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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: _ DATE FILED: a % I PLAN REVIEW FEE: RECEIPT NO.: 1 1 ERMIT NUMBER: CONCURRENCY FEE: , RECEIPT NO.: CERT, CAP. NO.: 1. 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 34982-5652 No F nL Qom-; 7 772-462-1553 v. q ��C S� C4C APPLICATION for BUILDING PERMIT . 0�, CERTIFICATE ®f CAPACITY/ZONING COMPLIANC PROJECT INFORMATION LOCATION/SITE ADE PROJECT NAME:_ PROPERTY TAX ID #: LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT BOOK 9. 10. 6. PAGE NO. - /— ) 3 7. BLOCK NO. 8. LOT NO. PARCEL SIZE (ACRES/SQ FT.): e L Rer, LOT DIMENSIONS: A04 COMPLETEEDESC//RIPTIft Z/�fA/--t 11. SETBACKS (ACTUAL) FRONT: ��� BACK: WORK Sze ncrat-RIGHT SIDE: 1D LEFT SIDE: ZA / 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] . RESIDENTIAL [ ] COMMERCIAL [ ] TRIAL Ill OTHER (SPECIFY) ' 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1st FLOOR: l'a 16. VALUE OF CONSTRUCTION: $��l�. 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 constriction activities. If the valuc;is S2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 6 i OWNER 0WF0 B T!9N � r NAME: ADDRESS: �d `�- CITY: / STATE: ZIP: PHONE (DAYTIME): �( 7y ��v� ! �.h1 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): (_) CONTRACTOR FORMATUGH ST. of FL REG.CERT #: e c::! OU31INZ00 1Nt11v1G. QUALIFIERS NAME: ADDRESS: A - CITY: PHONE (DAYTI ST. LUCIE COUNTY CERT #: �' STATE: l - ZIP: r ife FAX NO:°Za o�;0�'U��Eniail: Qa1btfel�G AKl:tlll/�NlillV�rK: Q/ Q/ �/ - o i ADDRESS: Eno f '9 ilfxw CITY: STATE: PHONE (DAYTIME): ( 3 BONDING COMPANY: ADDRESS: CITY: STATE: ZIP: MORTGAGE LENDER: ski rr9�' ADDRESS: CITY: STATE: ZIP: IM-POitTAN; T 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. i 4 CE ATIFICATI®No 1 ['his application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a. certificate of capacity, f 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 nay be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, kND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. it. 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. Che following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swinmung pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- •esidential 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. VOTICE 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. ATURE STATE OF FLORA STATE OF R COUNTY OF 1- -e,— COUNTY OF The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this A-IiL day of 20 1�, me this I O day of ACLC , 20� by who is personally known or has produced who is personally known or has produced r\ . fl !/' bi nature i n , x VVukLA g EXPIF�ESHUFF Mvco M5sONkEE08 ,_ ComniSSi®n NB0nded7hruNotap�dy�,Aii [VOTE: 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 linptructions sere ap ropraate permit lhecklist. s i '6FFICE USE ONLY BF SECTION TOWNSHIP RANGE Lto MAP NO. 7 �V ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 111990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE ci AREA FEE FEE (RADON) LIBRARY PUBLIC BLD IC BLD PARKS .IMPACT IMPACT FEE IMPACT IMPACT FER GORRE GENERAL t'CHOOL ROAD CREDIT Y N LAW ENF "IMPACT IMPACT IMPACT FEE FEE FEE FIRE/EMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEE VARIANCE FEE FEE SPECIFY MECHANIC ROOF 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 COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE 41-4-13 RECEIVED DATE 043. COMPLETED e INITIALS . DUNK. PhBERGER � engineering & testing, inc. _A Density Test Report Project Name: Spanish Lakes Country Club Village Address: 2 Danzar Project Number: PSL-09-3011 (BG 10.2) Date Tested: 8/30/2012 Technician Initials: Client Name: