The URL can be used to link to this page

Home My WebLink AboutSUBMITTED PAPERSDate: S 11, '1�1/ / N Fee Due: Permit # '—�%� , 3 Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 ScgYNED St CUCi@ CCUnt y SPECIALTY PERMIT APPLICATION ❑ Electrical Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/SiteAddress: / 2q CU/,.IrrVee' �a� t o�� Re CO 2. Parcel ID Number: ® 4 � / P �� Fuel -3` 1 f 54s- Office Use Only Section Township Range Map Page Zoning La Use Initials 3. Complete Description of Project or Work: 0 4. Owners Information TOLA-P—r-s-sn_ 5. Contractors Information Name: ru ( FL Reg/Cert #: Address: 4� erg hct r County Cert#: City: State: Business Name: Zip: T'/`7� Phone: ' a t0I Phone: J� �/� 6. Value of Construction: $ �i 0 OWNE S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in i- cm ianceWith �all applicable laws regulat' co ction d zoning. PRI&T O R OR CONTRACTOR ISI T F OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ^ n ACKNOWLEDGED BEFORE ME THIS DAY OF O- - 20�, BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED ® O A�IDF�NTIETCATION. SIGNATURE OF N ARY 1VkT E OR COMMISSION NUMBER `12CLAM HUFF MY COMMfS ON H C-E 835.?0 EXPIRES: aped 12, 20+'. Bonded T�ublic20 NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING- TV►'IEZI-WOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 Revised 04/26/2010 NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000. INSTRUCTIONS Please complete all information in the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The information to be provided with this application includes: 1. Location/Site Address 2. Parcel ID Number 3. Description of Project or Work Activity 4. Owner Information 5. Contractor Information 6. Value of Construction Indicate the street address or general location of property where the building activity is taking place. Indicate the tax identification number of the property where the building activity is taking place. Fully describe the activity to take place. Indicate the name and address of the owner of the property on which�activity is taking place. Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name of the business doing the work. Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the building/construction activity. Construction- value is used to determine the permit fee. 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. ❑ Gas Attach 2 piping schematics with tank size,location, and BTU of each appliance ❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications ❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for new system or full replacement This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications will be accepted .for processing after 4:30 P.M. For assistance in completing this application; please call (772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. NOTE. Emergency electric service change out inspections will not be performed after 3: 00 PM without special arrangements and additional fee paid. Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261. Planning & Development Services Department Building & Code Regulations 2300 Virginia Avenue Fort Pierce, Florida 34982 (772)462-1553 OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT 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 or a commercial building at a cost of under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within one year after the construction is complete, the law will presume that you built or substantially improved it for sale or lease, which is a violation of this exemption. 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. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all appl'c 1 s, ordinances, building codes, and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on ho t eet the minimum code. Initial do un ers tat as anowner-builder that any contract disputes with sub -contractors and I must be hatlftd in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial I understand that if I compensate any person or company for work performed they are required to licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and l abl o t cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction roje - they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate e cost, which could include loss of wages during recovery from their injury. Initial an 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 o 'ng Depar ent to a Florida S Department of Professional Reg t' n igned and acknowledged on this day of of 20 O erBui der ignature STATE OF FLORIDA JJ0. COUNTY OF�3 1 lQr , 20 fore going egoing in trume t w ackn wled ed before me this day of by who is personally known to me, or who has produced _ as identification. Signature of&4otary Type or Print ame of Notary �,aY"� AN E W. HUFF Title: Notary Public Commission umber MYCOMMl3g10lVq r, EE 083530 N •...BondedXThru Nofsry p R ;, Public bddit fifers t..0 SLCPDSD Revised 07/22/2010 Fort Pierce Utilities Autht". !Y ? "Committed To Quality" Key Accounts :.206 S. 6th Street 1 ' 1=ort_P_ierce,-FL_34984-31.91--- - Phone (772)466-1600 Fax (772)465-6984 Job-L-ocatiorr:-- - 1-795 COPENHAVER RD------- - --------------Invoice-Number: - KA-186-12 Account Name: KRYSTAL PATTERSON - " - PCNt 23fi324400020001 -NaKRY_STBL�ER O —_- __ __ - LoED_:rtGGG59-40--2331'F5__ - - --- Billing Address: 1795 COPENHAVER RD FORT PIERCE FL 34945 Phone•. (-1- Fax:_(-)-- _ __ _ __ _ _ ,6ellc (7-72)801='t856==-=Gust-Type=-=Residential-�-City=Limits ==Outside V 5/8 X-3/4" Water Meter and/or Service Installation $800.00 Water Security Deposit $60.00 ___Water-NewAccourlt_Setup-Charge__ __ __ _ _ ._ _ . $40.00 Water Capital- Improvement. Charge. . _ _ W ERC's 1.00 $920.50 'Water Accrued Guaranteed Revenue. Charge $0.00 --- ------ ------114eterA1erifieatjon=Fees $0.00 Wastewater Security Deposit $0.00 Wastewater New Account Setup Charge $0.00 Wastewater-Capital-Improvement-C-harge- - - -- WW ERG's 0.00 $0.00 "Wastewater Accrued Guaranteed Revenue Charge $0.00 Lien Fees 0.00 -- --- &r c#tan Gas � �""" � k� ¢_ 'ra u _ ts�ttmat .�tx� rw 4 � Fee s'� 0.00 0.00 *Water and- Wastewater AGRC fees are good until the end of the month. If not received by the end of the month; new fees will apply. Please contact our office for updated fees. --- ---- -- - - - Description for service order: INSTALL 5/8 X 3/4" WATER METER W/SERVICE, Total Paid: K2 Date Paid: '`� Down Payment: $0.00 - Invoice Total: $1,820.50 Check Number: �lJ Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank abandonment. Contact the Health Department at (772)873-4931. Construction cost estimates are based on current labor, equipment and material prices. Actual -costs -of construction will be determined at the completion of the.project. Should unforeseen circumstances be encountered during construction, including but not.limited-to.adverse weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority. Reviewed By: Joyce Easterday Key Accounts Specialist Date: 12/04/2012 Customer's Signature: Date: Printed Name: