HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE- ONLY:
DA''.f E FILED: (�
PLAN REVIEW FEE: RECEIPT NO.: / _7 0�V PERMIT NUMBER: l 7'� C
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
772-462-1553 S C,
APPLICATION for BUILDING PERMI"I['/Oze c
CERTIFICATE ®f CAPACITY/ZONING COMPLLOVE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:0 q,572,
2. PROJECT NAME: k 1L<(�_74-2— � oOO'? -k SITE PLAN NAME:
3, PROPERTY TAX ID #:�-
RIVER PARK -UNIT 2- BLK 1 LOT 18 (MAP 34/22N) (OR 1093-2728:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 1471-907, 909) —
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. _/ 8. LOT NO. /,�?_
9.. PARCEL SIZE (ACRES/SQ FT.), ") 0-,2 2 LOT DIMENSIONS-�
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
11
12,
13.
SETB CKS.(ACTUAL FRONT: BACK: s0 RIGHT SIDE: /7 • LEFT SIDE: _
TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION
N[ ] RESIDENTIAL
,] OTHER (SPECIFY) _
[ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] COMMERCIAL [ ] INDUSTRIAL
DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: d0 - =3 C� 15. SF. FT 1st 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 types of construction activities. If the value is $2500 or more, a
RECORDED Notice ofCommcucemcnt must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25109
�.t�.'YAm
OWNER INFORMATUCH
NAME: oC/T a v6 L a G/ �
ADDRESS:
CITY: ��L STATE: �� ZIP: j
PHONE (DAYTIME): Entail:
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 ONFORMATION
ST. of FL REG.CERT #: `
BUSINESS NAME:/
QUALIFIERS NAME: r
ADDRESS: 3,243
"�y n S�
CITY: PA STATE:
PHONE (DAYTIME): 2 Z 24Z' �'9,.Y 2 FAX NO.
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): (�
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
STATE:
STATE:
ST. LUCIE COUNTY CERT
�! ..r Xc 1 c G
ZIP:
Entail:
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.
i
i i 1
OFFICE USE ONLY - Bl? az�> �
SECTION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
C` l�
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
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
T
INITIALS
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 OR CONTRACTO SIGMA URE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this day of 20
by
who is personally mown or has produced
The foregoing instrument was acknowledged before
me this C77 day
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 OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit ilecklist.
o
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,
(Parcel Id#/Legal description/.
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.
L.Ioo "� J v�► �..-coos
Properfy Owner Name (Please Pririt)
ACKNOWLEDGED BEFOREME THIS � l!/� DAY OF 20�
BY M OJ)�h a l l a- 'V Vj- �S WHO IS PERSONALLY KNOWN O ME OR WHO HAS
,TION.
Eli 5—xm�/ COMMISSION NUMBER
(SEAL)
, ANNEMARIE SINGER
SLCPDSD Revised 08/24/2010 WOtary Public - Stateof F,Ioridt
air My Comm. Expires Mar 3, 2017"
Commission a FF 879788
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #:
BUILDER/CONTRACTOR:
PEST CONTROL CONTRA(
PEST CONTROL LICENSE
We, the undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in accordance with.the standards of the National Pest Control Association.
Square feet if area treated: Chemicals used: /5/,q/ L
Percentage of solution: •, ®�v o
Date of Treatment: i
Footing
1s� Treatment
Re -Treat
Driveway
-k-1st Treatment
Re -Treat
Other
1st Treatment
Re -Treat
Total gallons used: .50
Time of Treatment: o 515
Slab
-!L1St Treatment
Re -Treat
Pools
-' 1't Treatment
Re -Treat
Perimeter for Final Inspection
Signature of Exterminator
Note: There must be a completed form for each required treatment or re -treatment and this form must be on the job
site to be picked up by the Inspector at time of each inspection or the scheduled inspection will fail and a re inspection
fee charged.
FBC104.2.6 Certificate of Protecffve Treatment for prevention of termites A weather resistant jobsite posting board
shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed,
providing a copy for the person the permit Is issued to and another copy for the building permit files The Treatment
Certificate shall provide the product used, identity of the applicator, time and date of the treatment, s/te location, area
treated, chemical used, percent concentration and number of gallons used, to establish a verifiable record of
protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall
be completed prior to final building approval.
St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on
the electrical panel box cover, listing all the treatments and dates of applications.
'•A
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CONCRETE DISPATCHERS:
MIAA - 7ADE: (305) 264-7101
DEE ELD: (954) 480-9333
BLOCK PLANT: (305) 805-3226
is `The On Time Concrete Company"O WWW.SUPERMIX.COM
-v' CENTRwL CONCRETE SUPERMIX, INC.
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PHONE: (305) 262-3250 • FAX: (305) 267-0698�� '`„ ...�iy;��Ic_`�'I' `r ~"
SERVING MIAMI-DADE, BROWARD, PALM BEACH, MARTIN & ST. LUCIE COUNTIES
SOLD TO DELIVERY ADDRESS
I IE"IF:I: :,. a..l. r;e,�± c:,l°.�� 1 I_I,IL:
..:!'t:1n 11-3
i..•1�:1..�L_CS P i"r.i f` ;I,JI ..I f_:•I..• S 1Y i �. .I, ..."Y �.i
.I. fi;fi � I-�6eEf;7' t �:�1'•4" f�(.,°P..I«f��,: l' k..1:yt.; '
QUANTITY DESCRIPTION PRICE UNIT EXTENSION
Ji 5ID 3fl711;60
MINUTES — ALLOWABLE TIME" — PER MINUTE —
EXTRA UNLOADING TIME -CHARGE X $1.00
*6 MINUTES PER CU. YD. ALLOWED SHORT LOAD CHARGE y
SLUMP s.i. -;k, AMOUNT
THIS DELIVERY TOTAL CU. YDS.
OF YOUR ORDER FOR ,ta`CU. YDS. TAX
CUSTOMER OR HIS AGENT ASSUMES FULL RESPONSIBILITY FOR STRENGTH AND/OR
PERFORMANCE OF ANY CONCRETE PLACED -ABOVE DESIGN SLUMP OR WHEN •
WATER IS ADDED. WATER ADDED fUrYES U NO f �� GLS.
TIME ARRIVED ON JOB• STARTED UNLOADING
FIN[SHED 'UNLOADING LEAVING THIS JOB TOTAL TIME
SUBJECT TO THE TERMS; CONDITIONS AND "CAUTION" WARNING LISTED ON BOTH THE
FRONT AND BACK OF THIS TICKET., 19e,*.; ^ 110, L 93j 11"T[17-
TRUCK
DRIVER I acknowledge that I have received and ac0lepted the materials listed won this ticket. I
understand and agree to the terms on both the-fronj and,back of,tfjis'ticket.
1.._y .,ff `'t3H I RECEIVED BY: X
CONTROL
19 LOADING POINTS AT 16 LOCATIONS TO SERVE YOU BETTER
_.
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4�Op coN,,9�
'
MIAMI • AIRPORT • OPA LOCKA • MEDLEY • PERRINE • PEMBROKE PINES DEERFIELD • BOCA RATON
RIVIERA BEACH • STUART • W. BROWARD • FT PIERCE E. BROWARD • DELRAY LOXAHATCHEE673
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PRODUCERS AND SUPPLIERS OF QUALITY READY MDCED CONCRETE AND CONCRETE BLOCK
NRMCA
ASSD
DELIVERY COPY
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