HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAil APPLiCABしE INFO MuST BE COMPLETED FOR AP
Date:
g克也岨G肥
正 巳 ⑨ 龍 E 匹)徳一、二二二一二 Buildi
P/。ming ond Development Services
Bui/ding and Code pegu/c,tion Divis;on Co
2300 V/rginio Avenue, Fo万Pierce FL 34982
Phone: 〈772)462-1553 Fax: (772)462-1578 C
しICAT書ON TO BE ACCEPTED
Permit Number:
g Permit AppIication
mercial
DG Funding
Residential X 臆
PERMIT APPLICAT10N FOR:いじ了(久.
PROPOSED IMPROVEMENT LOCATION:
PropertY Tax ID #:
Site PIan Name:
Project Name:
夕s/I- g 一の〆I一 000-0
伽l十SO
DETAiLED DESCRiPTION OF WORK:
NewEiectricalMeter SecondElectrical Meter (A怖davitrequi「ed)
CONSTRUCT10N 1NFORMA丁ION: 音 音 音
AdditionaIworktobe Performed underthispermit ーChecka旧hatappiv:
XMechanical GasTank GasPi ing Shutters Windows/Doo「s Pond
Eiectric Plumbing _Sprinki rs Generator Roof Pitch
TotalSq.FtofConstruction: Sq.Ft.ofFi「StFIoor:
。。St。f。。nSt「uC,,。n.$功57)坦・ Ut亜ies:∴∴Sewer _Septic BuiIdingHeight:_
OWNER/LESSEE: CONTRACTOR‥ I
NameWcc肋[04uで((a/Lhf)(.Avf, し⊥4・ Name‥Fuatnpノ亀-小lCJ生シ月
Add。。SS:#ユOIYつてSC)&dnd子囲O 6砥 音 c。mPa言冊庇寸…山五人J心で.h色・
city‥舶橘Cn勉rfu st。te: 円 Address‥挺f神S溶LDC虞/bvb
zipふ癌、竿柄S弓 Fax: ph。n。N。.S“/b,BsO-雪3轡3 E- citv:†袖手でSo…d Ist詰五 zipC。de‥幾[信号一 F。X‥
Mail:^kfすね.L初uで((a㈹nmrhl・ め PhoneNo|「arS-「「づI「(フ
帥nf。。Simpl。Titl。H#d。言n。XtP養生fdiffe. fromtheOwnerIistedabove) さnt 王_Mai巾九肩Oua正人I心で㈲00I・○○ 巾へ
stat。。rC。u言ty’Li。。nSe仇f2/岳l丁「q「
if vaIue of const「uction is 2与00 or mo「e, a RECORDED Notice of Commencement is required.
If vaIue of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESiGNER/ENGiN駈R: Not Appiica
Name:
Address:
MORTGAGE COMPANY: Not AppiicabIe
Name:
Add「ess:
State:
FEE SIMPしE TITしE HOしDER: Not Applica
Name:
Address:
BONDING COMPANY: Not AppIicable
Name:
Address:
OWN駅I CONTRACTOR A田DVIT: Application is h中ebv made to obtain a permit to do the work and instalIation as indicated.
1 ce面fvthat no work or instaIiation has commenced p「io「 to the issuance of a permit.
罵撥灘富鱗諜盤欝認諾鵠認諾鵠鵠講競露鵜野智r e
ln consideration ofthe granting ofthis requested permit, I do herebv agreethat i wi町n訓respects. perform the work
in accordance with the approved pIans, the日orida Bu肥ng Codes and St. Lucie Countv Amendments.
The fo=owing bu=ding permit appiicatjons are exemptfrom undergoing a fu= concurrencY reView: rOOm additions,
accesso「γ StruCtureS, SWimming pooIs, fences, Wa=s, Signs, SCreen rOOmS and accessory uses to another non-reSidentia血se
WARNING TO OWNER: Your faiiure to Record a Notice of Commencement may result in paγing twice for
藍器謂器器搭謁豊島盤帯等葦嵩f缶詰豊島藍曲譜詰露語
WithIenderor nattomevbeforecommenc干ngworkorrecordingvourNoticeofCommencement.
.卿囲 戒・
輌ureofOwne Essee/ContractorasAgentforOwner
詳解音豊OR臥仙功∩
譜艶措醐醒Cribed薗岩f -如vsICa'P「esenceor On一一neNotarlZation
“▼.i
身命乞^l虐三千宮山IC色うん
Nameofpe「sonmakingstatement.
