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HomeMy WebLinkAboutSUBMITTED PAPERS❑.Electrical *❑ Shed -w Wx war 1 Gl A X& ff• manning & Development Services Building & Code Regulations Division 2300 Virginia Ave. `SC'9/VN Fort Pierce; FL 34982 (772)462-1553 Co Ut7tV SPECIALTY PERMIT APPLICATION M Plumbing ❑ HVAC ❑ Fence 0 Demolition 0 Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 0 (f�44 PI EK 2. Parcel ID Number: -- Cob �--L�- 3. Complete Description of Project or Work: 4. Owners Information 5. Contractors Information Name: 41RA0-SM j- W FL Reg/Cert M Address: o ©-A, County Cert#: City: j State: L Business Name: Zip: {-9 Phone: ; , - . 9 Phone: 6.. Value of Construction: $ OWNER'S AWMAVIT: I certify that all of the information contained in this application is correct and that all work will be doi compliance with all applicable laws regulating construction and zoning. P .OWNER OR CONTRACTOR NAME ^—f— SIGNAT3aVOF OWNER OR CONTRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWL IS o DAY OF ,_�^ , 20—ABY - IS PERSONALLY KNOWN TO OR WHO.HAS PRODUCED AS , Ei3�i ION. /I /VI SIGNATURE OF N ARY \ � TYPE OR PRINT N OF NOTARY "' ""1°'"ws�iuia � EE 083530 f10 EXPIRES: April 12, 2015 „g Bonded Thru Nofary Public Underwriters COMMISSION ER *ALL RESIDENTIAL AND NONRESIDENTIAL STRUCTURES ARE REQURIED. TO MEET THE FLOOD ZONE ELEVATION OR 19 INCHES ABOVE THE CROWN OF THE ROAD, WHICHEVER IS APPLICABLE. (see instructions on reverse side of this sheet) Revised 03/18/2014 NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR IPAYING TWICE FOR WP'?"' `EMENTS TO YOUR PROPERTY. IF YOU 7--,ND TO OBTAIN FINANCING, CONSULT WITH YOi 3NDER OR AN ATTORNEY BEFORE RECORI_ YOUR NOTICE OP CONOENCEMENT. EXEftrr : A/C -HEAT REPLACEMENT WITH CONTRAS t 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 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 workto 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 fullreplacement. 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.serpice change out inspections will not be performed after 3: 00 PM without special arrangements and addhional 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 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 XAA �5 I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. Initial _qS 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 Cyr 1M 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 medical 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 Zo Dep e t to the Florida Sta a partment of Professional Regulation. Signed and acknowledged on this day off of 20 � e O er/Builder Signature STATE OF FL D COUNTY OF The oing instrument was a knowledg before me this - by w personally known to me, or who has produced A as identifteition- A r C_ Signature otary UATypeoKPrint Name o Notary (Seal) Title: Not Public Commission Numbs �0, ANGELA M. HUFF *= F 41 CONIdA5SIJN # EE 083550 SLCPDSD Revised 07/22/2010 ° EXPIRES: Bonded Thru Not' Prrl 12, 2015 ry Public Underwriters St. Lucie County - PCIS 05-29-2014 10:06:43 15263/6011 2410HdAKRDRE FLLR34949RCE Amount Tendered: 4,484.00 Amount Paid: 4,484.00 Change Due:, 0.00 Thank You User ID: WARDD LATaRRAt �. t %y+.tir'_,-' TOTAL 3P ;E ;E ►LL. ST. LUCIE COUNTY UTILITIES - P.O. BOX 728, It PIERCE, FL 34982 NAME ACCT; # SERVICE ADDRESS'�� 'i SUBDIVISION � ', ' 3)dale LOT . ', 'V ,5 BLOCK { d BILLING.ADDRESS� PHONE # 2— MOVE IN/CLOSING DATE This application hereby request and authorizes the Utility to render water and/or sewage disposal services to the premises described above in accordance with the Utilities present or future rates, rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay, the Utility promptly for such services in accordance with the established rules and regulations. CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. CUSTOMER' r 6. ` SOCIALSE.C/ SIGNATURE FED ID NAME OF SPOUSE SPOUSE'SOCIAL SEC. DATE RECEIVED—), / OFFICE USE ONLY 1� CASH CHK # aI RECEIVED BY.