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HomeMy WebLinkAboutSUBMITTED PAPERSDue: Planning & Developmei it Services Building �`70Building & Code Regulatio s Division t� COUNTY .2300 Virgin i Ave. Fort Pierce, 4 34082 (772)462-1 53 SPECIALTY Electrical ❑ Plumbing ❑ HVAC ❑ Shed ❑ Demolition ❑ Gas Seepage 2 for instructions and addPitional paperwork 1. Location/Site Address: r LG� A 2. Parcel ID Number: SCq St �u By Ft3 cie CoUhtj APPLICATION Fence Siding 3 I a-T® la® //,,, ©© F specialty permits Ptotca F-1- "s-/ Office Use Only Section Township Range Map Page Zoning an se in q uy 3. Complete Description of Projector Work: ' 4. Owners Information d- - �— S. Contractors I Name: %�e�i C� c� del-� FL Re Address: �Q '�C� ��+ `7 County City: /- [�_ _ State: F L' Business Zip: • �J�/ Phone: 7 72 If-3 ffhone: 6. Value of Construction: $ -31Y)_ OWNER'S AFFIDAVIT: I certify that all of the information contained in this ap compliance with all applicable laws regulating constru to, V1e L 5flAto — Z2L PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF STATE OF FLORIDA, COUNTY OF'_ ACKNOWLEDGED BEFORE ME THIS _ DAY OF ^� A� 2Q- WHO. IS PERSONALLY KNOWN TOME OR WH HAS PRODUCE 0AAWME'tA�Y NTIFICATION. NA RTI'COMMISSIOR NOTICE TO OWNER FAILURE TO RECORD A NOTICE OF COMMENT IMPROVEMENTS TO YOUR PROPERTY. IF YOU LENDER OR AN ATTORNEY BEFORE RECORDING Y EXEMPT: A/C HEAT REPLACEMENT WITH CONTRACT UNDE Revised 04/26/2010 l� JlY/ :ems g c.3 Name: anon is correct and that all work will be done n and zoning. OR rY:Z�0004-1C U. F (Seal) ?MENT MAY RESULT IN YOUR PAYING TWICE FOR (TEND TO OBTAIN FINANCING, CONSULT WITH YOUR UR NOTICE OF COMMENCEMENT. $7500.00 1,r eye, ANGEIA M. HUFF S IN COMIMS10111 # EE ON 30 w EXPIRES: Ap6l 12 20, F ." Bonded Thru Notary Pull UndenNriters s NOTICE TO OwNER: - FAr TO RECORD A NOTICE OF CON&MMEME MY RESULT IN YOUR PAYING TWICE FOR HAT, CEMENTS TO YOUR PROPERTY. IF .YOU I1cµ. ,_, ); TO OBTAIN FINANCING; CONSULT WITH" YOU.<;:UNDER 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. I 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 ofthe 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, 23QO Virginia Avenue, Fort Pierce, FL 34982. All permit.applicatioiis,must be filled oifidcompletely 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 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 Se. gi's Department Building & Code Regii�ations ° 2300 Virginia Avenue Fort Pierce, Florida 34982 (772) 462-1553 - OWNERBUILDER AFFIDAVIT F.S. 489.103 (7) E State law requires construction to be done by licensed i exemption to that law. The exemption allows you, as the owner though you do not have a license. You must provide direct, or may build or improve farm outbuildings, a one -family or two -fa under $75,000.00. The building or residence must be for your ( improved for sale or lease. If you sell or lease a building you b one year after the construction is complete, the law will presum or lease, which is a violation of this exemption. You may not h. to supervise people working on your building, it is your respor have licenses required by state law and by county or municipa responsibility for supervising work to a licensed contractor wh Any person working on your building who is not licensed mu., employed by you, which means that you must deduct F.I., compensation for that employee, all as prescribed by law. Your ordinances, building codes, and zoning regulations. I understand that the building official and inspectors are the mininlum.code. STATEMENT mtractors. You have applied for a permit under an if your property, to act as your own contractor even site supervision of the construction yourself. You lily residence or a commercial building at a cost of vn occupancy. It may not be built or substantially ve built or substantially improved your self within that .you built or substantially improved it for sale e an unlicensed person to act as your contractor or ibility to make sure that people employed by you ..licensing ordinances. You may not delegate the is not licensed to perform the work being done. work under your direct supervision. and must be .A. and withholding tax and provide workers' onstruction must comply with all applicable laws, Initial 'o-q-0 to design or give advice on how to eet Initial Q i 4 I understand that as an owner -builder that any contract d sputes with sub -contractors and I must be handled in a civil court with the advice of an attorney. This