HomeMy WebLinkAboutSUBMITTED PAPERSDATE: FEES DUE: ECEIPT #: ?ermit #:
Planning & Development Services Department
_ SCgIVjV
Building & Code Regulation Division
2300 Virginia Avenue St D
Ft. Pierce, FL 34982-5652 IlC/19
Tel. 772-462-1553 CO
APPLICATION FOR ROOF PERMIT
SEE REVERSV,SIDE FOR INSTRUCTIONS � ^ i__�/
1. Location/Site Address:
2. Parcel 11 Number:I �� I ICI
Office Use
Section
Townshi
Range
Map Page
o
a d Use
I ' 'a s
Only
3. Description of Project or Work Activity:
4. Total Roof Area (square feet): 5. Roof Pitch:
6. Type of Roof: 0 Fiberglass Shingle
[ ] Tar & Gravel
] Concrete Roof Tile [ ] Wood Shake / Shingle
[ ] Modified Bitumen [ ] Other
AVProduct Approval required for all types of Roofing Material (2 Sets)
] All Commercial Roofing requires design by an Engineer or Architect (2 Sets) with Product
Approval attached
** Roof Mitigation per F.S. 553.844 will be required.
7. Owner Information
Name:
Address:�
City: State:
Zip: Phone: QI-CA "2_C_)E;9
8. Contractor Information
FL Reg/Cert #: C7CL�
County Cert #:
Business Name:
Cell Phone: '7�,
9. Value of Construction: $ 50Z� 2
"Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval.
CON T OWNER'S AFF VIT: I certify that all of the information contained in this application is correct and that all work will be
done in coLppliance with all applicable laws regulating construction and zoning.
PRINT QUALIFIERS/OWNE NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF C. I
BY
ACKNO ED BE ME T DAY OF 20
WHO IS SONALLY I n ME/ R QrS PRO UCED AS IDENTIFICATION
SIGNATURE OF NOTARY, — T E UK rtuiv i i�Al m yr 114U Aix :� wn ANG,S�
U v o �yUOM,y oM 11UFF
COMMISSION NUMBER P,F'oQ. eondeh:gp�N#�O(J3530
' � No 12 2
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RES
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YO
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Revised 4/26/2010
77
INSTRUCTIOT"'.-
Please complete all information in the space provided. All information must be printed (use black or blue ink
only) or typed. This roof 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. Building activities involving structural alteration, in addition to the roof work, must be permitted
through the regular building permit review process. 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. Total Roof Area
5. Type of Roof
6. Owner Information
7.. Contractor Information
8. Value of Construction
indicate the street address or general location of the
property where the building activity is taking place.
Indicate the tax identification number of the property where
the building activity is taking place.
Completely describe the building activity to take place.
Please indicate if tear -off or shingle over shingle etc.
Indicate total roof area to be affected by this permit. Also
indicate the pitch of the roof, expressed as a standard ratio
of run rise.
Indicate the type of roof being repaired or resurfaced.
Indicate the name and address of the owner of the property
on which building 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 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.
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..
Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261.
St. Lucie County Roof Permit Application rev. 3/1/2009
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Avenue
Fort Pierce, FL 34982
772-462-2165 or 772-462-2172
Fax: 772-462-6443
ROOF INSPECTION AFFIDAVIT
Re: Permit #
l s�
Le,,licensed as (n)Contractor* Engineer/Architect
(Please print name & circle license type) *FS468-Buirding Inspector
*General, Building, Residential or Roofing Contractor or any individual certified under 468 F.S. to make such an inspection.
On or about I did personally inspect the roof deck nailing
(Dat
work at: ��s� ,s��y �17��r ,�, � , ,"rZ
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the Florida Existing Building Code Section 611 or the product approval submitted (whichever is
most s� �)`-
1 - e
Signature and Seal
�-? 0�/3�
License #
STATE OF FLOAkDA,
COUNTY OF �—
Sworn to and sub cribed efor me this 20�
by . W ' personally kno . �mewho has produced
as tle ion.
Notary Public, State of FI id
Signature of Notary:
Commission Number:
`o 'UyCO�� SOM.HUFF
En 01/19/2011 F��"��`` OondeEX12201,
h� ES: gpnN EE083530
Notary publi Unde�wriler