HomeMy WebLinkAboutTriTEL Services Building PermitApplication All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/04/2021 Permit Number:
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 CBDG Funding
PERMIT APPLICATION FOR: Existing Cell Tower l
PROPOSED IMPROVEMENT LOCATION:
Address: 375 E Midway Rol
Property Tax ID#: 1026301 Lot No.
Site Plan Name: Midway Road Block No.
Project Name: Midway Road
DETAILED DESCRIPTION OF WORK:
install new oun ,anon rcinlo rcement. InsLall additional itiona Bolts hctxcccn csisting - )o is on cristin an, e 12g
reinforcements from o —100' Er-E'V. Tristalt additional V- o s between exis ingV 15olts on existing ang e
lea reinfnrcements from —1 20' tn ---140'FT FV All existing equipment, antenna mnynYg gnd transmission lines
to be removed at —99', —151', —233', —262' and—300' ELEV.
New Electrical Meter Second Electrical Meter (Affidavit required)
INSTRUCTION INFORMATION:
f
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: $ 20,000.00 _ Utilities: —Sewer _Septic Building Height: 300'
lNlffJ $, EE: CONTRACTOR.
Name SBA Towers 11 LLC Name: David Paul Betlino
Address: 8051 Congress Ave Company: TriTEL Services Group Inc.
City: Boca Raton State: FL Address: 326 Hurricane Shoals Rd NW
Zip Code: 33487 Fax: City: Lawrenceville State: GA
Phone No. (800)487-7483 E- Zip Code: 30046 Fax: 770-213-3520
Mail: Phone No 770-213-3530
Fill in fee simple Title Holder on next page (if different E-Mail pm@tritelservices.com
from the Owner listed above) State or County License CGC1527943
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.
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 our Notice of Commencement.
Signature of Owner Les ee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Miami-Dade
Sworn to(or affirmed)ands bscribed before me of X Physical Presence or Online Notarization
this 4th day of November ,Zo 21 by
David Paul Bellino
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification ro uced
(Signature of Notary Public-t tate of Florida)
EMPM111
SARA A IAPATA
Commission No. Seal Nota Public-State of FloridaG-G 4 2�11 1l "( ) Commission M GG 927711
y Comm.Expires Oct 29,2023
d through National Notary Assn.
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