Wynne Building Corporation Permit No: LC1ZU3:�Q246 8000 South US 1 #402 Port St. Lucie FL 34953 Report Date: 8/30/2012 Project Manager: Dave Youngstrom Attention: Matthew Wynne Contact Number: (772) 343-9787 Test No. Probe Depth (in) z` I#aborator�y Proctor F F I+'leld Tests r Maximum Dry Density (Pcf) Optimum Moisture (%) Dry Density (Pcfl Cone Resistancel (tst) Moisture (%) Minimum Required Compaction (%) Percent Maximum Density (%) Test Results 1 12 113 12 107.3 --- 4.9 95 95.0 Pass. 2 12 113 12 108.1 --- 10.5 95 95.7 Pass 3 12 113 12 108.0 --- 9.6 95 95.6 Pass Type of Field Density Test: r ASTM D 1556 r ASTM D 6938 Minimum Required Compaction Based on: r AASHTO T-180 (ASTM D 1557) Nuclear Gauge Info: Gauge No. 23713 Daily Standard Count: Density: ASTM D 2937 AASHTO T-99 (ASTM D 698) 2471 Moisture: 674 Ke�tu;r N f �S�`3.1\oiv�°£ie' 1 ' B .r �Soll�Type ��?��j5i3�3.1:',�4` 1 n°'-py ` y ; i'Y j Rlevatioh� �!'.._���sax_v�i� 0-12 �"'9 ^�^�" ^$j' q �. J i3`�" Y'�'":t:- Y - +.i �.,V.-...,a. '. j j�'�.: Test'Location Z Danzar; Structura[ Flllt , .� ...3'�v -- �v��>s�..�-_..�.31a �_a.r,: a.2.3.L� x ...�..L_____.�i. � u_wt � .'l-C..��1�= .Ln_��;• Front of house pad (footing subgrade) 2 1 0-12. Center of house pad (slab subgrade) 3 1 0-12 Back of house pad (footing subgrade) 2. We U 3— 0 hpy u x UG Elevation/Depth Referenced to: " I XK"YRi N_..°1T��v t' 1 Structural Fill 2 Final Grading Fill 3 Mass Grading Fill 4 Utility Backfll - Sanitary 5 Utility Backfill - Water 6 Utility Backfill - Storm 7 Compacted Subgrade 8 Stabilized Subgrade 9 Base Course 10 Other: r— NGVD r MSL W Other: Inches below top of final fill cc: Client ... (1) Wynne Building Corp., B. Bailey (field) ... (1) St. Lucie County Building Department ... (1) Xiaoyan Zheng, P.E., PhD FL Registration No. 68330 The original of this report was signed and sealed by the registered engineer in accordance with Rule 61 G15-18011, of the Florida Administrative Code. This report is submitted as the confidential property of our client and authorization for publication of statements, conclusion or extracts from or regarding this report is reserved pending our written approval. No other warranties with regard to subsurface exploration, recommendations or design are expressed by this firm. Fort Lauderdale • Port St. Lucie • West Palm Beach • Sarasota State of Florida Board of Professional Engineers Authorization No. 6870 877.643.6832 3011(10.2) Progress Report PR 32 30-OCT-2012 05:05 FROM:SOUTH,�-7^tST 111/041ZUIxd 12C40 //2041144a CERTIF col PERMIT BUILD lCONMACrnR: PEST COI+ ML CONTRAC I PEST CONTROL LICENSE 4 We, ft urOn4M4 hrreW =0 wAft"rAm"rnit 8 in m=dm 7723446042 SLC li .r Forla IFL 34M 62-16 a 2 F= "340 :A E C��I,� TER�IM 1 ICi,�IDi1 1. TRA u tt INS t+i; 6 F1 ob+0 tta, w o em fiblihifwdt of t* m . of ►:ROL Tobd gtlbm um Daft of mWouneft — 7we arTramm :a �-"Fw"dbAi arhwr /- -.—.P 1i+Wbn" Alta 7MV mret br & cwwpbold/brmtr do,* to rd' I.- +d b+on w arm � � �dlr '+t afraoh Im �iaw�bY ar��! �.a 1'�14�1.�/�r��rl�►�R'v77�bnerit�d►pr,�a`,of � A MfAWa 4WJ*Aftpnr 0 0WArl ;uEfto�ra►nwri�u�'ord�tlb►�r . ffe�.au ar�,w► :m oraraleprt►rm be m�b s# lode nrquk" for the pa bf�ptCl�rtiil br G4, a ftm `�� 4626443 IONS I ,i i THENT ?7v N 9 W i i �aibrd oonab.ud'Ln !br t : or* J � PAGE 01/01 art!moAnn mm*Awand*jvb r� w�l�rcli �pwri�rll�t 71i'l� 7�1�p�1r►�t r elLrr�6r�ohbr� arer •MWNAWr 'WVf Arb�nAr�i .1 ~ Offir Seklarr to be Amd an ccMC_ -S ../ 5 772 Plant:,' Begin Loading: To Job: Arrive Job: Start Unload:" finish Unload:.. Leave ,Job: Return. Plano Customer Code Customer Name Customer Job Number. order'Code I Date: .% M t.s: _ :iS.?# I`','f a . `,s •iitF 4 t, frC `` t` Project PONumber OrderP:O Number , I Project Code PrgjectName I,t"I. S�r'�I 1 tl:t F'7 _ - r c:jls '2 L.1 !'�')'�,'ii 1;i y S t I ee. 1 ,' _.�13.,.' e - _ ,. r _.4 ' Ticket Date; Delivery Address: - _ Map Page: Map/Row/Column: } - Delivery Instructions - - D i �aspatcher }'� X? f e. a°' ...t t'f i $' A, Ticket Number. _ w t t Due OnrJob_ Slump: r _. {'t..i Truck Number s. =t Driver Number: f1.. f.l'. =f F _ Dhver Name: fik 1 .. S i;l..{�_j.7t_P t End Use: yy 7 � ��,�4(� C: LOAD CUMULATIVEORDERED MATERIAL' CODE i PRODUCTION DESCRIPTION QUANTITY QUANTITY QUANTITY 1 r ,,t A M1i; }r V Check it I Auth Code, i iture of Driver Receiving Cash, Nov 12 z - i f, WATERADDED:_ Cash Received: Total COD Order Amount to. Collect Without Standby Charges: - GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: ' SIGNATURE O LOAD WAS TESTED BY: Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any wsteradded is at customers own risk. If water is added on job, connate strength Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation,. CAUTION: Material terms of sale and delivery and accepts concrete as is: Due to important factors which,are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling Information, and to the material safety data sheets for additiorial ihformation. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE: within one business day after the receipt of materials. O 68UNIVERSAL -' r_ r,' ' ('•flri ; )DRiL'.' 0 , lrr! . CUSTOMER 12/13/2012 09:51 77287R79-56 WYNNE BUILDING A RP PAGE 02/04 Professional In.sulators of South Florida FTC Insulation Installation Certificate To: St. Lucie County Date: December 5, 2012 Re: Lot/Block- Address: 2 Danzar Project: The undersigned hereby certifies that insulation has been in4alled in the nhnvp dpeq evhpr1 L Exterior CBS walls have been insulated with: Spray -on Cellulose Thickness in inches: Fiberglass Blankets Manufacturer: N Foil Rock Wool Blankets Density: X Aluminum Foil R-Value: R-4.1 Rigid Board Polystyrene Qther Exterior (frame walls) have been insulated with: Spray -on Cellulose Thickness in inches: Fiberglass blankets Manufacturer: Rock Wool Blankets Density: Aluminum Foil R-Value: Polyurethane Other 2. Ceilings (rear porch) have been insulated with: S ray -on Cellulose Thickness iu inches: 10.25" VibeXglass Blaakets osnuag Rock -Wool Blankets Density: X Fiberglass Blown R-Value: R-30 rICellulose Loose Fill Qtber Ceilings (Vaunted/Catbedral) insulated with: lFiberglass BlanMkels Thickness in inches: Fiberglass Loos Manufacturer: hock Wool Density: X Fiberglass Blow It-Value: Cellulose Loose Other 3. Interior kneewalls have been insulated with- Fiberglass Blankets Thickness in inches: Rock Wool ,Manufacturer: polyurethane Density: Spray -on Cellulose R-Value: REC=Other 4. Garage partition walls of A/C living area have been insulated with: LJEC 1 Rock Wool Blankets Tbickness in inches: 91/2" X Fiberglass Blankets Manufacturer: Fibertech Spray -on Cellulose Density: Polyurethane R-Value: R0 Other 5. The following have beep insulated: CBC1254039 WYIv1nt>~ J31J11 DXNG CORD Competency # Professional l<nsulators•of South Florida, Inc. General Contract/Builder Insulation Contractor ENGINEERING REVIEW BOAT LIFT COMPLIES WITH THE ASCE/SE/ 7-10, MINIMUM DESIGN LOADS INCLUDING WIND LOADS FOR BUILDINGS AND OTHER STRUCTURES, THE 2012 FLORIDA BUILDING CODE AND THE 2010 ALUMINUM ASSOCIATION'S DESIGN MANUAL — SPECIFICATIONS AS REQUIRED BY THE FLORIDA BUILDING CODE. PILINGS: PILING PENETRATION TO BE 10' INTO THE SAND BOTTOM OR 5' INTO ROCK STRATA, SUB —SURFACE CONDITIONS CAN VERY GREATLY, THE CONTRACTOR SHALL VERIFY ALL PILE CAPACITIES. ALL PILINGS TO BE 8" MINIMUM DIAMETER 2.5 C. C. A PRESSURE TREATED WOOD, PRESTRESSED CONCRETE OR COMPRABLE EQUIVALENT. ELECTRICAL REVIEW. 