The URL can be used to link to this page

Home My WebLink AboutSUBMITTED PAPERSPlanning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical J9 Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address:' LA 3 3 L- I�) i N �t-6 RA1 2. Parcel ID Number: D 3 S� l - a00 1 - C00 - L county Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Complete Description of Project or Work: Lhv , tj Li tiJ L.,,,, w Na aa- I , u A E r--e. is .t-l.o, 5c, . 4. Owners 'Information 5. Contractors Information Name: L lkU 6 N iTV FL Reg/Cert #: Address: 93 3 C W LAT H L- J C,;, 2-'3 County Cert#: City: State: FL Business Name: Zip: 3LAC1 �� Phone: -)"iol- - °I-L-L-03Phone: Fax: 6. Value of Construction: $ C. 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 regulatin construction and zoning. PRINT OWNER OR CONT CTOR NAW SIGN �XT - OF R OR CONTRACTOR STATE OF FLORIDA, COUNTY OF. ACKNOWLEDGED BEFORE ME THIS f& DAY OF 20C, BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED t ' ✓ V ,puuy AS ID CATION. ,otPnY v�9 ,- DAWN MILONE Notary Pub] c - State of Florida FNOT Y T NAME OF NOTARY -.N ; MY Corn epires Mar 22, 2017 iqf;OFO. Oommisslon # EE 877571 COMMISSION NUMBER Bonded Through National Notary Assn. , 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 i NOTICE TO OWNER: FAILUR�IO 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 $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 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, 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. 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 emption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even Dugh you do not have a license. You must provide direct, on -site supervision of the construction yourself. You 1y build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a cost of der $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially .proved for sale or lease. If you sell or lease a building you have built or substantially improved your self within e year after the construction is complete, the law will presume that you built or substantially improved it for sale lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or supervise people working on your building; it is your responsibility to make sure that people employed by you ve licenses required by state law and by county or municipal licensing ordinances. You may not delegate the ponsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. iy person working on your building who is not licensed must work under your direct supervision and must be iployed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' npensation for that employee, all as prescribed by law. Your construction must comply with all applicabl la s, linances, building codes, and zoning regulations. Initial PAI I understand that the building official and inspectors are not there to design or give advice on how to m et minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled 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 maybe responsible and liable �for� th cost of the license. Initial C 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 medic st; which could include loss of wages during recovery from their injury. Initial 0-8 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 anviolation of the terms of the owner/builder exemption shall be reported by the Building and ivday g Dep t t e Florida S epartmcnt of Professional Regulation. Signed and acknowledged on this of of 20 i O er d i Signature of Notary Tittle: Notary Public SL:CPDSD Revised 07/22/2010 before me this I d day of_� who is personally known as identification. Type or Print Name of Notary Commission Number DAWN MILONE Nu i uy Public - State of Florida My onus. Expires Mar 22, 2017 C miniss,on # EE 877571 Bon' ^unugn National Notary Assn. W Fort Pierce Utilities Authority committed To Quality" Key Accounts 206 S. 6th Street Fort Pierce, FL 34984-3191 Phone (772)466-1600 Fax (772)467-3115 Job Location: 433 E WEATHERBEE RD Invoice Number: KA-26-14 Account Name: CHAU NGO Contact Name: I CHAU NGO PCN:340350100010001 LocID: Billing Address: 433 E WEATHERBEE RD FORT PIERCE FL 34982 Phone: Fax: (_) - Cell: (772)332-4881 Cust Type Residential City Limits Outside Sze.w s nesccstidx;. fees # y 1 5/8 X 3/4" Water Meter and/or Service Installation $800.00 $60.00 Water Security Deposit $40.00 Water New Account Setup Charge Water Capital Improvement Charge W ERC=s1,00 $920.50 *Water Accrued Guaranteed Revenue Charge $0.00 $0.00 Meter Verification Fees $0.00 Wastewater Security Deposit $0.00 Wastewater New Account Setup Charge Wastewater Capital Improvement Charge WW ERC's 0.00 $0.00 $0.00 *Wastewater Accrued Guaranteed Revenue Charge 0.00 Lien Fees yx� x n Donstrction Cost�stimatEes ss ` 4 ti , es k t=e . v rs 0.00 0.00 _ t and Wastewater AGFtC fees are good a end of tf m th If �otxeceFved by Down Payment: $0.00 # of ttte month, neuviees will. apply}!?tease contact our office for updated fees $1.820.50 the end `.� invoice Total• Description fo,r service order. INSTALL 5/8 X 3/4" WATER METER W/SERVICE %/ Paid: Check Number: CD -a Total Paid: ^��( Date Customers will be assessed wastewater charges the day they connect to the wastewater system or wmin aoa uayu a un, ud= Charge is paid - whichever is first The cost of the service line from the point of delivery at the properly line to the house/building is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health Department must be obtained Prior to initiating a septic tank abandonment. Contact the Health Department at (772)873-4931. Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather conditions and construction conflicts,'ithe customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) of the total estimated construction costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be percent refunded by Fort Pierce Utilities Authority. Reviewed By: Joyce Easterday Key Accounts Specialist Customer's Signature: Printed Name: Date: 02/13/2014 Date: Fort Pierce Utilities Authority -committed To Quality" Key Accounts 206 S. 6th Street Fort Pierce, FL 34984-3191 Phone (772)466-1600 Fax (772)467-3115 Job Location: 433 E WEATHERBEE RD Invoice Number: KA-26-14 Account Name: CHAU NGO PCN: 340350100010001 Contact Name: CHAU NGO LocID: Billing Address: 433 E WEATHERBEE RD FORT PIERCE FL 34982 Phone: i.l - Fax: ( ) - Cell: (772)332-4881 CustType Residential City Limits Outside .. srpon Y((j�.�Defik' }• - 1 5/8 X 3/4" Water Meter and%or Service Installation $80 00 $60.00 Water Security Deposit Water New Account Setup Charge $40.00 Water Capital Improvement Charge W ERC's 1.00 $920.50 *Water Accrued Guaranteed Revenue Charge $0.00 $0.00 Meter Verification Fees Wastewater Security Deposit $0.00 Wastewater New Account Setup Charge $0.00 Wastewater Capital Improvement Charge WW ERC's 0.00 $0,00 *Wastewater Accrued Guaranteed Revenue Charge $0.00 0.00 Lien Fees r -Con�tirttctloln Cost'Fst�mafek r F a, fees} 0.00 0.00 *V t I Wastewater AGFtt fees �re.gooduntti the end of the:rnonth If hot received by °-j Down Payment: $0.00 and the end of the month, new fees will apply Please conta�t:our office for updated fees Invoice Total: $1.820.50 Description for service order: INSTALL 5/8 X 3/4" WATER METER W/SERVECE �/ o ` Paid: Check Number: Total Paid: ° Date Customers will be assessed wastewater charges the day they connect to the wastewater system or wimm o0o udyb Hum U.I. . a ��• •• •��• • Charge is paid - whichever is first. The cost of the service line from the point of delivery at the property line to the houselbuilding is the responsibility of the customer and is not included in this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank abandonment. Contact the Health Department at (772)873-4931. Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project. Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather conditions and construction conflicts, the customer will be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above. Estimated costs paid by the customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority. Reviewed By: Joyce Easterday Key Accounts Specialist Date: 02/13/2014 Customer's Signature: Date: Printed Name: