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Home My WebLink AboutSUBMITTED PAPERSDate:, _ J Fee Due': -'Receipt# 0 � Permit # J Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 �v33d SCAN/VEEI St. Luc By CAunty SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2 r v 2. Parcel ID Number: st 40 ED c,e Couh�y Office Use Only Section Township Range Map Page Zoning Land Use Initials 3. Complete_ Descriptionof Project or Work: — Ln A., — I—to-.-1Z 4. Owners Information V V 5. Contractors Information Name: ��j`� �%nr��/1J/g )Cra!4Cl f FL Reg/Cert #: Address: yo, U i 6we �2a City: 10?1!!� VW& State: Ez Zip: County Cert#: Business Name: a 7i Phone: Q.Z3%d 7 T,SO YPhone: 6. Value of Construction: $ C36a;yU Tel Fax: OWNER'S AFFIDAVIT: I certify that all of the information contained in this applicat ect and that all work will be done in compliance with all applicable laws regulating cons on an on' g. PRINT OWNER OR C n / OR AME � s SIGNATURE O RACTOR STATE OF FLORIDA, COUNTY OF e,A ACKNOWLEDGED BEFORE ME THIS - DAY OF 20 ///`22� 13Yff WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PROD CED r-[, •CJV ENTIFICATION. 1 w �� OWN ULM •, •tiNpv NAB �i ;•r°. ,�� ; &Q pu6lle - Stile of Florida TURF OF NOTARY T R PRINT NAME OF NOTARY _ . • . g .My Comm. Expires Mar 22, 2017 v • COMMISSION NUMBER Commission # EE 877571 Bonded Through National Nora,v %sSr NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL `- IN V6C7i YAYIPi' E FFOR ` 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 OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT mAy- xESULT IN YOUR PAYING TWICE FOR 11MMOVEMENTS 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 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•whi6.'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, ofthe work to . -take place. Total cost•.of construction includes alb6urrent retail material and labor costs associdted with the building/construction activity. Construction value is used to`'determine the permit fee. St. Lucie County reserves'tlie right to'question and/or modify the indicated: value of construction if it is demonstrated that the submitted figureg are not consistent with similar•types of construction. ❑ Gas Attach 2 piping schematics with tank sizejocation, 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 full replacement This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, nil`permit applications must be filled out completely before submission. No applications will be AN pr6cessingafter 4:30 P.M. For assistance in completing this application, please call (772) 1FM46?jx1 ,3durm' regular office hours (8:00 AM - 5:00 PM), Monday through Friday. 1N0W'E nergency electric service change out inspections will not be performed after 3: 00 PM without special arrangements and additional fee paid. Upon issuance of this per **required, inspections can be scheduled by calling (772) 462-1261. � J 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 provid ers' compensation for that employee, all as prescribed by law. Your construction must comply with all licab s, ordinances, building codes, and zoning regulations. In' ial I understand that the building official and inspectors are not there to design or give advice on w eet the minimum code. Initi I understand that as an owner -builder that any contract disputes with sub -contractors and I mu�>= in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. I understand that if I compensate any person or company for work performed they are licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible a cost of the license. Init I understand that if any person that is unlicensed and uninsured gets injured on my construction e - they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and rela d c 1 cost, which could include loss of wages during recovery from their injury. Initia 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 o the Florida Stak�,e,, Department of Professional Regulation. Signed acknowledged on this day of of 20. 