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OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
PERMIT # 1 -7UO - 0 _2 2-2-
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
REVISINO (772) 462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
7704 Salerno Road Fort Pierce, FI 34951
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
Chimney / Fireplace Repair to be included with Stucco Installation
CONTRACTOR INFORMATION:
STATE ot'FL REG./CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: _
PHONE' (DAYTIME):
OWNERAWILDER INFORMATION:
NAME: Lisa Parker
ADDRESS:7704 Salerno Road
CITY: Fort Pierce STATE: FIL
PHONE (DAYTIME: 772 216 9182
ARCHITECT/ENGINEER INFORMATION:
NAME: Benchmark Engineering of the Treasure Coast LLC
ADDRESS: 806 Delaware Ave
ST. LUCIE CO CERT. #:
FAX:
CITY: Fort Pierce STATE: FL
PHONE (DAYTIME): 772-267-1399 FAX:
SLCC(': 9: 23109
Revised 06 `30i 17
ZIP:
ZIP: 34951
ZIP: 34950
,--NA A
BENCHMARK E-N-E-ONEERTN(i
OF THE TREASURE COAST I.I.C.
806 Delaware Ave. (772) 267-1399
Fort Pierce, FL 34950 benchmarkenaineeringtc@gmail.com
Re: Permit # N/A
Certification of Inspection — Fire Place
Single Family Residence
7704 Salerno Road
Fort Pierce, FL 34951
To Whom It May Concern:
not -daa�
RECEIVED
NOV 0 3 2021
3L Lucfe courny
Plermitting
RF��S�ON
Please be advised that Benchmark Engineering has inspected and approved the structural
elements of the masonry and aesthetic stone fireplace at the aforementioned location.
Although not a FBC 2020 requirement, we recommend that a nearby tree be removed prior to
the utilization of the fireplace due to the close proximity to the flue.
Thank you for your diligence and please feel free to contact me at (772) 267-1399 with any
comments or concerns that you may have.
H U,
Sincerely, CyEN
��'�-
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g I'
_m'�r f Z'
�r ST E OF c
Bowdoin G. Hutchinson Pt00Ile ' 'F�0R0p
j•,., i 11111001"0
Planning & Development Services Department
Lt • e — ° Building & Code Regulations
2300 Virgini u
Fort Pierce, F 4
(772) 4 jx,
OWNER/BUiLDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a pen -nit 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.
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.
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 co , and
zoning regulations. Initial Here.
I understand that the building official and inspectors are not there to design or give advice on how to the
minimum code. Initial Here. �w
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled ip 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 the
license. Initial Here.
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -they nliay be
entitled to workmen's compensation. i could be held liable for all doctor, lawyer and related medical cost,
could include loss of wages during recovery from their injury. Initial Here.
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 b the Building and Zoning
Department to the F orida State Department of Professional Regulati Si led a ackn wledged on this
day of of 20��
ILA( , i, )n
nerBuilder Signature
STATE OF FL IDA
COUNTY OF- � • L j,KA-C
The foregoing 'pLsArurnent was acknowledged before me this _� day ofy , 20 X ``�g11111NN1�����
y who is personally known _X to me, or who has `\��0� ,G .........RC���i��
produc d as identification. �� B.�CN,.•
i
C� 1 I j�, + C`1W 661-
ure of Notary Type or Print Name o�Qtoj}'',,
Titlb: Notary Public Commission Numbed IA
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