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HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due:- - 1� Receipt#(AD '_-/ Permit # fIU•w I Noil;--ni 1� Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. SCANkSo Fort Pierce, FL 34982 BY ® (772)462-1553 Fax 462-1578 Bt. LUCie COUntV SPECIALTY PERNIIT APPLICATION X ❑ Electrical ❑ Plumbing ❑ HVAC 0Fence . 0 0 ❑ Shed* ❑ Demolition ❑ Gas ❑ Siding'P� Seepage 2 for instructions and additionpa�ejw required for specialty permits o„ m 'o 1. Location/Site Address: �FF����� b 2. Parcel ID Number: a3 a 3 1 D 0 D O O 3. Complete Description of Project or Work: d r—<e T ( tyr 4. Owners Information 1�y� 5. Contractors Information Name: B P, 1 60-1 O S S FL Reg/Cert #: Address: Z S3 1 C L e a8w del-* LE 9 o County Cert#: City: Zip: FT Pi eXG'9— State: rc_ Business Name: `% % 4< Phone: •?d'16,92 8 /%7 Phone: Fax: 6. Value of Construction: $ 2- #6 6 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 construction and zonin . PRINT OWNER OR CONTRACTOR NANT SIGNATURE OF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF, cz-z� i ACKNOWLEDGED BEFORE ME THIS DAY OF 20 BY WHO IS PERSONALLY KNOWN TO ME ; . OR WHO HAS PRODU D I)— 7 TIFICATION. IZ"d SIG TYPE OF NOTARY OR PRINT NAME OF NOT'�:SP" �U DAWN MIL N Notary Public - State of Florida COMMISSION NUMBER : • My Comm. Expires Mar 22, 2017 Commission # EE 877571 Bonded Through National Notary Assn. *ALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED TO ELEVATION OR 18 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on reverse side of this sheet) Revised 04/17/2014 LOS �Ny Pi4,,oc2 NOTICE TO OWNER: FAILURE TG -�'CORD A NOTICE OF COMMENCEMENT MA'S-- _2SULT 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 $7,500.00 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 ,a 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 describes 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 Wildirig/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 No attachments necessary This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All,pe'rmit applications must beIfilled out completely before submission. No applicationswill be accepted` for' "processing `after 4:30 P.M. For assistance in completing this application, please call (772) 462-1553,, during regular;off de hours (8:00 AM - 5:00 PM), Monday through Friday. Upon issuance -of this permit; requited inspections can be scheduled by calling 1-866-284-1280 or logging on to http://codeinspectionpublic.stlucieco.gov/ 4 ' S auv Planning & Development Services Department Building & Code Regulations ° 2300 Virginia Avenue I-Ax Fort Pierce, Florida 34982 (172)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 -2!Z4 I understand that the building official and inspectors are not there to design or give advice on how to meet the•minimum code.. Initial ,TT 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 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 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 firrther understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this Z Y day of 107.4 Y of 20 f Owner/Builder Signatur STATE OF FLORI COUNTY OF p The fo oing instrument s acknowledged before me thi© day of 20_jW by who is personally known to me, or who has produced L as identifl ion. Signature of Notary [ Type or Print Name of Notary - (Seal) Title: Notary Public Commission Number ♦S,,pV PV�i DAWN MILONE Notary Public - State of Jorida SLCPDSD Revised 07/22/2010 : : •e My Comm. Expires Mar2Commission # EE 877,0FBonded Through National Nota 53 - - - - -, � - � " � - � -t' �'-' ' "-. !"" �1­­­ r , �� --, '. �­- — - --- ___ 'T TWEST-137v� f - T, 7,7� 7 VIE',NOR -Ul " —All -LEVEN'MLE2"H0AIJ 'A .1 -, . '. '­ - - � !�: TH,--lINE-:'OF­'jHI 2,��NOR-,' H_-2 NO SOUTH N.W CORNER- OF-_-."-THE- SOUTH S.A " OUTH IV E.L N E �U " HFErIc EW 1/4N.E. 14CORN t N4 /k U SN.E. 1/ TOWN 3 .2-'OF.311E W. 1/4 SECM�TEN "28 Nt rs r 2 too,. 1068. 'I z' -2�N NORTH 3 t3 7 30 .2419, PAGE 510) EET OF THE SOUTH.; HALF, ITHWEST QUARTER'- OF SECTION . u - _:' __.. -, ". - .... 'COUNTY- FLORIDA,: 0 ST. LUCIE U) 4TY, FLORIDA COUTAINING' _4 z rn � 0 rn 0 n -4 -4 3: m rn M rn USE tn 4% Ict EA, 0 rq -n -4 m En 0 c: 7-S, INC. co -4 M R s ILEVARD .4983 �2 -ICA- 0 O zz u) 0) a). CL NC 0 63.6* SB 65.3' SB 0 SET I.R.& C. (IFID. I.R. 2.60'NORTH) Pon" Ig i STORY WOOD FRAME BUILDING (IN DISREPAIR) 42-00' #3531 O TANK V) vi c[) 00 234.00' (D.) (M.) .043 4 In, '70 OQ an 4 'V 7 5,' a� ......... e. (31Z 0004 opa) '011 . . . . . . . . . . . Ao" 0 jj m rq _0 z _w R. Lill (A r- . -4 z c 0 m r- M /DIRT o > r- , 'A GRASS, < r M rn ENTRY rn rrl z 4:I z rq O. 0 > > 105.5' SB - 103.6' SB THE SOUTH LINE OF THE NORTH 253' OF THE SOUTH 1/2 — .1 c %AJ i 1A cg7r.TIOM 9R SET I.R.& C. 00 o > Ln z 0 ';u 00 * cr -4 > R 7, O;u w rri Z c: r- a rri ;u rrl mi 0 0 rn 0 q En ;E 15. FD.NAlL & DISK LS# 2391 130.00'__. F.E.M.A. F.I.R.M. FEB. 16, 2012— (AKA—THE EAST LINE OF -1 THE EAST LINE OF THE N( 1/4 OF THE SOUTHWEST 1 SECTION 28,'TOWNSHIP M RANGE 39 EAST, ST. LUCI LEGEND: P. - PLAT X=MASUM C. - CALCULATED 1D.=DESCFJM0N 11L& C. = MON ROD AND CAP W.0 - WrrNnS CORNER C.M - CONMEM rdoMMENT LP. = MON PIPE N. & D. -NAM MM ]DISK P.P.-POWER POLE