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HomeMy WebLinkAboutRevision - 9-9-15OFFICE USE ONLY: DATE FILED: REVISION FEE: 1. 2. 3. 4. PERMIT # RECEIPT # SERVICES qDIVISION 462-1578 APPLICATION FOR BUILD TG PERMIT REVISIONSA PROJECT INFORMATION LOCATION/SITE ADDRESS: Jr 04,-1 Q A-r- DETAILED DESCRIPTION OF PROJECT REVISIONS: . L�Q�41!157 2-4�� y CONTRACTOR INFORMATION: STATE of Fl, REG./CERT. #: ST. LUCIE COUNTY CERT. #: BUSINESS NAME- L=7-z QUALIFIERS NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: PHONE: 5. ARCHITECTIK NAME: ADDRESS: CITY: PHONE (DAYTIME): Revised OV2=014 t T7r,)--l"L5 2:1 STATE: M, �1' XI r NGINEER INFORMATION: 0 WD. troved -> C. OFFICE USE ONLY: DATE FILED: PERMIT # REVISION FEE: RECEIPT # PLANNING & DEVELOP BUILDING & CODE REG 2300VMGINILA FORT PIERCE, F] (772).467,1553 FAQ APPLICATION FOR BU PROJECT 1. LOCATION/SITE ADDRESS: . �f- 00 2. DETAILED DESCRIPTION OF PROJECT REVISIONS: 3. 4. CONTRACTOR INFORMATION: STATE of Fl, REG./CERT. #: ST. LUCIE COUNTY CERT. #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: PHONE: 5. ARCHITECT/E 13,,f2,zj-i rge3- )-&a /- 5u—tz Ir ` : s 11 ON: RMATION: INFORMATI M, W�a ZIP, I u Vl A NAME: v ADDRESS: -oW7 CITY: 4-77-11 - PHONE (DAYTIME): 779— Revised 07/22WH planning & Development SeMces Wilding & Cocks Regulation 19W1200an 2300 v orgirfas Ave Fort Heroe, Fi. 34962 772-462-2172 Fax 772-462- 3 R77FECATE OF TERMITE TREA MENT CoNsTRUCTION SOIL TREATMENT . y en �7L6 qT7 iJt::K1bli a : r.�vv-- J 3liGDDRES ,ns� va6-7 K V UL2� v� tiCI� BUILDER/CONTRACTOR: PEST CONTROL CONTRACTOR: a --� PEST CONTROL LICENSE #: We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: / ©° �6 Chemicals used:. Percentage of solution: t16 -5 Total gallons used: �U5 Date of Treatment: 3 J 5 Time of Treatment: �'y Footing -S:Kl't 1s' Treatment Treatment Re -Treat Re -Treat Driveway Pools ,Ist Treatment 1 Treatment Re -Treat Re -Treat Other Perimeter for Final Inspection 1 Treatment �Ex:r iat0r��� Re-Treat Signature o Note: There must be a completed form for each required treatment or re -treatment and this form must be on the job site to be pfcked up by the Inspector at Lime of each inspec#on or the scheduled Inspection will fall and a re -inspection fee charged. FBC104.2.6 Certificate ofprotective Treatment for prevention oftermites A weatherreslstantjabsite posting board shall be provided to receive duplicate Treatment Cer0cates as each required protective tread nt fi Pl s.Treatment providing a copy for the person the permit is issued to and another copy for the bullding pe Certificate shall provide the product used, identity of the applicator, time and date of the treatment, site location, area treated, chemical used, percent concentration and number ofgallons used, to establish a verifiable record of protective treatment. If the soil chemical baler method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Ludy CoontV requires for the final iruspecdon for CC, a perniiieaWit Sticker to be placed an the electrucal panel box cover, listing moo the treatments ind dates of applications. - Soil Nuclear Gauge Client: Project: Report Date: 8/26/2015 L & C Construction 12-1674.00 %yaaNnno�P. Test Method: ASTM D 6938 2808 Sun Court 10725 South Ocean Drive Port St. Lucie Port St. Lucie, FL 34953 Jensen Beach, Florida FBPE CA # 4930 521 NW Enterprise Drive Port St. Lucie, FL 34986 ,�1— Phone: 772-924-35751 Fax: 772-924-3580/ v' (.' / p S 06 — ©y$� Test Results Test # Retest Of Test Date Proctor ID Method Soil Classification Optimum Moisture N Maximum Dry Density (pcf) In Place Moisture N In Place Dry Density (pcf) Probe Depth (in) Percent Compaction Min/Max Comp. M) Remark 1 8/24/15 P-1 N/A 12.0 105.0 11.4 103.6 12 99 95 / 105 Pass 2 8/24/15 P-1 N/A 12.0 105.0 12.2 102.1 12 97 95 / 105 Pass 3 8/24/15 P-1 N/A 1 12.0 105.0 10.9 102.9 12 98 95 / 105 1 Pass Test Information Test # Test Location Elevation Reference Gauge Make / Model / SN Field Technician 1 Below Slab Grade: Foundation Pad, Northeast Area 0-1 TroxierT3430 22260 Rivera, Angel 2 Below Slab Grade: