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HomeMy WebLinkAboutSUBMITTED PAPERS16 o OFFICE USE iONLY: ' DATE FILED. PLAN REVIEW FEE: RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER:4W-0)-D7 CERT, CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue 5 C Ft. Pierce, FL 34982-5652 A���� p 772-462-1553 St Lucie CQu�ty APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION I. LOCATION/SITE ADDRESS: `7 S S :: t6,1\ l+ 2. PROTECT NAME t� SITE PLAN NAME: 3. PROPERTY TAX ID #: �J � 20 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: 00 x IC20 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: �rU 2 J 136 F- ©� t�at�c2 �� ��ll t w1�� _1®0 0 ps' i - P If/ br 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. 13. 14. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] RESIDENTIAL [ ] .CO RCIAL [] OTHER (SPECIFY) A�� S to C-F t-r', N c DESCRIPTION OF PROPOSED USE: [ ] INTERIOR RENOVATION [ ] INDUSTRIAL n..,-...r,�i SQ. FT OF CONSTRUCTION: 19 0 0 15. SF. FT 1 st FLOOR: 16. VALUE OF CONSTRUCTION: 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 typos of construction activities. if the valuc is $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 �I 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. OWNER R CONT OR SIG AT CONTRACTOR SIGNATURE 1 STATE OF FLO �, STATE OF FLORIDA COUNTY OF < COUNTY OF The foregoi instrument as a knowledged bef re me thi� day of 2Q by who is personally known or has produced g-AWN MILONE Signature of Notary Notary Public -State of Florida Mar 22.2017 , ; • _ My Comm. Expires Commission No. s : •Sealtommission EE 877571 h National Notary Assn. The foregoing instrument was acknowledged before me this day of by who is personally known Signature of Notary No. , 20 or has produced as identification. (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 P19RSONALLY 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 instructions see appropriate permit checklist. i OWNER INFORMATION NAME: RI) �-Z- d L f� n-*- ADDRESS: 130 i � Ac 0-cc Oflx CITY ,j,Eg ' @I gDNG� - STATE: ZIP: PHONE (DAYTIME): (!9-7? (9 -SS', e'� Email: 16:9ZcJ P -0— Q f',�of At �a% L(;� ��r�' 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: PHONE (DAYTIME): (... ) CONTRACTOR INFORMATION ` ST. of FL REG.CERT #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: STATE: CITY: STATE: PHONE (DAYTIME): (_) FAX NO. ARCHIT/ENGINEER: ADDRESS: CITY: STATE: PHONE (DAYTIME): (� BONDING COMPANY: ADDRESS: CITY: STATE: MORTGAGE LENDER: ADDRESS: CITY: STATE: ST. LUCIE COUNTY CERT #: Email: ZIP: ZIP: ZIP: ZIP: ZIP: 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. S � t OFFICE', USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE I OCCUP TYPE MAX OCCUP 1 # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT -FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC BLD IMPACT FEE GENERAL PARKS IMPACT FEE ;SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE s ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED INITIALS 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 laws, ordinances, building codes, and zoning regulations. Initial I — I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. Initial s l_ 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. Initialv�_ 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 liable for the cost of the license. Initial 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 related edical cost, which could include loss of wages during recovery from their injury. Initial (A 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 Z�yg Dep e t t the Florida Sta F epartment of Professional Regulation. Signed and acknowledged on this //t�� day of of 20 At A4"J a/v M0-.A q r�s j STATE OF FLORIDA . COUNTY OF The f going, u nt was by Title: Notary Public SLCPDSD Revised 07/22/2010 / SA < _z; 4 / caner it Signature 0 A� ����,,� ckn ed ed before me this day of , 20 _�ft who is personally known a to me, or who has Type or Print Name c Commission Number as wenuncauon�,,,,,, -- .SPn� DAWN MILONE c=°. .`� ; Notary Public - State of Florida WMY Corn Expires Mar 22, 2017 i?rC�tlsion # EE 877571 �i Bonded Through National Notary Assn. PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772) 462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, -z-/L.11JJan ti'vev Id#/Legal description/Address) 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. —2ko L �r Property Owner Name (Please Print) PropeQ'Z(tv�0er—=Signature Date STATE OF FLORIDA, COUNTY OL)JL-, e 20 ACKNVWLEDGED BEFORE M&THIS DAY OF BY PROH ED iJ v olj�� SIGNATURE OF NOTARY PUBLIC COMMISSION NUMBER SLCPDSD Revised 08/24/2010 Y KNOWN TO ME OR WHO HAS AS IDENTIFICATION. TYRE QRP jVOTARY ONE 4 Notary Public - State of Florida -' u : • 5 My Comm. Expires Mar 22, 2017 'n°`� 4, Commission # EE 877571 F 5 ;° Bonded( National Notary Assn, e I. 1142 Water Tower