314 HP ELECTRIC MOTOR 10.8 AMPS ® 115V EACH 5.4 AMPS ® 230V EACH QUANTITY- 2 TOTAL WATTS: 2484 THESE PLANS AND ALL PROPOSED WORK ARE SUBJECT TO ANY CORRECTIONS 0 REQUIRED BY FIELD INSPECTORS WHAT -fit° MAYBE NECESSARY 1400�R TO :. COMPLY WITH ALL PLfC,Jj LE. C '5. .:.a, .t ..._. X2 ELECTRICAL REVIEW. — 1-112 HP ELECTRIC MOTOR -- AMPS ® 115V EACH 9.6 AMPS @ 230V EACH QUANTITY.• 2 TOTAL WATTS.- 4416 6, 000 LB. GAL VA GEAR I & & GAL VA GEAR X2 / & // BOA T R. HYDE SCALE. • NTS DATE. 2112113 REV - MIN. SETBACK REQ, FRONT SIDES CNR S S REAR TE NOTE TO EXAMINER. THIS CERTIFIED ENGINEERED DRAWING HAS BEEN PREPARED SPECIFICALLY FOR USE ONLY BY.• °°°°°°� R o a o M o 0 0 6 °q 0000° °0° o C E N .9 a 0 0 � F F o Q' NO.43855 0 op ., •3 - i 2 - Z�:. t 3 � P STATE OF °OOOo°of ooO N A poop0°' °° ROGER SABER P.E. NO.43855 MCR PROFESSIONAL ENGINEERING CA N0. 26W 85M SW KANSAS AVE. STUART, FL 34997 kj PILING MOUNTING TABS MINIMUM (2) 3/B" D/A. LAGBOLTS FR WOOD PILING OR D� "a �'�j�(p CONCRETE ANCHORS FOR OUNTY$UII.1)INGDIMION' CONCRETE PILINGS PER PILING F0 rp�i �N REQUIRED. MINIMUM (A HIN �``�""(Tlry", DIA. BOLT FOR ATTACHING BY ✓ MO UN TING TAB TO 01 / /7 —_ LIFT REQUIRED PER PILING. PERMlf MUST BE KEPT ON JOB ECTION WILL BE MADE. nnD �Q�� BOATLIFTS AND MARINE PRODUCTS 0 4050 SELVITZ ROAD FORT PIERCE, FL 34981 1-800-544-0735 www.hi-tide.com nEsmrno 0 � FILE ✓'� • `ifs `'` ,®-- �� l�l�ia���''�'� Canal wldt% IW-' 10096 ofsfiorelltae to have msngraveshtmmsd, �t> Red andwhXe mangrves wyh a pre -Om helgbf of 1Q-12'Fn©xwlrf ha � ldrmodto a height of 8' as rroftsuredtram the substrate. rrmJng w1.7 be dorm by s profeselonal mangrovs MMMOr. P.—MgO ,10? a fttt r!rtt area fr f Yaasb' �d� f_aterattrimmingmay benaae �� '�x � Proposed 12V12'llft arcs for terminof PDXorm ,¢ for a 32' vessel b�d�t �rN�WW1! �Ytr, Mangrove fringe Max width 10' Y 4' 80� pfopissd 5'.retara wag AdjLcerd o w , .t ..i-- W Y Prano"d rotaiMlrrg woo landward of mangroves. Bob Barn LOI f 0Queen's Road Fort Pierce 100'sharelfro teMg;h .,I-; V-0 a, -A Q • n�S�� O Design 6 DMVIMg by: ,lemar & Assoclinfes, Inc. Emkoonmeelal Consulting 895 NE pixie f,V;y, Stole 103 Jansen Beach, FL 349a7 (581)223-1421 ,r'EriG1l�°! Aajaeenfpro W '��,, 4 pF e scale: I" = 20, Dare. 0111W2 `- °uen� P J `REV: 02 • EV. Y1202 Lydia Galbraith From: Macon, Christina <Christina.Macon@dep.state.fl.us> Sent: Tuesday, March 05, 2013 9:39 AM To: Lydia Galbraith Subject: RE: Question about renewal permits Hello Lydia, Boatlifts (installed or replaced) within an existing slip would be exempt from needing a permit. Thanks! Christina Please take a few minutes to share your comments on the service you received from the department by clicking on this link DEP Customer Survey. From: Lydia Galbraith[mailto:galbraithl@stlucieco.org] Sent: Friday, March 01, 2013 3:59 PM To: Macon, Christina Subject, Question about renewal permits Hello Christina, In 2002 your office issued an exemption permit to construct a seawall and dock with 2 boatlifts, original permit 56- 0193933-001-002. An Army Corp permit was issued as well. The seawall, dock and boatlifts were constructed and installed at that time. The owner is now looking to replace the existing boatlifts. He has the permits from 2002. We are wondering if they can replace the boatlifts without new permits or do they need to apply for FDEP and Army Corp permit. Please let me know. Thanks, t_�0141 -& CiaLbraLth Planning Technician Planning and Development Services Phone: (772) 462-1555 Fax: (772) 462-6448 Email: gal braithl(cDstiucieco.orQ Please Note: Florida has very broad public records laws. Most written communications to or from County officials regarding County business