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HomeMy WebLinkAboutSUBMITTED PAPERSDate: -I f Fee Due: Receipt# 1 permit # Planning & Development Services CCL ,u; i. i�'f Building & Code Regulations Division . .2300 Virginia Ave. Fort Pierce, FL 34982 3(772)462-155C,(�� _ SPECIALTY PERMIT APPLICATION 4% Co'loty 0 Electrical ❑ Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: S-7 J / 6 (Ar, "x1A Iv 22R r v& 2. Parcel ID Number: Office Use Only Section Township Range Map Page Wing L Use tials ICI 3. Complete Description of Project or Work: ff 0 0 k (A � �D �' / 4. Owners Information C�2(1 h C� S. Contractors Information Name: &0 R bd /i L (7 (;-S 17 () /lJ FL Reg/Cert #: Address: bQ / P� I A n N A N A ,V DKWE County Cert#: City: y, lot c !4C State: Business Name: Zip:9 RZ Phone: 77a- S� g _ �S 19 Phone• 6. Value of Construction: S . ! © D © O OWNER's AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance.with all applicable laws regulating nstruction and zoning. - ��'d .�d'� r/ PRINT OWNER OR CONTRACTOR NAME ' _ SIGNATURE OF`OWNER OR CONTIYACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS _/ DAY OF WHO.IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCED ': IDENTIFICATION. 1' SIGNATURE OF ARY TYPE OR COMMISSION ER AhGEIAIIG;It�,W d "IOU Notary Public Unde ;ari(ers � __,___ 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 -BEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 Revised 04/26/2010 NOTICE TO OWNER: F'1 ` LM TO RECORD A NOTICE OF COMMENCEIN '.` MAY RESULT IN YOUR PAYING TWICE FOR D, NEM RM TO YOUR PROPERTY. IF YOU, L _ AID TO OBTAIN FINANCING;, CONSULT WrrH YUGR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMWT: 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 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 ,propertywhere 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 propeiV on wliioh activity is taking place. 5. 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 plat 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 0 HVAC: Attach 2 residential energy studies, 2'manual-J calculations. 2 sets of duct layouts for new system.or'full replacement " This application cari 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. Foriassistance 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 Services Department Building & Code Regulations 2300 Virginia Avenue 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 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 applicable s, ordinances, building codes, and'zoning regulations. Initia I understand that the building official and inspectors are not there to design or give advice on ho top et the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initia I understand that if I compensate any person or company for work performed they are required to be licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liab foythe cost of the license. Initial r I understand that if any person that is unlicensed and uninsured gets injured on my construction project - they may be entitled to workmen's compensation. I could be held liable for. all doctor, lawyer and relate edjcal 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 statement and that I further understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of % of 20. Owner/Builder Signature STATE OF FLORIDA COUNTY OF The oin . strument vps acknow d before me this day of 20 1--? by who ' rsonally known to me, or who has produced �� as identifi tiop, ` _ Signature o No ype or Print Name of i Totary (Seal) Title: Notary Pu is Commission Number rr: _ SLCPDSD Revised 07/22/2010 My COA41�$S10N HUFF °f 8ondedXP(RES: Al v cl 0 83530 Thru Notary t>ahli U� en niers 3 ° `ST. LUCIE COUNT. UTILITIES - P.O. BOX 728, FT PIERCE; FL 34982 Y I NAME..- - jD6 P .. �� .t9 S .�7 d ",All: St. Luc* County - PCIS 01-07-2014 11:44:55 AccT # " ') `SERVICE 5 i°e d 'V�- 4984/4116 6 ADDRESS LOGS ON, GORDON W. 5701 FORT BUCHANAN DR PIERCE t ' LOT ' BLOCK FL 34982SUBDIVISION . Amount Tendered: 518.00 :LJ,BILLINQADDRESS - Amount Paid: 518.00 Change Due: 0.00 PHONE; # 7 7 J�o7 Q �•� ..MOVE IN/CLOSING DATE Thank YOU This applicatiori hereby; request and authorizes the Utility to render water'and/or sewage disposal i„` servicds..to the premises' described above in accordance with the Utilities present or future rates; rules and regulations, which by reference are made apart of this contract. Applicant agrees to -pay " RDDRIGUEZM the Utility promptly for -such services in'accordance with the established"rules and regulations: User ID: °. "CUSTOMERS DEPOSITS ARE NON NEGOTIABLE, OR TRANSFERABLE - SOCIAL; SEC/ FED ID dJf :3z%— .. SPOUSE SOCIALSEC. L OFFICE USE ON DATE RECEIVED EIVED CASH CHK RECB „