HomeMy WebLinkAboutExecuted_ATC 5100 Dish MIMIA00633A BPATC 5100 Dish MIMIA00633A Collocation
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
gy. L U lzm
p _ , l � . ." ~ f ~� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5690 Environment Dr., Fort Pierce, FL 34981
Property Tax ID #: 3406-501-0040-000-5
Site Plan Name: ATC 5100 Dish MIMIAOD633A Midway Road
Project Name: ATC 5100 Dish MIMIA00633A Collocation to existing cell tower..
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
ATC 5100 Dish MIMIAOC6333A Collocation to existing cell tower installing (3) Panel Antennas, (3)Sector Frames, Jumpers, (6) RRUs, 110 OVP, (1) Hybrid Cable, (1) Metal
- , (1)
Meter Socket, (1) Fiber Hand Hole. No increase to height of tower. Scope of work will not exceed bounds of compound. See plans for details.
New Electrical Meter . Second Electrical Meter (Affidavit required)
.CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical —Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
X Electric _ Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Dish Wireless, LLC
Name: Paul Scott
Address: 9601 South Meridian Blvd
Company: Engineered Environments, Inc
City: Englewood State: co
Address: 6861 GArden Rd.
Zip Code: 80112 Fax;
City: Riviera Beach State: FL
Phone No. E-
Zip Code: 33404 Fax: 561-282-4115
Mail:
Phone No 561-282-4111
Fill in fee simple Title Holder on next page (if different
E-Mail EEI-PM@eeigc.net
from the Owner listed above)
State or County License CGC061570
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 Appiica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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 grantin 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 your Notice of Commencement.
e /0' 10,
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA; y,
COUNTY OF I't-tCh
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this ItM day of IJCXJ )1WJ11 20�21 by
q�tu l A, SCt--
Name of person mak�in`g statement.
Personally Known y OR Produced Identification
Ty of Identification Produced
ignature of raftot
Nwary ?uMic State d F70t1da
Commission N Stacey QQ��
G 231131
Ex�irea osr2v2n22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21