The URL can be used to link to this page

Home My WebLink AboutSUBMITTED PAPERSDate: Fee Duey Receip t# 7 TjPermit # • a ; Gj 4 G Planning &Development Services SC ^ r Building & Code Regulations Division B \t- 2300 Virginia Ave. St. LOct Fort Pierce, FL 34982 COUn fy (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ' �umbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: E c d /( A 2. Parcel ID Number: �r11� �(�! �1�/ '� [�� Township Range Map Page Zoning Land Use Initials Office Use Section Oniy ' 3. Complete 4 Owners Inform tion e n 5. Contractors Information Name: Address: �2 City:r , t✓� Cep State: Zip: i L �2- Phone:-7-22 6. Value of Construction: $ FL Reg/Cert #: cp County Cert#: Business Name: 2P ode: Fax: OWNERS AFFIDAVIT: I certify that all of the information contained in this applic is c rrect and that all work will be done in i m lance with all applicable laws regulating construc i • d zo ing. I PRINT OWNER OR CONT CTOR NAME C N��AT.UREOF O OR ONTRACTOR STATE OF FLORIDA,COUNTY OF � l • , y ACKNOWLEDGED BEFORE ME THIS _ DAY OF C 20 BY� .ern y WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED A TTIRNTiFT('ATT(1N� �-. .I S iSO• i�S �':.�I� COMMISSION NUM13LK I 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 Revised 04/26/2010 1 I AUDRE'X B. HUMPHREY MY COMMISSION N EE 061159 .ee EXPIRES: March 6, 2015 N' . o: •�1yq;:•' Bonded thru Notary Public Underwriters Al NOTICE TO OWNER: FAILURE RECORD A NOTICE OF COMMENCEMENT M'_ tESULT 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. EXEMIPT: A/C -HEAT REPLACEMENT WTfH 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. 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 of the 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 plansshowing 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 be 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. F .aLO T?' ;4_ r. Planning & Developmeni_ , vices Department Building & Code Regulations 2300 Virginia Avenue Fort Pierce, Florida 34982 (772)462-1553 - 0WNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT F.S. 489.103 (7) EXEMPTIONS I 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, cone -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 prom de,,11wRgrkers' compensation for that employee, all as prescribed by law. Your construction must comply with all appli}aws, ordinances, building codes, and zoning regulations. Initial �"``'d��"'''��aa� I understand that the building official and inspectors are not there to design or give advice on ho meet the minimum.code. Initial. I understand that as an owner -builder that any contract disputes with sub -contractors and I must b dled in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. I Initial . 11 I understand that if I compensate any person or company for work performed they are requ' be licensed hi this jurisdiction. If for some reason they do not possess a license, I may be. responsible and lia or the cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction r ect- they tray be entitled to workmen's compensation. I could be held liable for. all doctor, lawyer and rel' edical cost, which could include loss of wages during recovery from their injury. Initial I I 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 undeFgtand that any violation of the terms of the owner/builder exemption shall be reported by the Building and Dep to the Florida S Department of Professional Regulation. Signe acknowledged on this day of of 20 I Owner/Builder Signahk STATE OF FLORIDA COUNTY OF The foregoing instr—=ew— was acknowledged before me this � day of C ' 20 ; by 1' YI who is personally known to me, or who has produced �2'A tin A A^ as identification - �- I�y�-� Signature o otary pe or Print Name (Notary (Se) Title- Notary Public ommission Numb r SLUDSD, Revised 07/22/2010 poll �r Mp1{REK AOpRE`I B EE 061159 . ry• MV COM ES. Mach tyy.PlR ola�NPabNCbode... aets gondedlhNN `:Dec 041312:400' pr .1 t 6i Pi e erc'Utilities ,, u thoHty :. "Committed To Rual ty4r 4 A Accou it$ � ,r,• i � i ' � �� .i a � � -x t - ��+� ''%i .1 , �.; '/1• ,':� ', i i l 32t' It it .,.i• i1 } i 1' • �•'i•� 1:,i: :•' y . li: 206 S. 6th Strsef' ra ' r . - 1 I � ..: Fort Pierce, FL 34984-3191 R' .. 1 j a .. :Phdrit'(772)466-1600 , ax 772.467 ( ) -3115 Job;Ld6atlbh:i 149W ELM'AV NUEinvoice Number: ' KA-4¢-13 ''Account Name: • IJOSEPH PAIR JIMY PCN:3404501651104002 Contact Name: IJOSEPH'PqFMY' LoctD:10006027�09075illing'Addlrest: ; 4580 ELM ,., FORT.PIE34982Fax- :Cefl•(772)216-2074.0 , , ust Tyne': Residential }city Lln�;+ nrdcirto -77 De�criptiotli I, 7 Ix °:Water Meter andfor.SerV PP. ijtstallatibn L 3 . $800.00 Water Security Deposit $0.00 Water New Account Setup Charge $40 .00 •Water,Capital ImprovementCharge wfRC'S ' 1.00 $920.50 'Water Acciued Gtaranteed Revenue. CFtarge i '$.0@@//�� -00 //��` ' L; Meter Veriflcation Fees '' $0.00 Wastewater•$ecurity•Deposit { $0:0t) ° 1Nastewater•Kew Account Seiup'Charge Wastewater Capital Improvement Charge WW ERC's 0.00 $0.00 WaslewaterAccrued Guaranteed Revenue Charge $0.00 Lien Fees 0.00 'Construction Cost Estimate ' Fees 0:00'L 'Water and Wastewater AGRC fees On the and of the month; ne� fees wilt Opp good until the and of the month. If not recelved by Down Payment: 0' y. Please contact our office for updated fees, Descriptionfor service order:, tnvoilce Total, _ $1,760.50 = INSTALL 518 X 3A" WATER .METER WISERVICE ' ' + TotaI Paid: +_ / ' �-✓ , N' Date Paid:' 1• ,& �j--•' �%�:,�, t ... h. Chock Number [. Alefmm�re drill Ac ,:a. . Z,. .. t Char is �, •"-, """!,!7" to "ra wdsiewraier pysmm cr wtnln a55 days from date wastewater Con'r�ction Charge paid. - vftchever' is first: The cost the service line from the potntof delWry at the prope^ty line to the hbuse/bulldingis the r�esporgibility of the customer and is not included it this invoice, tate laws require that a permit from the Health Department must be obtained odor to irltiatina a sepjic tank abandonmem• Contact the Health Departm t at (772)873.4931. Constn'icction cost estimates are based gn cui rent labor, equipment and material prices, Actual costs of constriction will be determined at the completion of , the project.' Should unforeseen circuntatan s be encountered during oertstruction, including but not limited to adverse V6aather condition's and, eenstruction conflicts; the customer vrill be responsible for:ncreased costs. Additlona_(eos{s incurred by the customer shall•nat exceed Aileen; 1 (5).,:, percent of the total estimated constructlon co ` shown abcve, Estimated costs paid by the customer that exceed the actual cost of construction will oe re'unded by Fort Pierce Utilities Authority. ; Revie BY: Joyce Easterda Kev Accounts specialist; Date, 311Y13r', Customer's Slgnat'urei ' `Date: Printed Name: i +