7 O erB STATE OF FLORIDJ COUNTY OF _ The fore oin instrument was acl5pwledged before me this G� aday of 20 L3 by who is personally known to me, or who has ,p uced as identification. 1 1 DAWN MILONE r �e.or re o atuf Notary_ T Print Name of Nota �ry � �,�, � • ��t�ry Public -State of Florida Title: Notary Public Commission Numberf My Comm. Expires Mar 22, 2017 Commiaalm • EE 877571 SLCPDSD Revised 07/22/2010 .. 60 @ondpd Through Nallooal Notary A�sr LOT, 3: LOT 14 Block 13 Block 13 . (VACANT) (VACANT)- . FIRC a GHE N 89'58'00" "W . 14 75.- - -4'-----------� ---- o �) _ m �. Z LOT 4- �a = Block- 13 m LOT 13 - A o (VACANT) I BIOCk 13 0. m WELL v - - m_ p i FFIR N 89'58'00" W �� LOT 5 ' � 61ock 13 LOT 12 (VACANT) �� Block. 13 Q (VACANT) r M i Z L _ CA SOUTH RIGHT OF -.WAY UNE MATANZAS AVENUE FIR O a . i � - m� I - rn v - v � .44' FIR CONCRETE 40-2� 24.8' ` --- --DEWAY -- - :---- RIV Z ;a Z o COVERED ` 0 s 0 N C -ENTRY m Z O C7 ;U (n 0 24.8' _ 40.2' p -: �'-.---------------------- O o� 3.45 FIR r� - Ln N (A fV M . C D FIR NORTH- RIGHT OF WAY UNE AVIENDA AVENUE LEGEND �► QS = SANITARY ACCESS LID CONC = CONCRETE ; �� Qo SANITARY CLEANOUT fid . = TELEPHONE RISER CL CENTERLINE RIGHT OF WAY = WATER METER EP =EDGE OF PAVEMENT A/C = AIR CONDITIONER PAD F1RC = FOUND 5/8" IRON ROD CLF = CHAIN LINK FENCE & CAP (NO I.D.) WF = WOOD FENCE pf CABLE TELEVISION RISER DUE '= DRAINAGE & UTILITY EASEMENT WILOAM. $. BENNETT H2o = WATER TREATMENT PAD FIR = FOUND 5/8" -IRON ROD Professional ' Suryor do Mapper -OHE= = OVERHEAD UTILITY LINES FIP = FOUND 1" IRON PIPE Florida Certificate No. 6353 = WO POWER POLE ± = PLUS OR MINUS LB No. 7608 - E-- - POLE ANCHOR = LIGHT POLE 4 Vichdty Map - (Not To scale) LEG AL DESCRIPTION: LO T 13, BLOCK 13. HARMONY HEIGHTS No. 4, according to the map or thereof; -as -recorded in Plat Book 9, at Page 71, of the Public Records of .ucie County, Florida. OT011:- : 7,724 Sq. Ft.; 0.18 Acres± STR SS: 2409 N -41st Street, Fort Pierce, Florida 34946. SURVEY S: 1. Bearings sho n are based on the West line of Lot 13 as platted and bears N 00'00' 0" E. AA 2: Writtendimensio ake precedence over scaled dimensions and distances are not to be scaled for construction and/or design purposes. 3. All distances and bearings are. as field measured and are coincident with "PLAT" and -description data unless otherwise .noted. 4. This drawing is not valid without the signature and original raised seal of a- Florida licensed Surveyor & Mapper. 5. This 'survey is based upon a description furnished by the client, there has been no search of the public records done ;by this office. 6. Property lies in Flood Zone "X" as scaled from the National Flood Insurance Program Rate Map, Community Ponel-Number 12111CO176 J, with an effective date of February 16, 2012. 7. This survey is ' not covered by professional liability insurance. 8. City water is available. in this area, no City sewer was observed by field crew. 9. No underground utilities or improvements were located unless otherwise shown. CERTIFIED TO: MARTINA FRANCIS Date of Last field work; 04/22/2013 H`oundary Survey �oe Prepared on the order of: nnett Bennett Surveying, Inc. Martina Francis 10223 Hunt Club Lane Fleld: LM/BH Job No.: 13-0408... Palm Beach Gardeis..Flodda 33418 I /72.336.4933 fox: 772.336.8689 D." W'" LM oat®: 04/22/2013 nail: bennettsurveying®yahoo:eom S 1"=20' Sheet: 1 of 1 i