are public records available to the public and media upon request. It is the policy of St. Lucie"County that all County records shall be open for personal inspection, examination and / or copying. Your e-mail communications will be subject to public disclosure unless an exemption applies to the communication. If you received this email in error, please notify the sender by reply e-mail and delete all materials from all computers. Marine Construction and Hold -Harmless Agreement The undersigned Property Owner desires to construct a facility on submerged land owned by .the Queens Cove Property Owners Association in the adjacent waterway of the Owner's Property, utilizing the undersigned Contractor. Both the Owner and Contractor wish to perform this construction as specified in the permits obtained by the Property Owner from the Association. The Owner and Contractor have read and agree to abide by the rules, regulations, restrictions and conditions of the permit(s) issued to the Property Owner. Because the St. Lucie County permit for this construction must be issued to the owner of record of the submerged land on which the facility will be placed, the Association has agreed to seek this permit in partnership with the Property Owner. The Owner and Contractor shall hold the Association harmless from any claims or fines imposed as a result of the marine construction. Property Owner / Name ?479- � ! Address /tom f, Address 2/�g/j�� Lot/Block Signature STATE OF FLORIDA COUNTY OF ST. LUCIE The foregoi instrume t as acknowledged before Pq t 's t —r dU of 201�, by lam: ' CX�IJ who is_�pe�rsonally known to me or produced as identification „',,,,•, ROSEMARIEROBITAILLE tarWCOMMISSION # EE 166658 EXPIRES: June 4, 2016 Bonded Thu NoWy Pulft Undery *,. Notary Public, State of Florida t Commission Expir : _ J For Queens e Propcfrty'Owners Signature SEAL Contractor I l Name 1 Mln kk Address Address License No. Signature STATE OF FLORIDA COUNTY OF ST. LUCIE The foregoing instrument was acknowledged before me this day of F� , 20 , by who is LZpersonally known to me or produced as identification HOLLY BURGESS %31%Vary Public - State of Florida My Comm. Expires Mar 1, 2015 Commission # EE 69484 qF Notary Public, State of Florida My Commission Expires: 1 Title 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 orkers' compensation for that employee, all as prescribed by law. Your construction must comply with all applic laws, ordinances, building codes, and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on how meet the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must 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 requi4 to licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liab cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my constructs roji 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 To qualify for this exemption under this subsection, an owner must personally appear and sign t uilc permit application and initial the above. I hereby acknowledge that I have read and understand the above understand that any violation of the terms of the owner/builder exemption &Zo Department to the Florida State Department of Professional Regulal day of of 20 \3 statement and that I further :ported by the Building and d and acknowledged on this STATE OF FLORIDA COUNTY OF � �,� � L The re o'ng instru ent acknowled ed before me this dayof , 20 by who is personally known to me, or who has produced as identification. ` 1,ne u5F S'ig6t—ur,F of ry Typforlsrint ame of Notary (Seal) Title: Notary P lie Commissi umber SLCPDSD Revised 07/22/2010 MY CO �E(q HUF�'� EXPIREE87.4ON 0 CE083530 Bonded Thrp Not' P11-112 2015 ,�ryPu6fic Urtden,,Ee,s