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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE [JSE ONL `�• `'.. J,;1 - DATE FILED: �r 3 PLAN REVIEW FEE: '159,01 RECEIPT NO.: CONCURRENCY FEE: RECEIPT NO.: PERMIT NUMBER ilOq 501-� CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 SCANNED 772-462-1553 By St; Lucie County APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE —7 PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: G J 101h PLACE 2. PROJECT NAME: SITE PLAN NAME: Q 3. PROPERTY TAX ID #: 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. '� 8. LOT NO. / 9. PARCEL SIZE (ACRES/SQ FT.): I � LOT DIMENSIONS: 190 3� V 10. COMPLETE DESCRIPTION OF CONSTRUCTIO PROJECT OR WORK ACTIVITY: R6P�CF r5rl,vG 6P.iVFWPry A►yL kj,4LK 11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] RESIDENTIAL [ CO IAL [ ] INDUSTRIAL, �. OTHER (SPECIFY) K PLACE K VE1/ A'`, A•Nb Wig L_ 13. DESCRIPTION OF PROPOSED USE: K" I pEi1T1(1 14. SQ, FT OF CONSTRUCTION: G1Nf1l/ 15. SF. FT 1st FLOOR: $�© 16. VALUE OF CONSTRUCTION: $ 1$150 The value of construction is used to determine the amount of permit fees to be assessed. St; Lucie County reserves the right to question and/or modify the indicated value of construction if itis demonstrated that the submitted figures are not consistent with similar types of construction activities. If the valueis $2500 or more, a RECORDED Notice of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 OWNER I f 1/N�FORMATION A NAME: � P.T9vU pGL � - EMMh-P X ADDRESS: -730(5 r-,V 11 oy-1 Pi - CITY: DO RT Sr- Lxe I L STATE: r L ZIP:: 6J PHONE (DAYTIME): l + l ) 370 _ Email: Dcx1P- &1C9 @' PrT ' IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY: STATE: ZIP: PHONE (DAYTIME): �) CONTRACTOR INFORMATION ST. of FL REG.CERT #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: 11 PHONE (DAYTIME): C—, ARCHIT/ENGINEER ADDRESS: CITY: PHONE (DAYTIME): L__) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: FAX NO. STATE: STATE: STATE: ST. LUCIE COUNTY CERT #: ZIP: Email: ZIP: ZIP: ZIP: IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification it will be voided and returned to you by mail. s i i i CERTIFICATION: This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- residential use. NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OVNEk OR NTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 5 k , L V COUNTY OF The foregoing instrument was acknowledged before The foregoing instrument was acknowledged before me this C day of S -. 20 13 me this day of , 20 , by 0► C1) i V,6, % q'N YN by who is personally known or has produced who is personally known or has produced fJ 6 O r. -' Ihs identification as identification. \ NNA GIVENS locida Signature of No a pub ' 16, 2016 Signature of Notary ey Pear;'• Notary ExPltes Dec Com ��Q EE 6 Commission No.5- s '-My �0����lNaionalNoaaY ass0' Commission No. (Seal) NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR,TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE'FRONT OF -THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNERBUILDER APPLICANTS. a For specific instructions see appropriate permit'' hecklist. { PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, 73W GuII®Tr Pi , PrT (Parcel Id#/Legal description/Address) 3'{l'{'S41-10/),-OSO-q for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , I acknowledge that as owner of the above described property, and in accordance with Section 7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring adequate drainage so that the immediate community WILL NOT be adversely affected. I further acknowledge that in granting this permit for the development of this property, St. Lucie County is neither obliged nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community, Property O er Name (Ple a Print) /3 Prop rty Owner Si ature Date STATE OF FLORIDA, COUNTY OF 'S 0 G ACKNOWLEDGED BEFORE ME THIS DAY OF �� �T� , 20 0 BY °+ t' $1n J r E ,naA1 W"A n>1 WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED m 5 ay — o S d G y r :QA 5 0 AS IDENTIFICATION. I SIGNATURE OF NOTARY PUBLIC —t4,rJA1rC 1COMMISSION NUMBER , SLCPDSD Revised 08/24/2010 � 2q,n�a► G � � e •,n s TYPE OR PRINT NOTARY (SEAL) DEANNA GIVENS J•1PRY Pj;0 Notary Public - State of Florida • . : • "e My Comm. Expires Dec 16, 2016 Commission # EE 858761 ''��•` Bonded Through National Notary Assn. 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 resp_nsihility for supervising work to_ajke.d 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 work s' compensation for that employee, all as prescribed by law: Your construction mu§t comply with all -applies e - , -" --- -- ordinances, building codes, and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on how t et the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must be han led in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial , 9 I understand that if I compensate any person or company for work performed they are required o licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable he cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my constructioX they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relatel 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 Regulatio igned and acknowledged on this p day of SEP GrCM$E(Z of 20 Ov�'her/Buildergnature STATE OF FLORIDA COUNTY OF 5k .1,1.) C . 4 The foregoing instrument was acknowledged before me this3 day of SA • , 20 13 , by E.r+!!N aJ v_v4 n who is personally known to me, or who has produced C 5 a Sd 6 'i ad b fa as identification. I D RC� A rq 6'` J sV% S NNA GIVENS Signature of Not T (S e or Print Name of Notary ; �PR� °�e Title:Notary Public NotPubl c Commission Number L.F.IS4l '_°• `ma's Not Pu Ile -State of Florida -. ` ; •= My Comm. Expires Dec 16, 2016 Commiss ,� °; �e o`, Bonded Through Ulonal Notary Assn. lE pP�� SLCPDSD Revised 07/22/2010 1 Planning & Development Services Building & Code Regulation Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-2172 Fax 772-462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #: �SOCA - 6� JOB ADDRESS: 7 30 o BUILDER/CONTRACTOR: G . PEST CONTROL CONTRACTOR: - - RAW PEST CONTROL LICENSE #: We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: �JO Chemicals used: 0 Percentage of solution: Total gallons used: Date of Treatment: C4 ` 5 " ( 3 Footing 1st Treatment Re -Treat Driveway _40 15` Treatment Re -Treat Other 1st Treatment Re -Treat Time of