Person訓yKnown X oRP「oducedldentification
黙諾嗣C三d 肱
SightureofN￣otarYT高"c-St∂teOfF嶋)rida)
c。mmissi。nN。.un腿un10(SeaI)
R亡VIEWS 戸RON丁 i ZONING 」 SUPERVISOR PLANS VEGETAT10N SEATUR丁しE MANGROVE
COUNTER REVIEW REViEW REVIEW REVIEW REVIEW REVI巨W
DATE RECEIVED
DA丁巨 COMPしETED
照evう/ZOIZl
NOTICE FCOMMENC田MENT
thatimprove PropertyTaxIDNo. entwil!bemadetocertajnrealp
lowinginform tionisprovidedintllisNoticeof
dres§請avai量a 廿l。強I血砧S.虹凶で叶
State of Florida, County of St. Lucie
The Undersigれed llereby gives motiee
Chapter 713, Florida Statutes, the foll
Legal De§Cription of prol]erty and ad
r 5ぴ3
aれd in accordaれCe Wさくh
Commencement.
es助川l丁≦ひる
GeneraI description of impI.OVemenls
Owm ern
Address
量れtere§t 三叢籠離脱’緒的読癖工二
Fce Simple Title holder (if other than owner)
Address
Co血書raetor
Addr。SSしl
Address
Am0unt OfBond
Lcn dc「
Address
Persons w融lin the State ofFIol.ida designated by OWne賞・ uPOn Whom notice§ Ol. Other doouments may be §eIVed as provided
by Section 713.13 (a) 7., Florida Statues:
Name Phone #
Address F租x #
In addition to him§elf; owner designates
Phomc # Fax #
to receive a copy oftIle Lienor’s Notice as provided in Section 713.13 (1) (b), FIoI.ida Statutes. Expiration date ofnotice of
COmmenCement is one year from the date of recordi唯unless a d鮒erent date is spec脆ed. WARNING TO OWNER:
ANV PAYMENTS MADE BY THE OWN巳R A干TER THE EXPTRATTON OF THE NOTTCE OF COMMENCEMEN丁ARE CONSTDERED TMPROPER
PAYMENTS UNDER CH.713.13, F.S., AND CAN RESU」T IN YOUR PAYING TW【CE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEM巴NT MUST BE RECORDED AND POSTED ON THE JOB S暮TE BEFORE THE F丁RST INSPECT喜ON.丁F YOU n`rrEND TO OBTATN
FENANCING, ⊂ONSUL丁WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
‡轍一望親妙御坊篭盟。皿二
飢n巳了l
Si郷ia同教γ’s富請IdO書凪:c
霊鳥諾豊藍牲,。ay。也他出 2。皇」b,腫男物〃鱈彪解什,
Type or Print NameOf Notary
Titl。: N。tarv Publi。 C。m血ssi。n Numb。r t出OOしかO lt)
(Seal)
しAUR脂PHIし捕
NotarY Public
State o洋Io「ida
Comm# HHOO6f
Exoi「es 6/3/202ふ
g柾止岨@し直へ
@◎幽開山叢苫田料三宅÷
OWNERIBUILDER AF
F.S. 48
State law requll.eS∴CO皿StruCtion to be done by
exemption to that law. The exemption allows yo
though you do not have a license. You must pl’
Planning & Development Services Department
Buiiding & Code Regulations
2300 VIrginia Avenue
Furt Picrce, Florida 34982
(77Z) 4e2-1553
IDAVIT DISCLOSURE STATEMENT
.103 (7) EXEMPTIONS
1icensed co血actors. You have applied for a pel竜t undel’餌
as the owner of your property, tO aCt aS yOur OWn COntraCtOr eVen
vide direcらOn-Site supervision of the construction yourself You
霊嵩嵩葉書語草詰議書認諾諾岩盤需請書
use or occupancy. You may not build or improve said structures for the purposes of se11ing or leasing that bullding.
You may not hire an unlicensed person to act as your contractor or tO SuPerVise people working on your building; it
is youl. reSPOnSi据ty to make sue that people einployed by you have licenses requうred by state law and by county
Or municipa=icensing ordinances.
工面itうal Hcr圏器If you se11 or lease a building you have built or improved within one year afler construction is comp
presumption is created that jt was built oI・ impl.OVed for sale or lease’Which is a violation of‘this exemption.
書面i書盲aう押ere.
You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed
the work being done. Your constmction must comply with au applicable laws) Ordinances, building code
ZOning regulations. I亜ia! He「e
I understand tha=he building official and inspectors are not thel’e to design or give advice on how t
minimum code. Initial HeI.