department wi 11 not mitigate any contract disputes. n Initial I understand that if I compensate any person or comp y for work performed they are required to be licensed in. this jurisdiction. If for some reason they do not posses a license, I may be. responsible and liable for #ie cost of the license. Initial I understand that if any person that is unlicensed and insured gets injured on my construction project - they may be entitled to workmen's compensation. I could be hel liable for. all doctor, lawyer and related medical cost, which could include loss of wages during recovery from their injury. Initial J-. To qualify for this exemption under this subsection, an permit application and initial the above. I hereby acknowledge that I have read and understand understand that any violation of the terms of the owner/builder Zoning DeparftWX to the Florida StateDepartment of Professio of of 20 STATE OF FL A COUNTY OF The oreoing instrument was ackn?v yledged before me this by Ot �p who it pepgnal Signature of Notary Type Title: Notary Public Corm SLCPDSD Revised 07/22/2010 must personally appear and sign the building above disclosure statement and that I finther .mption shall be reported by the Building and Regulation. Signed and acknowledged on this Owner/Builder Signature y .00kS\ , 20\�S known to me, or who has as identification. (Seal) :2���Y p(le,�i Q PI tt GQO�1�'J I MY COMMi�S10 ZB 16 * EXPIRE5: AN' 12, iilerh Sande Thru Notay Putlic Uhdet Planning & Development Service Department Building & Code Regulation Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-1553 Owner Builder Affidavit — DISCLOSURE STA F.S. 489.503 (6) EXED State law requires electrical contracting to be done by licen permit under an exemption to that law. The exemption allows you, electrical contractor even though you do not have a license. You n or a single-family or duplex residence. You may install efectrica construction costs of which are under $75,000. The home or buik may not be built for sale or lease. If you sell or lease more than or after the construction is complete, the law will presume that you b exemption. You may not hire an unlicensed person as your electf according to building codes and zoning regulations. It is your resl you have licenses required by state law and by county or municipal in a liability for you! To qualify for this exemption under this subsection, an ov permit application. I hereby acknowledge that I have read and understai further understand that any violation of the terms of the own Community Developmept Director to the Flo ' State Depar acknowledged on this • day of STATE OF FLORIDA I / c COUNTY OF JJ !� The foregoing instrument was acknowledged before me this day of by V ��_� P. , ''--' , who is personally knc has nroduced Signature of Nary -4 1 Print name of Title: Notary Public Commission Number SLCPDSD Revised 7/23/2010 St. Lucie County Owner Builder Affidavit -Electrical Contracting Contracting ;d electrical contractors. You have applied for a is the owner of our property, to act as your own iy install electrical wiring or a farm outbuilding wiring in a commercial building the aggregate ng must be for your own use and occupancy. It building you have wired yourself within 1 year ilt it for sale or lease, which is a violation of this ,al contractor. Your construction shall be done )nsibility to make sure that people employed by icensing ordinances. Failure to do so may result must personally appear and sign the building the above disclosure statement and that I builder exemption shall be reported by the ent of P fessional Regulation. Signed and 920 )ER SIGNATURE ,20 to me or as identification. M44L((Seal) ANGELA M. HUFF MY COMWSSIOIV # SE 003530 EXPIRES: April Ve y015 Sonded?hru Notary Pubtic UU=mars PLANNING & DEVEL PMENT SERVICES DIVISION BUILDING & COD REGULATIONS DIVISION • 2300 Virginia Ave • --- • •---- Fort Pierce, FL 34982 BUILDING PE IT SUB -CONTRACTOR SU ARY will be sing the following sub -contractors for the (Company/Individual Name) project located at (Street address or Propero Tax ID #) It is understood that if there is any change of status regarding tpartment participation of any of the sub -contractors listed below, Iwill immediately advise the Building and Zoning of St. Lucie County. Trade Name of Company/Contra for St. Lucie County/ State of Florida License Number Electrical Plumbing HVAC/ Mechanical Roofing Gas 4 nFFL("F NF.ONLY: PERMIT r ATE: NUMBER: