HomeMy WebLinkAboutBuiling Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: --A'd a.a a� 2ci
Permit Number: _(
Wit", RECE—IVEE)
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Building Permit Application AUG 2 0 2320 1+
Planning and Development Services
cie County, Permitting J
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:
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Address: t7�•[ L� ✓ r r �� ✓� 3 Cf c1I 4
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
New electrical Meter Second Electrical Meter
Ct3N5TRUCTI0N fNFORNf4TiON Vk
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: 0
' Utilities: _Sewer _Septic Building Height:
Name_ .0 Name:
Address: 3 5 Al tt LJ ✓ ✓" Company:
City: t c �/�-C� —L
- `��� State: /— Address:
Zip Code: Fax:_ City: State:
Phone No. 2(P '7 7 g' 1
ZipCode:
Fax:
E-Mail: cj \ !� vJ -C o"N Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
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 our Notice of Commencement.
Sig ature of Owner/Lessee/Contract as gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA \ STATE OF FLORIDA
COUNTY OF S COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this V\ day of o.O' 2a17, by this day of 20� by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Type of Identification
Produced t Produced
(Signature .4 u lic- (Signature of Notary Public-State of Florida )
MY COMMISSION p GG 022023
*' 0
Commission IF,v; a� Dom"' ' Commission No. (Seal)
n otary Publ a le r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
91ro ILUC M ,: �
O 0 Planning&Development ServZres Department
t`'' • o > • ,• Building&Code Regulation RECEIVED
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553 AUG 2 0 L''M
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEME sTOWNER/BUILDERcie County, Permitting
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.
Initi
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.
nitial 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 codes, and
zoning regulations.
I understand that the building official and inspectors are not there to design or give advice how to meet the
minimum code. �handled
I understand that as an owner-builder that any contract disputes with sub-contractors andcivil
court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial er
I understand that if I compensate any person or company for work performed they are required to be license 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
I understand that if any person that is unlicensed and uninsured gets injured on my cons ion 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. InitiN Herpl
To qualify for this exemption under this subsection, an owner must personally appear,�igntheilding 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 the Florida State Department of Professional Re tion. i and acknowled this
day of of 20_ _
erBuilder Signature
STATE OF FLORIDA
COUNTY OF --">)r. \_,)J< ,e
The foregoing instrument was acknowledged before me this \`� day of 'Z�, ,20 Za ,
by who is personally known to me,or who has
produced iD tr as iden � �1 �EANNA�c + •:: .:. 1IaRlE cIVElr3
�• MY corur~xssioro#cc o22023
P EXPIRES: 16.2020
Signature of Not Type or Print Name of Notary '' .�»tz.• &=W7hru Under***
Title:Notary Public Commission Number G6.e1��.
PLANNINP& DEVELOPMENT SERVICES DEPARTMENT
- Building and Code Regulations Division
2300 VIRGINIA AVE RECEIVED
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
AUG 2 0 --jc:0
AFFIDAVIT OF REQUIREMENT COMPILANCE
[ Residential Swimming Pools, Spa,and Hot In Luci C unt:y, permitting
PERMIT# a'd (1l a�
I(We)acknowledge that a new swimming pool,spa,or hot tub will be constructed or installed at
/3 6 ; �the.0 0 R n► ��e c�, L- , and hereby affirm that one of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515,Florida Statutes: (Please initial the method used for pool.)
. The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F1246-91(Standard Performance Specifications for
Safety Covers for Swimming Pools,Spas,and Hot Tubs).
All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing,self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck.
I understand that not having one of the above installed at the time of final inspection,or when the pool is completed for contract
purposes,will constitute a violation of Chapter 515,F.S.,and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to$500.00 and/or up to 60 days in jail as established in chapter 775,F.S.
I understand that the St.Lucie County Building Inspections Department assumes no liability for the final inspection of one of the
above protective devices,or the lack of maintenance,or the removal of such after the swimming pool has been finalized.
I,the contractor,agree to instruct the owner of the proper use and maintenance of such safety device.
CONTRACTOR SIGNATURE OWNER SIGNATURE __
STATE OF FLORIDA,COUNTY OF STATE OF FLORIDA,COUNTY OF �'T.ux'\q
NOTARY PUBLIC NOTARY PU C
The foregoing instrument was acknowledged before me The foregoing instrument was acknowledged before me
this day of .20 this 6% day of 'A�5 ,20�_
a
by by al`S 'C Jq Jc\
Personally Known or Produced Identification Personally Known or Produced Identification L
Type of Identification Produced: Type of Identification produced:
tip+"•�, DEANNA MARIE GIVENS
MY COMMISSION#GG 022023
y ., EXPIRES:December 16,2020
o Bonded TMu Notary Public Undermitem
SLCPDS Revised 07/22/2014
/fdoa aj�►�. RECEIVED
z AUG 2 0 2020
e,f e e + �-L , LSTLucie County, Permitting
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