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Home My WebLink AboutSUBMITTED PAPERSFee Due:_ Permit # AID V4. Planning & Development Services Building & Code Regulations Division .2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 //fbl -022-� SPECIALTY PERMIT APPLICATION S Electrical Plumbing ❑ HVAC ❑ Fence S cqN ❑ Shed ❑ Demolition ❑ Gas ❑ Siding �c Seepage 2 for Instructions and additional paperwork required for specialty permits �4hy 1. Location/Site Address:+'? 2. Parcel ID Number: Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Complete Description of.Project or 4. Owners Inform tion , ' 5. Contractors Information Name: FL Reg/Cert #: Address: County Cert#: City: r.,It Qt Stater i Business Name: Zip: 6' v Phone: / /& . / Ione.75Z� �/� Fax: 6. Value of Construction: $ CD OWNER'S AFFIDAVIT: I certify that all of the information contained in this applica ' rrect and that 1 work will be done in / compliance.with all applicable laws regulating d z PRINT wNER OR CONTRACTOR AME % p I OR CONT O STATE OF FLORIDA, COUNTY OF p I ACKNOWLEDGED BEFORE ME THI f DAY OF 20� BY (� WHO IS PERSONALLY KNOWN TO ME OR WHO PRODUCED ussy �fJEJoN leuogeN 46noi41 Pap a ` .�`�ii do ''. AS IFICATION. j ILSLLB 33 # uo!ss!wwo0 ° ll L ioz 'ZZ ieW sauld + � algWoO AW 5• • w� SIG1QtfifURE F OTAR TYPEURA PMT NAME OF NOTARY 7 !J0I3 /o aJeJS . oggnd AJeJoN 3NO1IW NMt/0 o: COMMISSION NUMBER 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 $7500.00 Revised04/26/2010 DAWN MILONE SP UB Notary Public - State of Florida J : : •; My Comm. Expires Mar 22, 2017 41 Commission # EE 877571 ` '�„ Bonded Through National Notary Assn. NOTICE TO OWNER: FAILUR7 -71 RECORD A NOTICE OF COMMENCEMENT Iv" RESULT IN YOUR PAYING TWICE FOR WRO`' NTS TO YOUR PROPERTY. IF: YOU INTENT', OBTAIN FINANCING, FINANCING, CONSULT WITH YOUR LnNj iBR OR AN ATTORNEY BEFORE RECORDING YGoi. NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000. 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 Indicate the street address or general location of property where the building activity is taking place. 2. Parcel ID Number Indicate the tax identification number of the property where the building activity is taking place. 3. Description of Project or Work Activity Fully describe the activity to take place. 4. Owner Information Indicate the name and address of the owner of the property on which activity is taking place. & Contractor Information Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name ofthe business doing the work. 6. Value of Construction 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 he perfonned 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. 03: 22P FROM: ED' ,c�,, -)7�FCTRIC ucr cw cusu sue. is rna � �h 772 467 1359 �s0:4626443 i i i i F.dward Rose1wrry Plane Fxmcirler Building; 1n9p0c40r PtANRUILDING & C ODE. ItEGl1 A56N tt'ICS ?3{Kl Virgi»in Avenge F'L 34982-5652 Ph. (772) 462.1575 Ft. l'Ierc L. Vnx t772) 462-6441 �..va_xtlucieca,orL Rr>Sebta'I'ye�I'wtivaiscs,+�r8_ PAYMENT COUPON /4Li5006400426eDoO27273180007044!i&00DL1065i4ta a,1, t 500,84DD4Z8800D2�TP 3, i BOtsO7tki4E{,®:04000667A6 Please mail Otis poftrf whh vow check i800070445 1 of i AVILINO DONASCIMENTO i= EASY ST PORT PIERCE FL 34982 Flohde?"W & LF( A COMPUY Invoice CuotVmr Naw and Address AVILINO DONASCIMENTO 1603 EASY ST FORT PIERCE FL 34982 Oust No.:6800027273 Inv. Na:i This Involc& mmkil ch.6 Pe9AAA. to FPL In VED Ed umil OWment+to *40"02 0 FPL General total! t%adW MlArAi FL 33108-0001 F@der017alt W.p. ��02477�5 customer !dumber: 611000272733 Invoice Numtwr:/800070445 Ir►voice Date: 0212612014 4,i,1 sao,e4oC-02.eeaeo�i27o.�s000►e4ae,e.oDGbae5a�6 Pease retrin INS 00rt]on for your Words CURRENT CHARGES AND CREDITS customer No: 6000027273 Incite NO; f ROW70445 Description I Amount 0104 PALMETTO, FORT PIERCE 652.46 ` For IngUlrles Contact: Total Amount Due $862 - SHAREKA HAYDEN 772 337.7025 Payn'tnnt Due Upon Rtareipt P.2/3 W vv.L TMAS7' i3tm- il O-VOWWWW ROWU a CPO* DOW= W MPT-W4&, OF"THE ibr� .. .... I � V-XINVI ON ..,.ii 4��.Sat'�nue.,-`'n�}y�t"�k.:Rf�•: � .. Planning & Development Services Department Building & Code Regulations ° • 2300 Virginia Avenue r Fort Pierce, Florida 34982 (772) 462-1553 OWNER/BUILDER 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 gale 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 ' compensation for that employee, all as prescribed by law. Your construction must comply with all appl, 1 , ordinances, building codes, and zoning regulations. Initi I understand that the building official and inspectors are not there to design or give advice on40� the minimum code. Initia I understand that as an owner -builder that any contract disputes with sub -contractors and I must be I understand that if I compensate any person or company for work performed they are requir o licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and li cost of the license. Initi I understand that if any person that is unlicensed and uninsured gets injured on my construction they may be entitled to workmen's compensation. I could be held liable for. all doctor, lawyer and relat cost, which could include loss of wages during recovery from their injury. Initia To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit application and initial the above. I hereby acknowledge that I have read and understand the above disclosure s understand that any violation of the terms of the owner/builder exemption shall be reF Z ' g Depari�i nit - e Florida S t partment of Professional Regulation. Signed L� day of of 20 STATE OF FLORI nt and that I further by the Building and CTjo F O ing ' s n cknowledgeded before me this day o 20s by who is personally kno to me, or who has nmduced'- as idmfification. e o 1, .� mt Name of Notary Title: Notary Public Commission Number DAWN MILONE aYN Notary Public -State of Flori Q My Comm. Expires Mar 22, 20 SLCPDSD Revised 07/22/2010 sNT ; Commission # EE 877571 ��''•F ° °` Bonded Through National Notary As