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Home My WebLink AboutSUBMITTED PAPERS7 OFFICE USE Y ONLY: l' DATE FILED: z)• D ' 19 • r i' ,- 7 PLAN REVIEW FEE: RECEIPT NO.: - �,� VPERMIT NUMBER: I oZ• L CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 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 SCANNED 772-462-1553 Y St. Lucie (_-cunh', APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION%SITEADDRESS: 2. PROJECT NAME: SITE PLAN NAME: 30 PROPERTY ITAX ID #: 4. LEGAL DESCRIPTION (attach extra sheets if necessary): Legal Description NETTLES ISLAND INC, A CONDO -SECTION II PARCEL 224 ANDPRO-RATA SHARE IN COMMON ELEMENTS (OR 3494-1418 _ - 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. . 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: 10. COMPLETE DESCRIPTI.ON OF CONSTRUCTION PROTPCT OR WORK ACTIVITY: SETBACKS ;(ACTUAL) FRONT: BACK: Ia- RIGHT SID) LEFT SIDE: L2. TYPE OF -CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ ] COMMERC [ ] .INDUSTRIAL OTHER (SPECIFY) 19 C 1F C � tkl zan P DESCRIPTION OF PROPOSED USE: 0-V � -e-A "IN SQ. FT OF CONSTRUCTION: 3'� • a tl S 15. SF. FT 1 st FLOOR: rh 16. VALUE OF CONSTRUCTION: $ IJ U I 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 construction activities. If the valuc':is $2500 or more, a RECORDED Nodcc of Commencement must be submitted with this application. • SLCCDV Form No.:1001-02 UPDATED 6/25/09 NAME: V l e % e `► m ADDRESS:,' CITY: _�p '1!1 �P teC\ STATE: r' I . ZIP: PHONE (DAYTIME): r2 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 INFORMATION ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT #: RTTRTNRSS NAME: QUALIFIERS NAME: ADDRESS: CITY: STATE: PHONE (DAYTIME): (� I FAX NO. Email: ZIP: T/ENGINEER: .-5 0 I t h M c 5^TP R :SS:'115��%"z—ni'�R/'�� 1 �1211>!� 3+�cf �Z P 0 1Z r ,o Iffj � STATE: �)T iZ }} ZIP: i (DAYTIME):..T 3 ? 7a i BONDING COMPANY: ADDRESS: CITY: STATE: ZIP: MORTGAGE LENDER: ADDRESS: CITY: STATE: ZIP: I IMPORTANT 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. 1 1 i 1 CERTIFICATION: - This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if 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 may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. 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. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- residential 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. NOTICE 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. The foregoing instrument was acknowledged before me this _� day of 20A(3 by i CONTRACTOR SIGNATURE m 0 < a STATE OF FLORIDA DCOUNTY OF o N"i w o ' The foregoing instru z c p,m-a M me this d of a by who is personally known or has produced dy-I. as ides fication. i Si ature of N ry who was acknowledged before 20 , known or has produced Signature of Notary as identification. Commission No. (Seal) %I Commission No. (Seal) NOTE: 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 OWNERBUILDER APPLICANTS. For specific intructions see appropriate permit checklist. i OFFICE USE ONLY s BP #: LE) a • 0 Q!FA SECTION TOWNSHIP RANGE MAP NO. ZONING I T ' 0 LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE I OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS 5TORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED i REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE (RADON) LIBRARY PUBLIC BLD PUBIC BLD PARKS IMPACT IMPACT FEE IMPACT IMPACT IEEE CORRECTION FEE FEE GENERAL SCHOOL 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 C LOT OF RECORD FEES REQUIRED PLUMBING FEES i ADDRESSING: DATE SENT TO i REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED 4✓� DATE COMPLETED INITIALS I I I I I i i PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 I FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, rg 62V &r- (Parcel Id#/Legal for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , I acknowledge that as owner of the above described property, and in accordance with Section 7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring adequate drainage so that the immediate community WILL NOT be adversely affected. I further acknowledge that in granting this permit for the development of this property, St. Lucie County is neither obliged nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community. Property Owner Name Please Print) 0 Property Owner Si&atbre STATE OF FLORIDA, COUNTY Date ACKNOWLEDGED BEFORE ME THIS DAY DAY OF, , 20 / BY /TIM 0,9,j-- e—G'S WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED / //�Sy-1- V1..7eTS �11fLL' L.,,_ AS IDENTIFICATION. i COMMISSION NUMBER SLCPDSD Revised 08/24/2010 (SEAL) ,.q•°r'ea�., AUDREY B. HUMPHREY *: MY COMMISSION # EE 061159 EXPIRES: March 6, 2015 �%:;;o' ;'•• Bonded Thru Notary Public Underwriters 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 exemptionto 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 applicable ws, ordinances, building codes, and zoning regulations. Initialb I understand that the building official and inspectors are not there to design or give advice on how o eet the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must b andled 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 be licensed in; this jurisdiction. If for some reason they do not possess a license, I may be responsible and 1 a f- the cost of the license. Initial L I understand that if any person that is unlicensed and uninsured gets injured on my construction broj*ect- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relatedical cost, which could include loss of wages during recovery from their injury. Initial 1 To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit application and initial the above. i 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 __VZonigg of�L•'Department to the Florida Stale ,Department of Professional Regulation. Signed and acknowledged on this G • � of 20 FS. c7 . _X_ "Al-Ld Owner/Builder Sighature STATE OF FLORIDA COUNTY OF C The foregoing in um( by f Title: SLCPDSD Revised 07/22/2010 was 4crqiowlpdged before me this 2�/ day C - , 201,1._, S . who is personally known to me, or who has as identification. Type or DAnt Name of Notary (Seal) Commission Number MWEY , ►iUMPHREY �£ ry M IO # EE 06115`•� s� �? My 0', IS5 oh 015 =*: EXPIRES: Mal public a g dedThNNotaty .ems,