HomeMy WebLinkAboutSUBMITTED PAPERSDate:; a eiaeW Fee Due: Receipt# Permit #
„5 3 Planning •& Development. Services 5�+�
Building & Code. Regulations Division e�E�
- - - - --2300 Virginia Ave: — - - -- - _� - - -- -
*. Fort_Pjerce; Fi, 34982.:-
"` " --_(772)4621553—
SPECIALTY- PERMIT_APPI,ICATI®N_- _
- Electrical - -
HVAC Fence _
_---® Shied =z�_ __ � DemOlit�on ._ ®_Gas--- - - ��Si_drng=•:_ -.�. � -- -_ i .,_ .... _ _: T � --
Seepage 2 for instructions and additional paperwork required for specialty permits
- - — —_I.-LocationlSite Address /fie—-i.�h•6R.
2. -Parcel ID _Number:
.3. Complete Description of Project or Work:
4 Owners Information 5. Contractors Information
Name. j/f rClo a9 @ (rS FL Reg/Cert #.
Address: County Cert#:
%�0)_A�,-<,Q_State"'i-� Business -Name:
Zip: 31`i� g� Phoa7J%�Z-Tlip�Phone• Fax•
6. Value of Construction: S I VC3P ®
OWNER'S.AFFIDAvrr: I certify that all. of the information contained in this application is correct at all work will be do
compliance with all applicable laws ulating-construction- o ing ,}..�•,,;
PRINT OWNER OR CONTRACTOR NA SIGNATURE OF OWNER oR CONTRACTOR,
.Q .
STATE OF-FLORIDA, COUNTY
ACKNOWLEDGED BEFORE ME TFIIS _ DAY O 20 BY / / / �Cl/ ,L ( �% �!5'�
H?
. v.._ W.I-IO'IS PERSONALLY_KNOWN._TO:ME -r ::OR.WH
ENTIFICATION It
GNA NO ARY E OR P T AME OF N0 ARY 6` / �sea(j �+
COMMISSION
"NUMBER
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 wrm YOUR
LENDER OR AN ATTORNEY BEFORE' RECORDING YOUR NOTICE OF. COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/7010
Dice Use'
Section
'Township•`,:`
.Range
Map Page
Zoning
Land Use
`Initials
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida,34982
(772)462-1553
OWNER/BUILDER AFFIDAVITDISCLOSURESTATEMENT_ _
-�---------- ------------- -,_--.�-----ES._489.1.03-(�-E7�EMP_TIONS.�-- ---- — ------ __--_ _ ...---�.�-�--
-�- — — - - -- .u-.. - -
dconaveStatelaw r-qiscotst-letator- Yuh—
underan — T"— led-fmtappio
exemption to that law. -The'eXemption allbWs y6ti as the owner of your property, -to act 2s-your own contr3ctor'eV8I1
.-though you. do.not:have.a license.. You_must.pr-ovide 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
--- - - ------impr-oved-for=sale-or-,lease:--If-you-sell-or-lease=a=building-you-have-built or -substantially -improved yourself -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 contractIor or
to supervise people working on your building; it is your responsibility to make sure that people employed by you
have licenses, r uired b -state law and b coup or munici al licensing- You --not deldgdte the
�I Y Y tY , p g Y g
responsibility- for supervising ;work to -a licensed --contractor wlio is not -licensed to perform the work being -done:
Any-persori-working-on your building who is..not licensed mustwork under your direct supervision and rust 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 applicaoq --laws,
_ - g g. g tial..
ordinances building codes and zonin re ulations. Ini
I understand that the building official .and inspectors are not there to design or give advice on ho meet
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be andled
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 maybe responsible and liablA 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 relat 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 farther
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
ZoUmg Department to the Florida State Department of Professional Regulation:. Siknowledged on this
dayofJ_of200. gne
Owner/Builder Signature
.STATE OF FLORID -
COUNTY OF
The fore. •ng in ume Nvas ackn wledged before me this �% day 61 20 6 ,
by J _S who is personally.k o�to me, or who has
du 'ed der�`=ucatio/n:. SS
//p
v �
Signa of otary Type or .Print Nape o Notary (Veal)
Title: tu�Public Commission N ber
SLCPDSD Revised 07/22/2010
AUDREY B. HUMPHREY
MY COMMISSION N EE 061159
orEXPIRES March � 2015
`
o ` Bonded Thru Notary Public Ondervriters
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Wednesday, Jun 05, 2013 10:47 AM
Property Appraiser - St.Lucie!'^��nty, FL Page 1 of 1
Michael R Chambers
Record: 1 of 1
Property Identification
Site Address:
1012 Charlotta St
Sec/Town/Range:
04 :36S :40E
Map ID:
34/04N
Zoning:
RS-3
Ownership and Mailing
Owner: Michael R Chambers
Address: 1012 Charlotta Rd
Fort Pierce FL 34982-4120
Sales Information
Date Price Code Deed
4/1/1986 3000 01 CV
PROPERTY RECORD CARD
<<Prev Next » Spec.Assmnt Taxes Exemptions Permits Home Print
ParcellD: 3404-501-0208-000-5
���}CI
Account #: 39710
O , 4'
Use Type: SF Res"
City/Cnty: St Lucie County
Legal Description
WHITE CITY BLK 39 LOTS 1, 2 AND 3 AND LOTS 10,
11 AND12 AND
20 FT VAC ALLEY LYG BTWN AND N 15 FT VA
More...
Assessment 2012 Total Land and Building
Book/Page 2012 Final: 126500 Land Value: 43400 Acres: 0.91
0497 / 2041 Assessed: 126500 Building Value: 83100
Ag.Credit: 0 Finished Area: 2217 SgFt
Exempt: 50000
Taxable: 76500
Taxes: 1741.99
BUILDING INFORMATION
14
10 f
m uw
4 1.
1 f
Exterior Features
View: - RoofCover: SA - Asph Shingle RoofStruct: HP - Hip
ExtType: HD+ - HD+ YearBlt: 1987 Frame: -
Grade: D+ - D+ EffYrBlt: 1987 PrimeWaii: BS - CB Stucco
StoryHght: 0010 -1 Story No.Units: 1 SecWall: -
Interior Features
BedRooms: 3 Electric: MX - MAXIMUM PrmintWali: DW - Drywall
FullBath: 2 HeatType: FHA - FrcdHotAir AvgHt/Fl: STD
1/28ath: 0 HeatFuel: ELEC - Electric Prm.Flors: CU - Carpet
%A/C: 100 %Heated: 100 %Sprinkled: 0
Special Features and Yard Items Land Information
Type Y/S Qty. Units Qual. Cond. YrBlt. No. Use Type Type Measure
CNC2 - CONCRETE LOW Y 1 1320 AV AV 1987 1 0100-SF Res 213 -Front Ft 190
FEN4 - CHAINLINK 4' S 1 500 AV AV 1987 2 0100-SF Res 520 -Acres 0.68
SDSF - SITE DEV S-F' Y 1 1 AV AV 2001
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
Depth
150
cpc
http://www.paslc.org/paslc/prc.asp?prclid=340450102080005 6/5/2013
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Applicant has been advised NO structures
can be erected within any easement or
right of way unl ise approved -
Applicant Initials