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HomeMy WebLinkAboutBuilding Permit App-updated, chg of contr and owner builder 7.30.21PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE no. ® --- - FORT PIERCE, FL 34982 OJs�� (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner, and the new contractor of record for the current permit. A new permit application must also be completed with new contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to commencing any work. There is a $50.00 fee for the Change of Contractor. CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor. The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub - Contractor. CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. 7�j'V Date: 7 / 3d Z Permit Number: �,d 1 � (6 l a Site Address: (:1 ll\-� U State License SLC License Original GC, subcontractor or owner/builder 9 S State License A-)/i�_SLC License// New GC, subcontractor Reason for Cancellation 7 411-A d Or by (d 10 The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of contractor/s bcy ontractor or cancellation of permit. A permit cannot be cancelled if work has been performed. SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME d GZ1 j/ A y�l9Q/ 6A I-L / \� PRINT NAME State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County The following instrument was acknowledged before me this The following instrument was acknowledged before me this -�ay of J w ^�-1.20�, by �V lX wC.� day of 20_ by l� who is personally known to me who is personally known to or who has produced �-L_ `.l7 l., as ID. me or who has produced as ID. Signature of Notary U Date Signature of Notary Date Revised 04/15/16 ,,\AYp�,, ELLEN VAUGHN State of Florida -Notary Public *= Commission # GG 270079 mmission Expires My Co �OFf�O October 22 2022 �lllll 111\\\\ All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n Date: RECENED Permit Number: Ovo EL �-1 Q JUL 0 �021 r�' p St. Lucie County Permitting ,,• r:: p+;.--.C^ 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: Address: Property Tax ID #: Site Plan Name: Project Name: _ 64— �C5— 06 q- dOo% cC761 CQk4rcndlof1 I New Electrical Meter Second Electrical Meter (Affidavit required) R-I", Additional work to be performed under this permit — check all that apply: _Mechanical _ Gas Tank —Gas Piping _ Shutters Electric —Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: !�)) Cost of Construction:$ yP I000. ©y Sq. Ft. of First Floor: Lot No._ Block No. Windows/Doors _ Pond Roof Pitch Utilities: —Sewer —Septic Building Height: s l Name i'iC'&0C 6G�-UC' Name: Address: vo c3nftvC , P, A Company: City: nt a 0_(cc? State: L Zip Code: Fax: Phone No. S — L� Address: City: State: Zip Code: Fax: Phone No E-Mail: Sat p 3 J 6 Fill in fee simple Title Holder on next l4age ( 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. c....,Y4'"i-ID'a6 o�, .Y w+..s d i'T �. +�-` .��- 5_. sy 3-.. y '.S. i+. ,... `=. � k*3i*��,„"' "'"': L .� •_ �Y-_-.§' `�. �'t'. ti't--..�¢41v.,"_ 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 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. Signature of Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORIDAS COUNTY OF Swor to or affirmed) and subscribed before me of this ay of :] I,-— __,.29, by sa\� etw� Name of person making statement. /. Personally Known OR Produced Identification Type of Identification Produced (Signature of N Commission No. Physical Presence or Online Notarization 1� L_ 6\�__ LLB �AUGHN state of Florida -Notary Public Commissi((S�aI)CC 270079. My Commission Expires October_22, 2022 REVIEWS I FRONT ZONING COUNTER REVIEW DATE RECEIVED DATE COMPLETED SUPERVISREVIEWOR I REVIEW I PLANS VREVIEWON I SEATURTREV EWLE I M EVIVE EW O LI Planning & Development Services Department ..-� Building & Code Regulations �U1 2300 Virginia Avenue RiUnO acu�ad Fort Pierce, Florida 34982 Onj 'l$ (772) 462-1553 �ZQZ ® E 7nr OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT ®ZVq03a 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. 5, 6, 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. 5,6. 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. 5-, G I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. Initial Here. s, G 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. 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 the license. Initial Here. ,S_ G 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, which could include loss of wages during recovery from their injury. Initial Here. S 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 owner/builder exemption shall be reported by the Building and Zoning Department to he Florida State Department of Professional Regulation. Signed and a knowledged on this 30 T day of J c, (( of 20 4 � / OwnerBuilder Signature STATE OF FLORID uV `_ rI' COUNTY OF �-� The foregoing instruent was acknowledged bef r me this � d 20�, by C, who is personall ka�., who has ' kz producedVgUG [ om t Florida N NN /'''OFII IIOP�� missio °tart P 1 C\ 1`�L11� My°mm ss o�G �700 Signature of Notary Type or PrinNafte of Notar t0ber 22, 2a�) Title: Notary Public Commission Number - -