Treatment: �5 Slab 1� Treatment Re -Treat Pools 1st Treatment Re -Treat Perimeter for Final Inspection Signature Exterminator Note: There must be a completed form for each required treatment or re -treatment and this form must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re -inspection fee charged. FBC104.2.6 Certificate of Protective Treatment for prevention of termites A weather resistantjobsite posting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed, providing a copy for the person the permit is issued to and another copy for the building permit files The Treatment Certificate shall provide the product used, identity of the applicator, time and date of the treatment, site location; area treated, chemical used, percent concentration and number of gallons used, to establish a verifiable record of protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Lucie County requires for the Anal inspection for CO, a Permanent Sticker to be placed on the electrical panel box cover, listing all the treatments and dates of applications. ZZCGMC_x 5.7 7 €r292 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Project Code: Project Name: Ticket Date: Delivery Address: .. ., 7 �Y„J. .'f ��.' ..S �.J S. `i i l...t V•`( i j+'t Delivery Instructions: Customer Job Number: Order Code / Date: Project P.O. Number: Order P.O. Number: Map Page: Map/Row/Column: - •-� 4 • 7 tv .� r t Dispatcher: Ticket Number: Due On Job:- t_t .t Slump: 4... Truck Number• ,1, _� . f)0i'. Diver Number: in Driver Nam@@ �,. i 1 �yI C'' End Use: *-i 1- j, y # -_ra ..� . JS1 i r._:.. r: .?.'_�'; ::�:5 i`j•S•°y ,} LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY f - 't� � � .. �„ � �.'+; ..51i: # i r,•,tL.: j41 �i-':51•..j i.ti.! 1 .:ti , 47 Cash Check # /Auth Code: Signature of Driver Receiving Cash: '' Cash Received: Total COD Order Amount to Collect ] Check �jjj ` Without Standby Charges: / Charge j fr % t/ ✓'� i Comments: � Fes._.._ t � ' l WATER ADDED � - CSA YARDS IN DRUM: P f r .��� WHEN ADDED. SIGNATURE / CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: } SIGNATURE 91d� ❑ LOAD WAS TESTED BY: Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customers own risk. If water is added on job, concrete strength Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important control after delivery, this Company will not accept any responsibility for the finished results. No credit for safeghandling information, and to the material safety data sheets for additional information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE: within one business day after the receipt of materials. O v'i 68UNIVERSAL d.; l: i r'.'!'.. CUSTOMER \ry Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Nditions, Seller's Quotatic '- any, and Seller's Order Confirmation (it ling limitations of warranties), as if fully Zn products ctivery Ticket ("Agree C). Seller will provide the Standard Tern d Conditions upon request. Buyer agrees erwise noted on the front hereof', all quantities and items were delivered as indicated and further expressly agrees to ante with the Agreement. AGGREGATE CEMENT CONCRETE PRODUCTS FLY ASH reaateare naturally occurring materials including limestone, dolomite, granite, volcanic -rock., sand gravel, and other 11CCOUs materials. Cement products include Portland, cement, masonry, pozzolan (Type IP), roof tile, and'stucco ' Concrete products include Portland cement and aggregate products including limestone, dolomite. granite, volcanic rock, sand, -ravel, and cc Zn Zn other siliceous materials. These products,includingflyash,may contain more than0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions. Dry concrete and aggregate dust may Cause irritation to eyes, skin, and/or respiratory tract. Dust from handling, crushing, grinding,, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled. .If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure. Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective tl clothing. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. If exposed to I (Just above recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection. First Aid: In case of eye contact, immediately flush eyes with flowing water for 1.5 minutes. If dust is inhaled., move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. Z-1 CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combined Houston, exas 77024 02/12 For more information please visit www.ccmexusa.com. Este ticket de entrega i,ncluye como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier t6rtyimo est6ndar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y CT -antfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los t6rminos est6ndares y condiciones detal- iados en caso de asi ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fucron entregados como se expresa en el mismo. Acepta pagan el monto de acuerdo al contrato; al menos que se identi- fique con una nota al frente de este documento. AGREGA DOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcAnica, arena, Brava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaffilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cernento Portland y productos de agregados como piedra caliza, dolomita, granito, roca volcAnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede contener m6s de 0.025% de sificio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piet y ojos, y reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, carte y/o perforaci6n puede contener materiales silicon, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura edlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amonjaco. Seguridad: La hurnedad puede causar la liberaci6n del an-ioniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o queroaduras en la nariz. t , garganta y pulmones. Acudir inmedia arnente a]. medico. El riesgo en la salud depende en la duva66n y el nivel de la exposici6n. Seguridad: Evite el. contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa Primeros adecuada Para protecci6n. Ldvese las manor con iagua ab6n suave y despu6s del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos miis de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, l6velos a fondo con agua. Acuda a atenei6n m6dica ini-nediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite .1900 V7 combinado Houston, Texas 77024 02/12 Para mds informaci6n visita www.cemexusa.com. .,_-•j-�I W Ss HE �UsE W 7Po LAG & )�5 r�v G I [�P 4 6611 -