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Home My WebLink AboutSUBMITTED PAPERS_ z Date:41 rj Fee Due: '� � Receipt# `Permit # v Planning &z Development Services Building &s Code Reg lagioia Division SC A/V IV Fort Pierce, FL 34982 St, (772)462-1553 �UCI@ Cotinty SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC �d Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty perntits 1. Location/Site Address: 5,2 10 `Z 1' )6 t"+l• °e (De— T+, Pu P a- Le tZ 3 Z(L? D 2_ 2. Parcel ID Number: `7, qd o2 °" 0 0317 " 00 0 '7 Township Range Map Page Zoning Land Use Initials Office Use Section Only 3. Complete Description of Project or Work: .e — 4. Owners Information 5. Contractors Information Name: In'l i ( I t 10y\ �� o1N, Address: 521 o City: r , �1 P y' C e State: FL Reg/Cert County Certl Business Nan Zip: 3 q !g A G— Phone: z'f2 --1- - jib/ c� Phone VZ1 6. Value of Construction: $ c3 L10 ` O C2 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 zoning. PRINT OWNER OR CONTRACTOR NAME SIGNATITRE OF OWNER OR TRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS rJ DAY OF 201� QQ . BY �J , WHO IS PERSONALLY KNOWN TO MEWHO HAS PRODUCE L P Co SO " ',� ' �z itPEANNA GIVENS Notary Public • State of Florida AS IDENTIFICATION. = : • _ My Comm. Expires Dec 16, 2016 Commission # EE 858761 Is,J @. %°F `, Bonded Thrdi*National Notary Assn. SIGNATURE OF NO ARY TYPE OR PRINT NAME OF NOTARY COMMISSION NUMBER V & 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 NOTICE TO OW1WR: FAII TO RECORD A NOTICE OF CO RESULT RESULT IN YOUR; PAYING TWICE FOR IIVIPROVEMENTS 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 11 D 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 1DCA 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 ,r ® IVAC Attach 2 residential energy studies, 2 manual'J calculations. 2 sets of duct layouts for -eli!,.&� •s��--- --- ? 1-' ne*-system or'full repl`aeement. r' ::�lR^U dn can vl Ed as phis appljatibe submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierc de, JQ racFL 3;4982.?All,permit appli�a ions must be filled out completely before submission. No applications will be r R 4&pp.W for ppocessing,aft& 4:30-Pa�fi: Por assistanceIn completing this application,;.please fall (772)_. 4�i2-15 3, 'during regular office hours (8:00 AM 5:00' P1V1); Monday through Friday. NOTE. Emergency electric service change out inspections will not be p'erOmed'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. St. Lucie County Building & Zoning Department 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 ?2J??— I understand that the building official and inspectors are not there to design or give advice on how to meet the minimum code. Initial 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 v 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 relate&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 Zoning Department to the Florida State Department of Professional Regulation.. Signed and acknowledged on this day of of 20 t. OwnerBuilder Signatur f STATE OF FLORIDA COUNTY OF Z-, � . L %) c \ The foregoing instilment was acknowledged before me this 91-11. day of , 20 3 , by who is personally known t o a produced S DSO - y GV. - �10 ' d as identification. �,�a�P.,, DEANNA GIVENS ..� oa ;tea°. <+ Notary Public - State of Florida D Q.q INh4 G •\�/ V` 5 : • e My Comm. Expires Dec 16, 2016 ^, °Pr' fission EE 658761 Signature o&oary�� Type or Print Name of Not %;FOF F�°��- Bonded Through National Notary Assn. Title: Notary Public Commission Number F F 5S� Property Appraiser - St.Lucie County, FL i Page 1 of 1 William K Bryan Record: 1 of 1 Property Identification Site Address: 5210 MYRTLE DR Sec7Town/Range: 02 :36S :40E Map ID: 34/02S Zoning: RS-4 Ownership and Mailing Owner: William K Bryan Esther Acevedo Address: 5210 Myrtle Dr Fort Pierce FL 34982 Sales Information Date Price Code Deed 9/30/2008 120000 00 WD 2/22/2006 210000 00 WD 11/29/2000 0 01 QC 8/8/1995 10000 00 WD 4/22/1992 8100 00 WD PROPERTY RECORD CARD «Prey Next» Spec.Assmnt Taxes Exemptions Permits Home Print ParcellD: 3402-608-0317-000-4< Account #: 37403 Use Type: SF Res City/Cnty: Saint Lucie County F Legal Description INDIAN RIVER ESTATES -UNIT 07- BLK 49 LOT 15 (MAP 34/02S) (OR 3021-1213) Assessment 2012 Total Land and Building Book/Page 2012 Final: 72600 Land Value: 6900 Acres: 0.23 3021 / 1213 Assessed: 72600 Building Value: 65700 2498 / 2785 Ag.Credit: 0 Finished Area: 1483 SgFt 1346 / 2349 Exempt: 47600 0970 / 0365 Taxable: 25000 0788 / 0829 Taxes: 681.39 BUILDING INFORMATION Exterior Features View: RoofCover. SD - Dim Shingle RoofStruct: HP - Hip Extrype: HC - HC YearBlt: 2001 Frame: Grade: C - C EffYrBlt: 2001 PrimeWall: BS - CB Stucco StoryHght: 0010 -1 Story No.Units: 1 SecWall: Interior Features BedRooms: 3 Electric: MX-MAXIMUM PnnlntWall: DW-Drywall FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/Fl: 1/213ath: 0 HeatFuel: ELEC- Electric Prm.Flors: CT -Tile-Ceramic %A/C: 100 %Heated: 100 %Sprinkled: 0 Special Features and Yard Items Land Information Type Y/S Qty. Units Qual. Cond. YrBIt. No. Use Type Type Measure Depth DWC - Driv-Concret Y 1 720 AV AV 2001 1 0100-SF Res BI -Front Ft 80 125 FEN4 - CHAINLINK4' Y 1 144 AV AV 2001 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED http://www.paslc.org/paslc/prc.asp?prclid=340260803170004 8/5/2013 Applicant has been advised NO structures can be erected within any easement or right of way unless o approved. FILE COPY Applimt jnitjW,