Foundation Pad, Center Area 0-1 Troxler T3430 22260 Rivera, Angel 3 Below Slab Grade: Foundation Pad, Southwest Area 0-1 Troxler T3430 22260 Rivera, Angel Remarks Comments Related Tests Pass: Tests results comply with specifications Tests are "Direct Transmission" (Method A) unless probe depth is noted as "Backscatter". Gauge calibration data on file with the testing agency. I Test # I Related Test # Test Type ti"tJ19ffdpg®® 0®%�4�0 ��� oA �oOC ENS°• ewe®, 15 o :Dg old W. Moliakr-P.E. `7 ° w ,(� P�ftzss onal-Enginedr #°§_4 7vfa` Stat�f�1ji, 1111111%P `eKo�®°oo Test Reports shall not be reproduced, except in full, without the written approval of GFA International Inc.. Page 1 of 1 PERMIT NUMBER: ADDRESS: CONTRACTOR: D BA: OWNER: NOTICE OF SPECIAL FLOOD HAZARD AREA fi IDE1Lf:I1 10725 S OCEAN DR LOT 4 JENSEN BEACH, JACK S BLAIR L & C CONSTRUCTION INC BRENDA M BALSER NOTICE This Notice is to inform you that your property is in a Special Flood Hazard Area. FILLS C®PV DATE: 8/25/2015 The base flood elevation of the property is 7 feet, NAVD. Federal law requires that a flood zone determination be done as a condition ' of a federally backed mortgage to determine if the structure is in a Special Flood Hazard Area and if so, to require flood insurance. It is up to the lender to determine whether flood insurance is required for a property. NO CONSTRUCTION is to proceed beyond the 1st floor/slab inspection, or just prior to the second floor pour of a multi -story structure, until the required elevation certification has been completed by a registered surveyor, and received and approved by the Building & Code Regulation Division of the St. Lucie County Planning & Development Services Department. 9 Violation of the requirement will result in the scheduling of a public hearing before the St. Lucie County Code Enforcement Board. The Board is empowered to levy a fine not to exceed $250.00 per day for each day the violation continues. A fine not to exceed $500.000 per day may be levied for a repeat violation. The fine may become a lien upon the real or personal property of the iolator. The elevation certification may be submitted any time within 21 calendar days from the above; however, no further construction should take place, nor will any inspections be made until the required certification has been received and approved. Signature Date ALL APPLICABLE NFO if BE CO PLETED FOR APPLICATION TO BE ACCEPTED _ Date: Permit Numre, Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S PROPt35ED IMPROVEMENT LOCATION Address: /6 7a5_ S nC° ,,0940 rf)ZL tkp Ainhf-); Legal Description: Property Tax ID #: 0O8A— o Op7 Lot No. L Site Plan Name: Block No. Project Name: & -(94P& Setbacks Front A—) Back: Back: r�5 Right Side: Left Side: _ 19- l LrJ c:� CQ.NSTRU,CT,I:C1N;lNF(.3RMATIOIV , :,� Ft: `� e g �t o n _ I Aaaltl .nal worK to ne errormea unaer tnis permit— cnecK all apply: RrFIVAC Gas Tank Gas Piping _ Shutters windows/Doors Electric lJ Plumbing Sprinklers 0 Generator _ M.-Roof Total Sq. Ft of Construction: / _700 S�Ftj. of First Floor: XCO . Cost of Construction: $ �� C�, �� Utilities: nSewer Septic Building Height: Name (2-gtQP1S _I. &415,01( J- 15)2e&Z4-M, Address: :3D/ A.S6 City: P / ©u aetz State: jaff Zip Code:g 3 q Fax: Phone No. e((01 �-- 23'7 R6 3V' E-Mail: 8,410 8 WZO RoA4teR,Aw Fill in fee simple Title Holder on next page ( if different from the Owner listed above) ame: k f ( — Company: _/-,I- e— Address: _Plj-oq" Scrod,! City: P S (— State:1�_ Zip Code: SCf 973 Fax: 7 2-3 .3%—C67' Phone No. 772--- 326 �—G/6 / E-Mail: CA" 4teo1 214X /U(? j& �610 f. dg)/M State or County License: C° &C C 7S3e If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I DESIGNER/ENGINEER: _ Not Applicable Name: Do;oJ .i I. i'U_ to l= L._L, a;:. A L Address: 5! LA ill r u e_Z fN l�ilr/ta A�1 �L city: J C4 t— State' a , Zip: '�"��( Phone: 9"�f — Qj— 6t?� FEE SIMPLE TITLE HOLDER: Name: Address: Citv: Zip: Phone: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: ox)/ _Q— Address: iv — City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: _ Address: City:_ Zip: I certify that no work or installation has commenced prior to the issuance of a permit. Phone: 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 your paying twice for improvements to your property. A Notice of Commencement must be recorded 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. Ole i��Y29�"v/ Signatur f Owner/ Agent/ Lessee STATE OF FLORIDA COUNTY OF The f nstr M nt was acknowledge ,ore me this day of 20 /�_ by (Name of pers cknowledging ) (Signature of Not Public- State of Florida ) Personally Known J . OR Produced Identification Type of Identif Commission N �$® Notary Public, I ae�(Florida Commission 7588 My comm. expires July 17, 2017 Revised 07/15/2014 9256er Sign #re of Contractor/License Holder STATE OF FLORIDA COUNTY OF The f, ng instr ent was acknowledged before me this. day of 20=(<by ��4ScoZ_f (Name of person ac nowledging ) (Signature of Notary ublic- State of Florida ) Personally Known OR Produced Identification Type of Identification Produced Comm si�q % KATHY K. GATES Se I) Notary Pub c, fate of Florida Commission i FF 17588 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE I N ITIALS JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT — SAINT LUCIE COUNTY FILE # 4100035 OR B(---- 3776 PAGE 1239, Recorded 08/10/201f- —` 01:33 PM 7 RECEI IT -D qU� 1, 11015 NOTICE OF COMMENCEMENT Permit No. 17 06 _ ID y�i6 Tax folio No. _�1611 6 zny— l State of Florida County of St. Lude The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following IMomration Is provided In this Notice of Commencement. ,_ Pin *and street address Ibavailable) 2t /-blriyo{�tT� Co%y General don 1pelonOFimprovememi:_ _CV S B Fh7 iY A:jy17Q— I Owner InfonFNUon or Lessee infor^wfion If the Lessee trotted for the improvement: Name S IJ PTV Address Interest in property: Npme and address of fee simple titleholder (if different from Owner fisted above); Contractors Name: -f• �rbgJ u` ContractorAddress� � a r,.i„ —T f� S Phone Number 2 �c/ i s' Surety (if applicable, a copy of the payment bond Is attached): Amount of bond: $ Name and address; Phone number. Lender Name;. /%%' ly y Phone Number. Le=5 address: - Penans Within the State of Florida designated by Owner upon whom notices or other documents may be served as provided bySectian 719,19(1) (a)7., Florida S tel: Nome:- Lire) .. J,,.+. Fry6,3. PhonefVumber: 772-3!ri-0/6/ _ Address: i?+y7 C tZ 2495�_ _ In addition to himself or herself, owner designates of to receive a copy of the Uences Notice as provided In Section 713.13(i) (b), Florida Statutes. Phone number of person or entity designated b/ owner; Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final Payment to the contractor, butw11 be 1 year from the detQ of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OFCOMMENCEMENfARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IFYOU INTEND TO OBTAIN FINANGNG, CONSULT W" YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under Penalty of Perjury, I declare that I have read theforegoing notice of commencement and that the facts stated therein are true to the best of My knowledre andhellpe. _ (Signatory's Trde/Offloe) The foregoing Instrument was admovNedged,before me this day of—JqIAA- , 20.(5— ey$i F-ndC, as(St for Name of Type of authority (e g. officer, trustee) Party on behalf of whom Instrument was executed Personally known or produced Identification ( nature of N ary Public - Sta O.S. n1S 1 � ( nt, Type, or Stamp Commissioned• bilc) HEATHER A. WILLIAMS� V L h ype of Identification produced g* * Notary Publla, State of Ohlo My COMMIsSlon Expires 04-01-2020 OF �aanm„ma, LB 3Jdd 0-1 ^ter 9VLL00ET95I 60 ;i 9T91/5L/L0 STATE OF FLORIDA ST, LUCIE COUNTY THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF HE 0 IGINAL. _ 1. dos I - Qe u Clark Weis: AU T 0 2015 MASCHMEYER CONCRETE COMPANY OF FLORIDA, 1142.Water Tower,Road, Lake Park, FL 33403. Phone (561) 848-9112 Fax (561) 844-7102 www.maschmeyer.com 6606 Concrete - GENERAL PROJECT-JM/13 Remit to: Maschmeyer Concrete Company of Florida Drawer #1887, P.O. Box 