Road, Lake Park FL 33403 ' �� O Z-- Z 2-7 Office:1-877-484-9994 / Fax:561-844-7102 South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311 Concrete Tested ❑ Yes P No LOT # Water Added at Customer's Cylinders Taken ❑ Yes ❑.No Request gals. to full load Comments gals. to 2/3 load gals. to 1/3 load Customer's Rep - Water Added NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES ADDITIONAL WATER ADDED TO THIS VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with skin and wash exposed skin areas promptly with water. if any cement powder or CONCRETE WILL REDUCE ITS STRENGTH SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water and get prompt medical attention. Keep children away from cement powder and all freshly mixed AND DURABILITY. ANY WATER ADDED IS AT CUSTOMER'S OWN RISK. BATCH TIME. cement products. To Plant At Plant ! ._:. PLANT TICKET# ORDER # TRUCK # LOAD SIZE TMIX SLUMP DATE CUSTOMER # SOLDTO P.O. # PROJECT# DELIVERY ADDRESS ZONE# USE DRIVER INSTRUCTIONS TIME DUE CUMULATIVE ORDERED PRODUCT CODE PRODUCT DESCRIPTION U.O.M. UNIT PRICE 0 1 ! QUANTITY QUANTITY SIGNATURE OR RECEIPT - CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING asc meyer Concrete Company)will not assume liability for any property damage or any SUB -TOTAL equipment damage for any deliveries beyond the curb line. ' TAX AUTHORIZED BY SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL-. PPPPPP— THIS DELI'I#S MADE SUBJECT TO THE FOLLOW11, 000NDITIONS- I;o pro -vide a sbitable roadway for our trucks free" the St,'00t pavernent to the place of delivery of material. If such suitable roadways are not provided, we res,rve the right to stop deliveries until conditions are remedied and, in such event, customer witJ br; held responsiDlo tor any loss caused thereby. 2Athen de it is beyond the curb ine at the custonrier or LL1SA0w(-;-r r9preset ita-tive's request, any damages including, . � bunat'llmitedto, w sidewalks, drive ways, buildings, trees: sr—� hrubbe-, sectic tanks and septic;systerns, including the drain old. arw t, at the oner's risk. ya Fnc custorner agraos to reimburse said Company for ioq; of time and equipment by reason of such delivery, and also to indsrnniify and save hauniests said Company frorn any and all clairns, demands and suits for or on account of or in any q-,anner caused by or arissinq from privatp drive,.'Vay dJ,, ivery acknoodedges tnat ell material and services shown have; been received, t! tat truck tir-nes shown are correct, arid that ,he amount of water added at the customer's request is shown correctly. CAUTION: The addition of water reduces con- crete strength and &rab;Iity, 6. Vie are not responsibska for fi,nished results obtained from this load of concrete; rnany important factors affecting the ultimate qijalftyo-fIthiacomploted k>lh are bevondour scope of respons*�bility and control, ,,5. A chxoe of S-11,00 will 6e charged after 8 rr);Mui` s per cubic yard unloading time is exceeded, 7. The CLIStOn IeY agrees try oxvide a suitable wash amnum facility for our trucks and tools at the place of delivery of material. 8. The custoniehereby s grees try pay all costs and expenses of collection, mcluding a reasonable attorney's 'tee, if he shall fall to paV lor the morcilandise retleute.d in this invo!Gf,', when, due: Past dunaccounts are subject to a 1-112% service cr,xge on the inpaid past due bal,anco. T he custopior hereby acknowledqs receipt of the complete copy of this contract. - . ', . _ h 1 . �, �c� 3w c`a { 1 '. r - -�P y vY- �� ti11CG0fla0//l =' i'.'. - y{ Y v 1 F n> _gym. 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DESCRIPTION )AD A portion of Section 9, Township `37 South, Range 41 East, being . a. part of those lands described in O.R: Book 272, Page 347, St. Lucie County, Florida, public records; said portion being more particularly , described as follows: - Begin at the point of intersection of the Easterlyright—of—way line of the Florida East Coast Railway and the centerline of 1 Old pepot Road, said point bein the point o curve concave to :the g p f curvature of a East;, having a central angle of 3 degrees 44'49" and a radius of 2814.93 feet; thence Northerly along s . dYright , of wa dine being_ on the arc of said 9 ' y d curve, a Y <�-a fir z drstance of 184.07 feet to .the, end of said curve; thence North �Y�� Yfi6 degrees 08'45" East a distance of 810 feet, more. or less f, , Wr �'� t .. t0 the waters o_f Indian �Ri.ver, ' s s �� T r ` x 'waters to a point, sold of thence Southerly along said } �� f�� p nt being on a bearing of North 59 t �sf egrees 47 23 �� East ^from ahe Point of beginning; .South 59 degtees 47.23 gl 9� thence 'Sou t - West talon . _the cI. 9. enterline of Old Depot Road, , �, � �K a dlstonceF- of 832 feet, more or less _::...�"��'� ;.. .. . to the Point of . _ �;e _:.:..B.eiilnnlnn :;I �:ce: ���n: r..:.;�.;.T' .