The URL can be used to link to this page

Home My WebLink AboutSUBMITTED PAPERSvDate: — --- -- -- Recein�Y f^ ),Permit #: Initials:) i /D PLANNING AND DEVELOPMENT SERVICES DEPARTMENT Building and Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 CANNEp F3 \J SPECIALTY PERMIT APPLICATION J L LICie Corm l y ❑ Electrical R7 Plumbing ❑ HVAC ❑ Fence ❑ Commercial Irrigation ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 9 % 7 IS u C `9 &_d Wry U r 2. Parcel ID Number: 42 A/� b&)�I ~ G od--k rr 3. Complete Description of Proposed Work: h r 9. L w---�T 4. Owners Information 5. Contractors Information Name: Kj -en2jQC t"h 4 440,0 // 1 �& � FL Reg/Cert #: Address `T l 17 13YC' A 6 ^) / Ay Dy County Cert#: City: %D_ -r P../� V CL° State: ^� Business Name: Zip: 9 Phone: %tfa-oZ��- �3�a(r Phone: 6. Value of Construction: $D oC i� U' Email: Fag: 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 con ction zo �� PRINT OWNER OR�CONTRACTOR NAME IGNATURE O OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF G ACKNOWLEDGED BEFORE ME THIS DAY OF G 2 _ BY � Y //J7G'l�� C1 U i1 e WHO IS PERSONALLY KNOWN TO. ME �) OR WHO HAS PRODUCED_ Ty— Eg-j V-so �. �% . _� AS IFICATION. (seal) SIGNATURE OF YFARY ' TYPE OR P NAME OF NOTARY COMMISSION NUMBER 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 01/03/2014 g,N��'pEp 59 V�AM\S kE6,20 S� N p 0 0 di d 5 diets M Ep1F�ES�� apub\�c�1� etw X No 11VJ1nut, 11V1VJ Please complete all information ;, the space provided. AS'1 information r t be printed (use black or blue ink only) or typed. This permit apl lion is to be used only for those activ , _._ 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 0 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. She Location Permit PLEASE LOCATE SHED AND ALL BUILDINGS WITH SETBACKS TO THE PROPERTY LINES. Example of Plot Plan for shed. Please show distance from shed to the lot lines House Smith Lane FRONT PROPERTY LINE ON ROAD Shed All. applications for Shed - Locational Permits are to be submitted to the St. Lucie County Building and Zoning Department, St. Lucie County Administration Building, 2300 Virginia Avenue, Fort Pierce, FL 34982. All applications for Shed - Locational Permits must be complete and filed with the Department no later 4:30 P.M. each business day. No applications will be accepted for processing after 4:30 P.M. For assistance in completing this application, please contact the St. Lucie County Building and Zoning Department, at (772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. Following the issuance of this Shed - Locational Permit, the scheduling of all required inspections may be made by calling (772) 462-1261. SLCPDSD 4/11/2011 1 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 applica e 1 ws, ordinances, building codes, and zoning regulations. Initial' ' I understand that the building official and inspectors are not there to design or give advice on how So meet the minimum code. Initial (Z LL 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. 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 liabl or 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 (` , 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 Departme t to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20 / `Owner/Builder Sign ture STATE OF FLORID COUNTY OF The fore ing ins @i ent acknowledged before me this-7--day of /�' 20 ) by who is personally kno to me, or who has produ a as identification. • ,. ,,�'•�i� Signature of otary e orPrint Name ofNotary (Seal) Title: Not Public Commission Number SLCPDSD Revised 07/22/2010 "= AUDHEY 8• HUMPH0611 9 Py�''- MY COMMISSION # EE 2p15 E,plRES. Malen 6Underwrilers " Bondetl thru Nolxry popllc ip h � j (�, , �� li I f •t � t; u:'l1iJ.Vv`�i7:�.��lirvW44'va`v'.,.r. I L -c v vnvr� 3T. LUCIE. COUNTY UTILITIES - _.... _ f� RES NAME SEWER M/F� j ' METER SZ ACCT. # _OX_,FT pfitkCE, FL II ' _--- c r f' SECURITY DEP ISERVICE ADDRESS I SERVICE FEE t ' SAME DAY FEE SUBDIVISION I1vlEFEE , OVERT 7 � BILLING ADDRESS r' ' METER INSTALL. CFC/WATER ✓" h ", ;MOVE IlkCLO; FPUA CFC PHONE # ' J i CFC/SEWER This application hereby request and authorizes the Utility it rend GUAR. REV• services to the premises described above in accordan art i f tliis�1 LATERAL rules and regulations, which by reference are made a p , the Utility promptly for such services in accordance'witli the - I4 v TOTAL CUSTOMERS DEPOSITS ARE NON NEGOTIAI3LE O�Z DATE and/or sewage disposal present or future rates, Applicant agrees to pay d rules and regulations. SOCIAL SEC/ FED ID I SIGNATURE.: ; SPOUSE SOCIAL SEC. NAME OF SPOUSE r OFFICE USE ONLY .r. • �; L - CHK # .ems RECEIVED DATE RECEIVED CASH— BY