5935 Troy, MI 48007-5935 CUSTOMER PHONE 772-201-3181 CUSTOMER FAX 772-283-2596 1st CLASS CONSTRUCTION INCORPORATED DATE 09/26/15 INVOICE No 337966 11039 MULLER ROAD CUSTOMER No 648 JOB NO FORT PIERCE FL 34945 PAGE NUMBER 1 ORDER NO 53 DeOVEW ADDr&SS PURCHASE ORDER NUMBER • 10725 S. Ocean Dr DATE QUANTITY MATERIAL PLANT DELIVEREDUNIT TICKET TAXABLE NON TAXABLE SHIPPED NUMBER PRICE EXTENSION EXTENSION 09/26 6.50' 305 3000 PRPM 103 ',857679 $96.00 $624.00 09/26 1.00 ENVIRO ENVIRONMENTA 103 857679 $15.00 $15.00 09/26 1.00 - FUEL SURCHAR 103 857679 $25.00 $25.00 b9/26 6.50' SAT �SATURDAY,DEL 103 857679 $5.00 $32.50 roud Suppo ter of Florida.Concrete Naso.nxy Education Act! y_ Cash o Ck Disc,. $6.97 CAN BE TAKEN IFIPAID PY 10/10/ 5. Pre ax Subtotal: $696.50 TOTAL SALES TAX TOTAL YARDS ,. . $738.29 I ASCHMEYER vi C0110111TI C01411ANY III It1111111A. INC cifiRk'n4wom / FOL5611-1144-71102 7970�@ Scuth'E.li JoNda Division Dlapa W.1-844-9994 I Central Florida Division Dispatch: 407-339-5311 1 . , I Conciste Tested 13 yes LOT A Water Added at CutwtomeffP Cylinders TeMn 13 yes Request gals. to full load' gals. to 213 load to I castamers mep - Waw Aca@ PRPUTnllgt TRllr!kt NOT RESPONSIBLE FOR WARNMI lUnAMON,T.O.THE SJQN AND EYES VARIATION IN for Avold contra wan Oft.. cwmnt powdar or WL:� ADDMONAL WAIN kbollibliq THIS C -EYE,, 0! Ift Jiftivilm Dm SURFACE LO Pw Mb -rcp= 8 jrVC::m X YZ Ml* 66 0 1 away wd P0 r =01-M. OURABM*Vi ADDED 19 - 6m C" vocluft .. 26 Ak G 08 ATC 6 �19 I n\%A I 49C "Eft I 'I W... F a 679 nnvj-%esi�-6APA ]'"ree 71i4r...'15N 0 SCILD m ot CLASS CONSTRUCTION INCOR PA# ker. S. Ocean Dr IMAT I N use CELLS $aVlid Moon " IN" ..j a an son Beach rpIl8S AM pff-- yd!' 1"60 0.00 ENVIRO E00 I RONMENTAL, D I! PO ea 1.00 0.1" 1 a FUEL SURCHARGE &a 6:50 777 ANQU—mm 0.00 SAT 8 W MEMOFRO"Ddama� SATURDAY DELIVER WAR"O - ' /yi. fa wry ME ....'w—pro—orn ow- SMTWAL TAX 5KII'mml uuuiwl 76 GONOM143 bN TOTAL / 5_06 —0'Y2% VA� �a ��G�IV�n AUG 111015 PLANNING & DEVELOPMENT SERVICES BUILDING & CODE COMPLIANCE DIVISION BUILDING PERMIT SUB -CONTRACTOR SUMMARY dolor 14Z4 'L7<«. will be using the following sub -contractors for the (Company/Individual Name) �/ project located at !D7ZsS QC'e&-�t.b?—L&_ j1( , �ti� �� / y-���—�� (Street address or Property Tax ID # It is understood that if there is any change of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical�L`9'��� 73c,O Plumbing 10 8-6 kVE 'Dt-tS-hZ,,Q1 60 HVAC/ Mechanical l)-eh (fcbll F'/'6 5 7 �bS 01;C - 1A PPt Roofing J: Iq . T // r/ \ 3d2 .�iL ( «e i`L q'9'9 Z Gas WFICE USE ONLY PERMIT ISSUE DATE: NUMBER: RECEP "D AUG 11'"'� PERMIT # 5-06 ` &f% ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Florida Certification Number (If applicable): A 0 yJk / t Re-' E-L-E-01-kic1W 6' N69� EC00930 7a have agreed to be the (Co7any Nam eAndividual Name) /2, Sub -contractor for Z, f Q --c- (Type of Trade) (Primary Contractor) For the project located at //V1 (Project Street Address or Property tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNA7S ARE R,rEQUIRED Business Name: «-�y�"�C, ��[ 6,V.r li�� I�� C' Address: 47309 Gall o Ti A_ City/State/Zip: / o&-r S Z,ele . rc::�L, 3 il`l� Phone, 77d-- 9� 70 9/ 71 email: 6 C-V1 WCW10­ If ;rVC-r SIGNATU�& PRINT AME STATE OF FLORIDA, COUNTY OF ` THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS � DAY OF DATE 20 % 5 BY WHO IS PERSONALLY KNOWN OR HAS PRODU AS IDENTIFICATION. C Dorise C. Virgilio SIGNATURE OF NOTARY PfBLIC PRINT NAME OF NOTARY PUBLIC SLCPDS: 08/06/2014 RECER`7.D AUG , 1015 PERMIT # J� _ %„ ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Florida Certification Number (If applicable): a:n_C - have agreed to be the (Company Name/IndiviName) U C YA c v Sub -contractor for L , ra4't'f.'h (yam , - C (Type of Trade) (Primary Contractor) For the project located at J .Lo'—'r_� �CJT (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED �% 1 . ^ 1 Business Name: Address: City/State/Zip: Phone: — 5 A % / email: .)amino-S -7l 9FG—NAiUir PRINT NAME DATE STATE OF FLORIDA, COUNTY OF THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF 