HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
Date: 04/04/17 SCANNE0 Permit Number: lU
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St. Lucre CountvI �b _o L b 4 U
Building Permit Application 7
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 x Residential
PERMIT APPLICATION FOR: Alteration
PROPOSED IMPROVEMENT LOCATION:
Address: 10975 S OCEAN DR
Legal Description: 121741 FROM SWCOROFSECRdl NN DEG 55 MIN41 SEC EALGSLT OF SEC 74.19 FT TO MY RAYAIA.TH N23 DEG 49 MN31 SECWALGSD RA SNM FT FOR POD,
SEC W 199.44 Fr, TH S 89 DEG 56 MIN 22 SEC W 2732 FT, TH S 23 DEG 49 MIN 31 SEC E 199.44 Fr, TH N 89 DEG 56 MIN 22 SEC E 27320 FT TOPOB (1.14 AC) (OR 240-698)
Property Tax ID #: 4512-323-0026-00D-4 Lot No.
Site Plan Name: Block No.
Project Name: CUMBERLAND FARMS, Inc.
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
INSTALL NEW FUEL CANOPY
I CONSTRUCTION INFORMATION: III
1_1HVAC LJ Gas Tank ❑Gas Piping u Shutters ❑ Windows/Doors
DElectric OPlumbing Sprinklers Generator 0Roof Roof pitch
Total Sq. Ft of Construction: 2.5 S Ft. of First Floor:
Cost of Construction: $ Utilities ElSeptic Building Height:
OWNER/LESSEE: p/f1 Vv7 8
CONTRACTOR:
Name CUMBERLAND FARMS, INC.
Name: STEVEN M. NALE
Address:165 FLANDERS RD.
Company: GREAT DANE PETROLEUM CONTRACTORS
City: WESTBORO State: MA
Zip Code: 01581 Fax:
Phone No.508-270-1400
Address: 1330S. ANDREWS AVE
City: POMPANO BEACH State: FL
Zip Code: 33069 Fax:
Phone No. 954-214-4087
E-Mail:ibohn@cumberlandfarms.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: mario@greatdanepetroleum.com
State or County License: CBC045595
If value of construction is $250D or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: NISRSAPPARKHAO.PE
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 1208 E. KENNEDV BLVD. SURE MO
Address:
City: TAMPA State: FL
Zip: 33602 Phone: slaaaa-ano
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of apermit.
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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Cumberland Farms, Inc., Kathleen Sousa, Sr. Pipeline Mgr
STATE OF FJEHtFBA Massachusetts
COUNTY OF Worcester
The or�oing inst ment as acknowledged before me
thi n day of 20 Lby
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 6aoN�P
The for oing instrument was acknowledged before me
this day of V�_uNE 20 / 7 by
�Orm $ ', 54rL/V SMVENM.NALE
(Name of person acknow dging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida.) (Signature of Notary Public- State of Florida )
Massachusetts
Personally Known X ORfiBat - - sonally Known OR Produced Identification
Type of Identification Produ d�Q �ON-@i � T e of Identification Produced
Commission No. I �'4TJW�TM OFh7As7A� I" � �' (Seal)
d �U ommission Expire Co mission No.
January 21. 2022 _ -
Revised 07/15/2014
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