The URL can be used to link to this page

Home My WebLink AboutSUBMITTED PAPERSFee Due: Receipt# Permit # Planning & Development Services Building & Code Regulations Division SC 2300 Virginia Ave. St. e y�FQ Fort Pierce, FL 349824 Ucl (772)462-1553 CpUnty SPECIALTY PERMIT APPLICATION ❑ Electrical ® Plumbing ❑ HVAC ❑ Fence. ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and 1 Location/Site Address: �T/ 5— paperwork required for specialty permits k 2. Parcel ID Number: 3 Z o.�- - &®5 ` o (-s-5- 3. Office Use Only Section Township Range Map Page Zoning Land Use Initials of Project or Work: . fN 5-f tC 0o- AS ID IFICATION. An ^ �F: eal) \ SIGN O NOT TYPE OR A OF NOTAR7 r Mv�oEtAM. HUF ..... os Ship F COMMISSION NUMBER Af doe BOnde�h o a prif �2 20 530 NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOM IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, C LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 Revised 04/26/2010 ; FOR YOUR NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPR(I ` AENTS TO. YOUR PROPERTY. IF YOU UM;'- `PO OBTAIN FINANCINC CONSULT WITH YOUR= _ , � DER OR AN ATTORNEY BEFORE RECORDING,_ fR NOTICE OF CO CEMENT. EXEMPT: A/C -HEAT REPLACEMENT WrPH 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 inchtded 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 Indicate the street address or general location of property where the building activity is taking place. 2. Parcel ID Number Indicate the tax identification number of the property where the building activity is taking place. 3'. Description of Project or Work Activity Fully describe the activity to take place. 4. Owner Information Indicate the name and address of the owner of the property.on which activity is taking place. 5. Contractor Information Indicate the State of Florida registration number (if ' applicable), St. Lucie County contractor license number and the name of the business doing the work. 6. Value of Construction 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 wi'tIi 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 offence ❑ Siding Attach.2 copies of manufactures specifications ❑ HVAC Attach 2 residential energy 4tudies,-2 manual•J calculations. 2 sets of duct layouts for -new system or full replacement 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 service change out inspections will not be perforated after 3: 00 PM without special arrangementsand additional 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 responsibilitx for supenvisin'g work t"Jbcensed 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 bylaw. Your construction must comply with a app ica — ordinances, building building codes, and zoning regulations. InitiaQwor I understand that the building official and inspectors are not there to design or give advice on how to et the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be ha d 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 e 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 me 'cal 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 owneribuilder exemption shall be reported by the Building and Zp>ting Departm t to the lcrida Stale Department of Professional Regulation. Signed and acknowledged on this la day of of 20 D1� Owner/Builder Signature STATE OF FLORIDA COUNTY OF c L% r.�� c The foregoing instrument w s acknowle ed before me this G day of S 20jZ by who is pqrsonally known to me, or who has produced as identificatior4., IQ - L 06 U�_ A 4 1?1.�Iu� W�Q�_ Ahc� P�� 4 Tf— Signature of ota Type or Pri t ame of Notary. (Seal) Title: Notary Pub c Commission Number • „ -----.__..,_:.___mom •. ANGELA M. HUI F i° .... r. SLCPDSD Revised 07/22/2010 *; +_ My COMM9011 E, 08353o M. EXPIRES: April 12, 2015 qg,4 Bonded Thru Notary Public Underwriters _ZWATER SEWER METER SZ. $ � CUSTOMER SIGNATURE NAME OF SPOUSE COMM RES M/F IRR SECURITY DEP SERVICE FEE _ SAME DAY FEE _ OVERTIME FEE METER INSTALL. CFC/WATER _ FPUA CFC CFC/SEWER _ GUAR. REV. LATERAL 1 TOTAL DATE RECEIVED, ST. LUCIE COUNTY UTILITIES - P.O. BOX 728 FT. PIERCE FL 34982 NAME ACCT. # � 9 SERVICE ADDRESS • / P` 1'Y] SUBDIVISION I� �— LOT 5�- BLOCK `- BILLINGADDRESS PHONE 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. SOCIAL SEC/ FED ID SPOUSE SOCIAL SEC. OFFICE USE ONLY CASH CHK # �� RECEIVED BY f