1 , 20 BY J GLVY\ WHO IS PERSONALLY KNOWN V OR HAS PRODUCED L%,&.A _dx� SIGNATURE OF NOTARY PUBLIC SLCPDS: 08/06/2014 AS IDENTIFICATION. SABRINA L. BLACK. PRINT NAME OF NOTARY PUBLIC g�� C � \SSIO-�(F'•• OF 195337 ; Qs RECEIVED AUG 1.11015 PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Florida Certification Number (If applicable): 24654 RF11067372 Jensen Beach Plumbing have agreed to be the (Company Name/Individual Name) Plumbing Sub -contractor for L&C Construction (Type of Trade) (Primary Contractor) For the project located at Holiday Out - Lot 4 ID# 4511-501-0006-000-1 (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name: Address: City/State/Zip: Phone: SIGNATURE Jensen Beach Plumbing 1086 NE Industrial Blvd Jensen Beach, FL 34957 772.225.6600 email: net Lonnie Culbertson STATE OF FLORIDA, COUNTY OF Martin ;7IAq DATE THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF / , 20 15 BY Lo n al L &. b4 4- zn WHO IS PERSONALLY KNOWN ✓ OR HAS PRODUCED J �( NATUPtf OF NOTARY PUBLIC PRINT N .SLCPDS: 12/16/2013 AS IDENTIFICATION. JACLY10FANW)SON X /Se F� _ 'r MY COMMISSION #FF159777 OF NOTARY PUBLI EXPIRES November 8, 2018, „ OF M1 •,+ (407) 39MIS3 FloridallotarvSmice-com `RECEI`."7D AUG 1.12015 PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES za� Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number:, O State of Florida Certification Number (If applicable): (Type of For the project located at have agreed to be the Sub -contractor for ` f 0, ebu& & C)0 (Primary Contractor) It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name: Address: 302 M E L T O N 0 R I V E City/State/Zip: F I, P I E R C E FL , 34982 Phone: email: 4z V,41-e lkikh i .19.15 SIGNATURE PRINT NAME DATE STATE OF FLORIDA, COUNTY OF THE FOREGOING I STRUMENT WAS SIGNED BEFORE ME THIS ai DAY OF BY L� -C, WHO IS PERSONALLY KNOWN _� OR HAS PRODUCED r, R n AS IDENTIFICATION. I ` L 11 (STAMP) ATURE OF NOTARY PUBLIC PRINT NAME OF NOTARY PUBLIC SLCPDS: 12/16/2013 KAREN S. NIELSEN Commission # FF 115637 My Commission Expires June 12, 2018 Prepared by and return to: Kacy P. DelBene Steger & Steger, P.A. 603 SW Cleveland Avenue Stuart, FL 34994 772-287-8888 File Number: 15.227 Will Call No.: 27 [Space Above This Line For Recording Data] Warranty Deed This Warranty Deed made this 26th day of June, 2015 between JAY HORST, a married man, whose post office address is 10725 S. Ocean Dr., #462, Jensen Beach, FL 34957, grantor, and DENNIS J. BALSER and BRENDA M. BALSER, husband and wife whose post office address is 301 Ash Dr., Pioneer, OH 43554, grantee: (Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and inconsideration of the sum of TEN AND N0/100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns.,,forever, the following described land, situate, lying and being in Saint Lucie County, Florida to -wit: Lot 4, Block A, HOLIDAY OUT OF AMERICA AT ST. LUCIE, INC., a condominium according to the Declaration of Condominium recorded in OR Book 168, page 1348, together with all amendments thereto, public records of St. Lucie County, Florida. Parcel Identification Number: 4511-501-0006-000/1 Subject to taxes for 2015 and subsequent years; covenants, conditions, restrictions, easements, reservations and limitations of record, if any. Subject land is being conveyed as vacant land. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the ' same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2014. In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTime® `1. C Signed, sealed and delivered in our presence: Witness Name: b if i ess Name: ,4a State of Florida County of Saint Lucie U Quci� c1o±11�s 4cflor rR a (Seal) JAY H T The foregoing instrument was acknowledged before me this 26th day of June, 2015 by JAY HORST, who L] is personally known or [X] has produced a driver's license as identification. [Notary Seal] Notap steyh., KACY P. DEL BENE i Commission # FF D ' 17 ti Expires December 2, 2017 Ban4ad7W'rmyFainlnwrowad003it6Y015' Printed Name: t a, f; IA", My Commission Expires: Warranty Deed - Page 2 DoubleTinnm 1 � e e e • . . 