADE 5821164459 05/11/2021 05/11/2022 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY YIN ANY PROPRIETORRARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT s (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ If yes, describe under DESCRI PTION OF OPERATIONS below Leased/Rented Egpmnt $ 25.000 D Inland Marine CM10004219703 05/11/2021 05/11/2022 Installation Jobsite Limir $ 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN St. Lucie County Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 2300 Virginia Ave AUTHORIZED REPRESENTATIVE Ft. Pierce FL 34982 I �Q �z„v n 10911 015 All rici rP.sprund ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD Q p w C� i H C @ 4 r _ w o i Z N @ W D m Q N v p � 3 m Q m 7 2 - o = O ' w J v N p N N N U Z p 00 N °� a)N Z 0 d N M N ei O Q LLI LI Z t/i i CV)C M J L LL V w o N w w p GC p J w w N. c p N S LL H G NeN C7 � c L J d o` G ��2 w.= g . cn Q LL p p o 00 Ln Z zza w o LL LU p Q v a w O co �'!� 0 Z < Z Z Z o L LI F- 0 2 w Q J Q Q Lu a H z z J V Q w ;zLU oo NN p Qo > > w u�'� U u Z a v 0 m J H N Z J x> D LL Q U O Q w a N O u LLJ 3 w Z U p v o L1J Q d u l7 F- L LJ w o a @ � N in N v a w 0 LU F- oil W.; A N N E M. G A N N O N P.O. Box 3353, West Palm Beach, FL 33402-3353 **LOCATED AT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel: (561) 355-2264 g14 FERN STREET Serving Palm Bench County Serving you, 0 5 EST PALM BEACH, FL 33401- 18 TYPE OF BUSINESS OWNER I CERTIFICATION# I RECEIPTWDATE PAID AMT PAID I BILL# 23-0012 CW COMMUNICATION & SOUND SYSTEM VANSON MARK & DUBEAU RONALO I ES12000771 I B20.560324 - 08/26/20 $185.85 1 B40113572 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 2020/2021 LOCAL BUSINESS TAX RECEIPT UNIVERSAL CABLING SYSTEMS INC m� UNIVERSAL CABLING SYSTEMS INC 914 FERN ST WEST PALM BEACH FL 33401-5756 Il�ilhllhllldlh�l�llh�ll�llll�ldl�lll11hl�ahl�rl,I,II,I= LBTR Number: 199802439 EXPIRES: SEPTEMBER 30, 2021 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. 0''�` � A NN E M. G AN N O N P,O. Box 3353, West Palm Beach, FL 33402-3353 `*LOCATED AT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel: (561) 355-2264 _ Serving Palm Beach County 914 FERN STREET Serving you. WEST PALM BEACH, FL 33401- 5718 TYPE OF BUSINESS OWNER CERTIFICATION# RECEIPT MATE PAID AMT PAID BILL# 23-0159 COMMUNICATION & SOUND SYSTEM VANSON MARK & OUSEAU RONALD ES12000228 B20560323-08128/20 $27.50 1 B40113573 This document is valid only when receipted by the Tax Collectors Office. UNIVERSAL CABLING SYSTEMS INC m- UNIVERSAL CABLING SYSTEMS INC w 914 FERN ST WEST PALM BEACH FL 33401-5756 Irhll�ll�ll^II��11�11411�IIII�dhP�l61h1111iii1111i1^loir STATE OF FLORIDA PALM BEACH COUNTY 2020/2021 LOCAL BUSINESS TAX RECEIPT LBTR Number: 199802438 EXPIRES: SEPTEMBER 30, 2021 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public.