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Home My WebLink AboutAPPLICATION FOR BUILDING PERMIT CERTIFICATEFP50 DATE FILED: In �� 1 PLAN REVIEW FED— RECEIPT NO.: PERMIT NUMBER: � o tP - Q lavcl CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICIRfi00YfiDT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue OCT 19 2012 Ft. Pierce, FL 34982-5652 �Q 772-462-1553 pEAMITTING ILAx�6UOn-) -I- -� �St Lucie County, FL APPLICATION foYr BUTLDING PE IT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT 1. LOCATION/SITE ADDRESS: SCANNED . BY 2. PROJECT NAME: FP50 SITE PLAN NAME: - V Iarty 3. PROPERTY TAX ID#: i319-yi 9. ' 6j)nn -C7DD - C' 4. LEGAL DESCRIPTION (attach extra sheets if necessary): See .Aikwlied 5. PLAT BOOK 6. PAGE NO. 9. PARCEL SIZE (ACRES/SQ FT.): 7. BLOCK NO. LOT DIMENSIONS: 8. LOT NO. 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Installation of AT&T antennas Cq_�___ at existing telecommunications 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [X] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [xj COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: rp ]eComrrer<nl n i /4Cj / `/ 14. SQ. FT OF CONSTRUCTION: 16. VALUE OF CONSTRUCTION: $ 7st-00 t) 15. SF. FT 1st FLOOR: The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 OWNER INFORMATION NAME: AT&T Mobility Corp. ADDRESS: 5201 Congress Avenue CITY: Boca Raton STATE: FL ZIP: 33487 PHONE (DAYTIME): Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): C__) CONTRACTOR INFORMATION ST. of FL REG.CERT #: CGC061570 ST. LUCIE COUNTY CERT BUSINESS NAME: Engineered Environments Inc QUALIFIERS NAME: Paid A Cron ADDRESS: 7341 Westport Place Unit CITY: West Palm Beach STATE: FL ZIP: 33413 PHONE (DAYTIME): 561 282-4111 FAXNO. (561)282-4115 Email: tsmith@eeigc.net ARCHIT/ENGINEER: Caltrop Telecom ADDRESS: 3400 Lakeside Drive, Suite 525 CITY: Miramar STATE: PHONE (DAYTIME): (� BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ZIP: 33027 ZIP: ZIP: IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it will be voided and returned to you by mail. CERTIFICATION: This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- residential use. NOTICE 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF TIES PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OWNER OR CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF _ PALM BEACH The foregoing instrument was acknowledged before me this 18th day of October 20 12 by Paul A. Scott who is personally known Vor has produced CONTRACTOR SIGNATTIRE STATE OF FLORIDA COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this 18th day of October 20 12 by Paul A. Scott // who is personally known IVor has produced as identification. as identification. Signature of otary PFlorida/Signature of tary �aaY ^oe Notary ublic Slate of Commission No. `O stacey(Sotfobn Commission =Expires c S(&ldjlodda a My CommiWon EE008770 rson N9? �P Expires 0812112014 rion EE008770 OF •'?112014 NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist. OFFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # I' FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP #OFFLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC BLD IMPACT FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF _ ELECTRIC GAS PLUMBING _ NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED EQTTIALS OFFICE USE UNLy: Co DATE FILED: 0 _� aZ PLANREVIEWFEE: 4X-1,0 _Ou RECEIPTNO.:.0 PERMIT NUMBER:/�6 /,36 CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 2. 3. 4. ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue Ft. Pierce, FL 5652 O 6 772.462-15531553 �V APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION LOCATION/SITE ADDRESS: Pam$® NI TC✓'1ZSo Q %,<D PROJECTNAME:_��_�.CS _ SITE PLAN NAME: PROPERTY TAX ID 9: L31 Z j ( Z- " c7'za'O LEGAL DESCRIPTION (attach extra sheets if necessary): SE E' A r1'Ae--�i 5. PLAT BOOKZ-DI_ i� 6. PAGE NO.',) %`9Z 7. BLOCK NO. 9. PARCEL, SIZE (ACRES/SQ FT.):��. LOT DIMENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: e�: 8. LOT SETBACKS (ACTUAL) FRONT: __ BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION -IIZf EXPANSION/ADDITION [ ] INTERIOR RENOVATION f ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 13. DESCRIPTION OF PROPOSED USE: e�--� �,y r"!Xn o; CJ 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1 st FLOOR: p� 16. VALUE OF CONSTRUCTION: $ 11 The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated va!u¢ of construction if it is demonstrated that the submitted figures are not consistent uith similar types of construction activities. I f the saluc is 82500 or more, a RECORDED Notice nfCommencemmt must be submitted with misapplication. SLCCDV Ferm No.: 001-02 UPDATED 625/09 1�Pso OWN RnINFORMATION NAME: AT-� \ �i C io C 11.1 ADDRE S: 5 Zo L.) k U-z 13,C'_C (-L- CITYoCE1 I_ p, STATE: � L- PHONE(DAYTIME): (� 61z& d -0-0- Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BEL( FEE SIMPLE TITLEHOLDER: gRC1 4-% 0 & -R.4" Rrzzlp t Fd ADDRESS: <�5 t�s•�S�_�iu JC. 1,3 CITY: C6'-A Ie RL to STATE: � L_ ZIP 3 `t �� Z PHONE (DAYTIME): (__ \ Ccrnccl2Slt5 �O Q�� CONTRACTOR INFORMATION Qn`� C M 4C& ST. of FL REG.CERT #: C G C OS �L Z L, ST. LUCIE COUNTY CERT #: I 1 BUSINESS NAME: QUALIFIERSNAME: JdPRFB-Z'� boEt ADDRESS: 3Oo4 Zcl''° CITY:B[�AD N 1 O 0 STATE: plc L PHONE(DAYTIME): l(ItU FAX NO. 1 ) 3 1SI03 CPL.-Ti2o ADDRESS:.3 y b O I MLVS mg —A)i2 *---- CITY: Kcg+ atsgL STATE: PHONE (DAYTIME): Ej' I) qJ S 7 I o (, BONDING COMPANY: A) ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: ZIP: S Lf 2-�Qc ,,�� Email: Ub.1K411vilrr "14commuri ZIP: 3 S O Z�- ZIP: ZIP: IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it will be voided and returned to you by mail. CDM 4 • . ' OFFICE USE ONLY BP #: U _ckvD SECTION I TOWNSHIP �� RANGE MAP NO. 2,5iL ZONING LAND I1SE 1 I l ' I LOT CVG % TAZ- NO. FLOOD ZONE FIRM MAP # Is' FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP 9 OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED I REPORT CODEO� HABITABLE AREA RADON FEE PERMIT FEE RADON j� LIBRARY PUBLIC BLD PUBIC BLD PARKS IMPACT IMPACTFEE IMPACT ACT FEE CORRECTION FEE' FEE AL SCHOOL ROAD CREDIT Y N LAW ENIF �IIMPACT IMPAC IMPACT FEE FEE FIRE,/EMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEE VARIANCE FEE FEE SPECIFY MECHANIC ROOF V NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: / REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE 1 DATE i RECEIVED COUN Eli REVIEW RLVI7W REVIEW REVIEW 1V REVIEW REVIEW _ DATE COMPLETED j INITIALS I V s- + CERTIFICATION: This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may he required for ELECTRICAL, PLUMBING, SIGNS,'WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses -to another non- residential use. NOTICE 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. The foregoing instrument was acknowledged before me this; day of byrn �. C who is personally known I_ or has produced Sq-KI'E OF FLO DA f _ COUNTY OF GM a The foregoing instrument was acknowledged before me this IT day ofV`1�20 12— , J by , who is personally known or has produced as identification. as identification. ,..•��•.,,, KATHRYN M. KINNETZ ,.,u,,,KATHRYN M KINNFI Sig at re f to `� `6's Notary Public - a e o orlda • My Comm. Expires Mar 24, 2013 6 S a e f Note ` `' °'� •roe ��,,.; Notary Public -State of F =•, �. - .)• My Comm. Expires Mar 24 Commission N Commis' �'%e'a`0,, (,S'�`j Nah SOD 866922 Notary Assn. Commission No. %� r CoI(Bdai)on # DO 868 ••,,,q... •••,�,.•` onded ThrouA9"n nal . Bonded Through Nalional Nola NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER(BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER(BUILDER APPLICANTS. For specific instructions see appropriate permit checklist.