1142 Water Tower Road, Lake Park FL 33403 Office:1-877-484-9994 / Fax:561-844-7102 IF 6(, lJ (�— II South East Florida Division Dispatch: 561-844-9994 / Central'Florida Division Dispatch: 407-339-5311 Concrete Tested ❑ Yes ❑ No LOT # Water Added at Customer's Cylinders Taken F-1 Yes ❑ No Request gals. to full load Comments gals. to 2/3 load gals. to 1/3 load Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with SURFACE DISCOLORATION skin and wash exposed skin areas promptly with water. if any cement powder or CONCRETE WILL REDUCE ITS STRENGTH mixture gets into eyes, rinse immediately and repeatedly with water and get prompt medical attention. Keep children away from cement powder and all freshly mixed AND DURABILITY. ANY WATER ADDED IS AT CUSTOMER'S OWN RISK. BATCH TIME:—' A' cement products, To Job 7p� On Job Begin Pour Begin Wash T.IM TICKET# ORDER # TRUCK # LOAD SIZE MIX SLUMP DATE CUSTOMER # SOLDTO P.O. # PROJECT# DELIVERY ADDRESS ZONE# USE DRIVER INSTRUCTIONS TIME DUE JILT01WANW4 ORDERED PRODUCTCODE PRODUCT DESCRIPTION I.I.O.M. UNIT PRICE AMOUNT ! ! QUANTITY Y C/+ SIGNATURE OR RECEIPT - CONCRETE AND,'ACKNOWLEDGEMENT`OF HAZARD WARNING asc Meyer Concrete gompany will not assume a • i I or any property daftran • equipment damage for any deliveries beyond the curb line. ��I SUB -TOTAL fTAX AUTHORIZED BY I SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL T ; 111 V" 0 C- L i I V 1e;MA GE SUBJECT TO ME FOLLOW ONf)lT10NS-. }omtr-,rj o;-: r4 -,litabie roIdWay f0f- OLI(trucks from the street pa''at,nent to t1he place of deliver�., 0i w,;Itorial rot,--rve tf,,e r ght tcJ stop deflveries until condikions are rerned�ed ar-,d,;nzwch i- - lieikd ie;sponi --ib4ol, any caused thereby cirn, iint 3,1 t&) Cuslorrieror .,ustorper representative's request, amy dwmages indoding TP,r fc t hrrkilP,,",, *m. tl`tja buildings, tre,,�,s, shrubbery, septic tanks and septil-, sysierns, including the drIin &k rr, its 1--li i -nbiar „ e sE;d Colrr�;Dany for I o3s o time and eqdipmeW by roas�c n of suc h dslivery, and a so to and srive ha—fnl,.,ss swku'iCompany from any and all c)airns, demands and suits for or on account of or in arlj ry, nna s-arvices shown have been reccived, that truck tirnes shown are, txxrr,�,, cn, t"t e2� i , U I I I rE 4 ef. custokrier . equest is shcwn correctly. C'Au'noN� The, addition ofwalFr Y ctrfl- tict resufts obtained frorn this io,-�-dof concrete; marty important factorsaffecting ti e jult inate IV, j b; -";?7; tuW`X00C of r,suonsibility and control - ,or cubic yard unloading time is Pxcv(.,,dea ip, �0, -,.- -, ;-10s --. I j 0 I , ou, trucks and tools at �he place of delivery otmM,,iflal. js� N, j -,%,�.v al! arici expelnsuNs of t-,,ollection, including a reasonable attorney's fee, H h:: ,)ii To Pay 1,or loo, ri"oic-01andit'r- i:-i tYO;s involice, avheii t-ue. Past due accounts dre subjectto a 1-1/2% st-i-vice j "'t t,- t TI-1�.� ,osftirnehereby:;cknowledgss receipt of tine complete copy of this crontraa 4 I /Y i� f li i I'I .I111 'll Ir, I' J 4 1142 Water Tower Road, Lake Park FL 3340371 ���'~ b& Office: '1-877-484-9994 / Fax: 561-844-7102 South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch:. 407-339-5311 Concrete Tested El Yes ❑ No LOT # Water Added at Customer's Cylinders Taken E Yes ❑ No Request gals. to full load Comments gals.,to 2/3 load gals. to 1/3 load Customer's Rep - Water Added „ NOT RESPONSIBLE FOR WARNING IRRITATION TO TFfE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water and get prompt medical attention, Keep children away from cement powder and all freshly mixed AND DURABILITY., ANY WATER ADDED IS AT CUSTOMER'S OWN RISK. BATCH TIME cement products: To Job On Job Begin Pour Begin Wash 61111* M-1 s ly H• PLANT- TICKET# ORDEF3 # TRUCK#, LOAD SIZE , MIX ,,,, .,a ; , - I SLUMP DATE , CUSTIOMER # SOLDTO P.O. # TECT# DELIVERY ADDRESS ZONE# , r USE - c bRIVER . INSTRUCTIONS ', TIME DUE iv�L'IMFAIWAMGI-lol:lti-l��PRODUO-Tr CODE PRODUCT DESCRIPTION U.0mm. UNIT PRICE AMOUNT ! ! ! ii t 4 1 7 14 a Orin10 . tI 2015 SIGNATURE