COurt W袖山e advice of an at[Omey. This deparment will not mitigate any coIltraC亡disputes.
喜nit盲al Her鍵
I unde一・Stand that ifT compensate any person or company for wo一・k perfomed they are required to be licensed in this
蕊豊On・ If for some reason they do no[ POSSeSS a licenseJ may be responsible and li蕊霊富諾靖the
I understand that if any pcl’SOn that is uulicensed and uninsured gets i中田●ed on my const上皿Ction prqiec
e雨tled to wo正men’s compensation. l could be he漢d吊ab】e for all doctol・, 1avyer and l・e]ated medica圧ost,
COuld include loss ofwages during recovery血om their垂ury. Initial Here.
To qualify for this exemption under this subsection㍉m OWnel. muSt Pel.SOna11y appeal., Sign the building permit
application, and injtial 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 tems of the owner/buildel・ eXemPtうon sha11 be reported by the Bu皿ng and Zoning叢畔富遇Depa血nent of Pl-Ofessional Reg山ation.
UlUR惟『刷ししIPS
Not∂母Pub=c
Sta章e Of日0「id∂
Comm# HHOO6610
巨xロi「es 6/3/2024
巨NelN富岳口INe烏X弼旨●鮒臨M SA膿§ ℃OM肌用INC.
嘉ま00 A眺関珊貫oAD Sし調号1400
仙南帆, G鼻
(770) 351-う00o
Ce巾ificate of Pr duct Rat冒ngs
AHRt Certified Refe「ence Numbe「 : 201 168356
Old AHRI Refe「ence Numbe「 : 7491225
AHRI Type : RCU-A-CB (Sp=t System: Air-Cooied (
Outdoor Unit Brand Name : RUUD
Outdoo「 Unit ModeI Numbe「 (Condense「 0「 SingIe
lndoor Unit Model Number (Evapo「ato「 and/or AI「 Handler) :
Region : SoIItheast and North (A」, AR, DC, DE
IA, lN. KS, MA, ME, Ml, MN, MO. MT,
丁e 「「ito 「i es)
l Unit, Coil with BIower)
RA1 430A」 「
HIP3017STAN
Region Note : Cent昭I ai「 conditioners manufactu「ed申0「tO January l, 2015 are eligible to be insta=ed in a= 「egions
u刷June 30, 2016. Beginning JuIy仁2016 cent「al ai「 condit-One「S can Only be inst訓ed in 「egion(S) fo・
Which they meet the regional efflciency hequl「ement.
Rated as follovrs in accordence with the Iatest edition of AトIRtl21 0/240 with Addendum l - Perfomance Rating of Unitary AiトConditioning
& AiトSource Hcal Pump Equipment and su申ect to 「ath9 aCfuraCy by AHRLsponsore串ndependent岬rd party testing:
Coo廟g Capacfty (A2) - S‘ngle or Hjgh Stage (95F), btuh
SEER : 14.OO
EER (A2)-Single o「High Stage (95F) : 11.OO
†“Active一’ModeI Status are those \hat an AHRi Cermcation Program Pa串ipant is cu「rently producmg AND seIling O「 Offering fo「 saie; OR new modeis th∂t a「e beIng
marketed but a「e not yet being p「oduced:f’「oduction Stopped’Mcrdel Status a「e those that an AHRI Certification Prog「am PartlCipant lS nO Ionge「 p「oduclng BUT is s刷
叢鵜謹詑鵠哩y埋中ロ暗中時n鳴り哩t。十両甲音噂h蕪興崎申町蕪哩W剛性叩頭理事.馳鎚関臆∴、_ 、臆、 ,….′.臆…
謂罵謹r諜…豊捲精薄豊認諾霊鵠器霊器霊蒜霊謹詣需誓書議書諸寄器鵜島。
unallthorl2ed alte′atIon of data llsted on this CertlfIcate. Certmed ratlngs ale Va=d oniy for modeis and con鴫uiatlons =§ted lれthe
directoly at WWW却下ridi『鈍;亡Ony.Org.鼎
AIR.CONDrriONiNG, HEATING,
&=REFRtGEf]ATION INSTITuT∈
Whlc=$ i心ed Qbooe、削d粗e cer湖eete N〇、、 Wh)〇両s l頓ed轡t botto動l晦hし
⑥2021 Al一七〇ndltlon!ng、 He寄tlng. and Refrほeratlon lnstItute CERT肝ICATE NO. : 13278冊駒湖綱64