OR RECEIPT - CONORETE' AND ACKNOWLEDGEMENT OF HAZARD WARNING asc meyer concrele Company will not assume Haouny Tor any property damage or any equipment damageJat" ant'deliveries beyond the curb line. SUB -TOTAL. ' TAX 7w d AUTHORIZED -By'" SHIPMENT'SUBJECT TO CONDITIONS o ,REVERSE SIDE. TOTAL 'LlaU TH�S DE. �VIADF SU6JECT TO THE FOLLOWING C )ITIONS: cwt�`rnxlr to pmlid e sultable roadway f:x our trucks from trig street pavement to the place of delivery of malterial. ioadviay,> aso not pmvicied, we reserve the rilght tostop deliveries until conditions are remedied and, in such, ever't, Cu!'Iower will be rield resconslbie too" any lo,,-s caused thereby. 2. When fine atthe,oustomer or customer representative's request, any damages including, -,)0 not Jimitzd to, dr;velpjays. buiidings, trees, shrubbery, septic tanks and septic systems. including the draizi fi--Id, rmjr,oCs risk. f 3, no C;,sSlofner agrees k, rei!nbufn5e sak)CompanVfOr loss of time and equipment by reason of such delivery, and also to hcm-mflffy A c lue narrrile-Fs said Conpan, from any and all claims, demands and suits for or on account oforin any mar -1 ner caused by or ansing from priva te drivrevlay delfivM. 4 ",uEufner It �t a; mate .-ia� axl, services shown have been recoivecijhai truck time-,3 shown are correct, arld I thz,! trie an,*unt of watei- c�dd,,3d at the i:;uMornrer's request is shown correctly. CAUTION. The add;bon, of walor aces -or- L 1 - mrale Ili and du,vabiity We at enc,* ruso,,msible for finis-hed re-stiqsnbtained from this load of concrete; many important factors affecting the UtN.;ale Of thc,' rr�rflo;oied job are Dei ond ou �icxps of responsibi ity and contyo! 6. '0 w minutewiii be 6, (ninules per cubic yard unloading firne is exceeded, 4 . -- . � I ) to provids a, nz�-Ifliwle wash down facility for our trucks and tools at the place of delivery of The c„s.lorner hereby pqrc6s 1- -, pay ail costs rand expenses of collection, cluding a reasonable attorneys fee, if he snall f furl to pay to the merchardise reflecled-WINs invoice, when due, Past due accounts are subject to a 1-1/20ilascrvicp --Margo on thij al palfd pazl dus bala ice, The oustomer hereby acknowledges receipt of the complete copy of' tfiis contracl, r 1142 Water Tower Road, Lake Park FL 33403 Office: 1-877-484-9994 / 'Fax: 561-844-7102 South East Florida Division Dispatch:561-844-9994 / Central Florida Division Dispatc�; 407-339-5311 l Concrete Tested ❑ Yes ❑ No LOT # Water Added at Pustomer"s Cylinders Taken ❑ Yes F�j No Request gals. to full load Comments u Is. to 2/3 load 4 a� gals. to 113 load Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water' and get prompt medical attention. Keep children away from. cement powder and all freshly mixed, cement pND DURABILITY. ANY WATER ADDED IS AT CUSTOMER'S 'OWN RISK: BATCH TIME -. products,_ l� 'bL ANT, TICKET#• ORDER '# TRUCK # 'LOAD 517E MIX, ;. i r SLUMP' DATE. 11 TOME t # SOLDTO I. •: I-; . P:O: # PROJECT# DELIVERY ADDRESS ZONE# USE , , DRIVER P INSTRUCTIONS TIME DUE • Y SIGNATURE D WARNING OR RECEIPT - CONCRETE AND ACKNOWLEDGEMENT OF HAZ asc meyer oncre a Company winnot assume ra I rty or; any, property damage or any equiprfient damage for any deliveries beyond th® curb line. ' SUB -TOTAL i - TAX AUTHORIZED BY SHIPMENT SUBJ CT•:TO,CONDITION ON REVERSE SIDE." TOTAL -flS DE -LIVE, 3 NIADE S1.16JECT TO THE FOLLOWIN( NDITIONS. GUSt��ry'lf`r agC``S -.,a projr-C!'a a ,;Uitahle mad,,Ajay for our trucks from the street pavement to the place of de4very of material, if t-,,--h, suitat,3v a rSit park v,dt.,di kw lasprvg�.:,n rj&t to stop deliveries until conditions are remediad and, ;r, �uch vvept, WiN bd nIEAd rosp (;n -J i,T)?p Tvr an V tlosy,, thereby, -luding ,,e- 1-ut sornez or Aisi -omer representative's request. any damages inf, a� 1 ive, ry i 's -,I �.Ztde bc', Y 0 r d; "e (,u �,b n e a tr 0,u, rr:l !;,ratpd, T,�, nvc;wqysbwildlng,7, trees, 4--,hrubbery, septic tanks and septic syferns, incliuding We dmin at 1�15, mvl nsk -eif, t Ya --Corripany for loss of Time and equipment by reason of such delivery, and alsei to- awd save fiorn any ancl, all c!airns, dem,s and suits f6t or on account of or ir, Fny Uv C 7, ah3ii �,,, -,rorn ovivatz,, &Wplvay deliVery, Rq me, "ait a ! a n"- e-rervices shown h a ve been, rece IV ad, ,I i t truck trnes shown a re coi-rect, a nd tfiake,,, at Cust"y"Tier's mquest is shown correctly. CWAIDN: The addition of waler Yduce-, strerqth and &t; Uilslbiidresulvs obtaineOtrorn thk; :'(j of coitcrete; many PmporlantfaGtoi`,: affe,,1X,,f1Lhe LAC rnaw i rf�;sp qi, �,�0'ty end controt, ,1�,l V rl- ccyr a k I r- he �,rooe of k� I dharge *00 kite Fi,,,ter it ,,in .Eyes v-x Cuoic ywJ unloading brn' �46 3 o(cvid,, i,k "i fac!IP!ty 1�)r cur trucks and tools at the place, of fivf�ry of it cafr?. 6 ,vr n-.is by 1c, pay; is s;F< s :� �nd exinense-;- of',Aledion, indludinga reasonable adorney'siee. H hash a!l 4a;, tr r0loy tot t:,Ic rnerchandise, (efiectCA tnis invol w3, WiIe ;r, Past due accounts are sijb,,ect to a I - I r,!% service -"�;ald past d 4 ie h iI t,�4 t -,ce, 1-h; � custo"ne r 'kil owledges roce I pt of the complete py of thS ca,-ttr av;j 1142 Water Tower Road, Lake Park, FL 33403 294895 t, Office: 1-877-484-9994 1 Fax: 561-844-7102 South EA'st Florida Division Dispatch: 561-844-9994 / Centtal Florida D"Mision Dispatch: 407-339-5311 9 Concrete Tested El Yes O'No LOT # Water Added at Customer's Cylinders Taken ❑ Yes F-7l,No Request gals. to full load Comments gals. to 2/3 load ``gals". to 1/3 load Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water and get prompt medical attention. Keep children away from cement powder and all freshly mixed AND DURABILITY. ANY WATER ADDED IS AT CUSTOMER'S OWN RISK. BATCH TIME cement products. 0 -01117;031411 RYQW��� FAM1117ral 77 T ICK T� ORDER #, JTFVCK$, LOAD, SIZESLUMP mix ., DATE CUSTOMER # SOLDTO P1yP.O. 9 _7_71VER DELIVERYADDRESS Al ZONE#-, USE INSTRUCTIONS TIME DUE CUMULATIVE ORDERED PRODUCT CODE PRODUCT DESCRIPTION U.O.M. UNIT PRICE AMOUNT QUANTITY QUANTITY SIGNATURE OR RECEIPT -CONCRETE AND A:CKNOW4LDGEMVNTOF HAZARD WARNING Maschmeyer Concrete Gornpaqy,,will n9t_assume- IIab.JIity for any property damage or any equipment dapage-!2pri,i�OlVeries-gEiibrid the curb line. SUB -TOTAL TAX AUTHORIZED BY SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL TAIS DELHERM.— -:)E SUBJECT TO THE FOLLOWING COP IONS: for our truc'N'S' from tf is street pavement to the place of delivery ol material, '1-tnwaysarp we until conditions are. remeoied and, insuct, for ariv iuss caul-ed 'hcn-rebv. Go! nNine at tharus*nm or or-CUStOrnerrepresentative's request, any damagesincluding, 6�-ivewa','fs' buildinq s, trqos, shrubbery, septic tanks and septic systems, including the du-ic '!Pid, 9w,'t avvrtsrs r'. i I K. C-"!�"'Tminsr agrees To (eia"Ourvot said comnt)any for loss of time and equipment by reason of such defivory, and also to in,Jcro-ifv aad.3av8 hirmless said Gompan,y fro n any and all clalm,3, demaods and suits for or on account of or in any J ts:-aj all tnateriai and services shown, have been received'.'that truck times shown are correct, and an,(,L'?!t C!"Oeter z fti 0 at the ouctorner's request i,,ti shown correctly. CAUTION: The addiflon of water redo(lles CIVI"ne'te strength and durabi0tf, Voatrc nolresp-anl� ible for f%nishod 4e sults obtained from this load of concrete; many important factors affecting th6 Arnatte Qu3llty of V,�P comoleted jon are bay::,nd our scope of responsibility and control. 6,. A '-harge of $'z. 31 P,.-!i- Tni-,:;te ,vJ 11 ba charged after 8 minutes p6r cubic yard unloading time is exceeded. ;k' W, 5 h'C'M' ��ss j s-wtabie, wash down facility for our trucKs and tools'at the place of dplivery of material. c i P. Th,r. r'-is"wcr he"! -by *Igreeto pay Costs and a3tpense5 of collection, including a reasonable attorney's fee, if he shall taii'o payf- r i�a rnerc1andise retiec,' d �rj' T 'j, in i 10 lager'. - hs V0 co, when due. Past due acoounts are subject to a 'I - 1 /2% service �n yew on IhGunpaid past r-lue ibaianca. The customer hereby acknowledges receipt of the complete -copy of this ccnlract, lit i It