HomeMy WebLinkAboutSUBMITTED PAPERSDate: 1J 3 1 Fee Due: , '�j' p Recei t# 6 Permit # l3d —003
Planning & Development Services
Building & Code Regulations Division ��
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 40 y
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SPECIALTY PERMIT APPLICATION 41
❑ Electrical ❑ Plumbing ❑ HVAC❑ Fence
"ed ❑ Demolition ❑ Gas ❑ Siding
Seepage 22f�for..,��instructions and additionalpaperwork
requiredfor specialty permits
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1. Location/Site Address:'/ l I ri otlan 1 1-• t`� IY� �e , �"�, l /SI
2'. Parcel ID Number: � Z y - 0015- 00 0 -s
3.
Office Use
Section
Township
Range I
Map Page
Zoning
Land Use
Initials
Only
of Project or Work: ?-e1(xa-)'f Cn 0 -� V c'-ejj j ecJ
4. Ownerrs�Information 5. Contractors Information
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Name: 1 io- r 0) (�/l Ufa- FL Reg/Cert #:
Address: ( J-i K lcan 1 er 1G1 Loi County Cert#:
City: �--i � ' uU' \.-1, State: Business Name:
Zip: Phone�Z-3 �J ` (Phone
6. Value of Construction: $ w
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is orrect and that all work will be done in
compliance with all applicable laws regal tion and z ni
ev-
PRINT OWNER OR CONTRACTOR NAME SI NATURE OWNER O T CO RACTOR
STATE OF FLORIDA, COUNTY OF ,,-L• L V C � R— `
ACKNOWLEDGED BEFORE ME THIS L \ DAY OF S 20 `3 BY V0 -k -I Q r
WHO IS PERSONALLY KNOWN TOME WHO HAS PRODUCED i. R eo00 - aq13 DEANNA GIVENS
tiARY PV9/'i
AS IDENTIFICATION. �ao� ��o , Notary Public State of Florida
My Comm. Expires Dec 16, 2016
l o+ �+Na A Co(rswD�sion # EE 858761
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY National Notary Assn.
��� �$� � � ��,,,,,,,,••`• Bonded Through Na Y
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 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 t0 OWNhKt 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 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
2. Parcel ID Number
3. Description of Projector Work Activity
4. Owner Information
5. Contractor Information
6. Value of Construction
Indicate the street address or general location of
property where the building activity is taking place.
Indicate the tax identification number of the
property where the building activity is taking place.
Fully describe the activity to take place.
Indicate the name and address of the owner of the
property on which 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 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 with 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 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,
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 performed after 3: 00 PM without
special arrangements and 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
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 provide workers'
compensation for that employee, all as prescribed by law. Your construction must comply with all applicable 1 ,
ordinances, building codes; and zoning regulations. Initial /L
I understand that the building official and inspectors are not there to design or give advice on h to e t
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
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 AV—
I
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 Regulation. Signed an acknowledged on this
day of of 20
Owner Buyy er Sign ture
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this day of 5 t ��', , 20t3
by G. ri 0. kk. , i who is personally known to me, or who has
produced KV. Od - 01.as identification.
` D Q,d y\ 4% ` J t yk DEANNA GIVENS
�••µY P( -
1P 6' -i
Signature of Not Type or Print Name ofNota ?�� o:; Notga9blic State of Florida
Title: Notary Public Commission Number ��54'I -• : : • My Comm. Expires Dec 16, 2016
58761
oz; commission # EE 8
14� OF %° ;;,`.0sP`, Bonded Through National Notary Assn.
SLCPDSD Revised 07/22/2010
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGIMA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
12 a� I ��al 2S S
(Parcel Id#/Legal description/Address) 5-n6I Ind( 9h 961 LA-)f
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.
3 —/
Date.
STATE OF FLORIDA, COUNTY OF C�
ACKNOWLEDGED BEFORE ME THIS 1 DAY OF t-� . 20
BY G \NN 0, 'k r d WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED I\�D a•� r O a ' rP~ <) AS IDENTIFICATION.
SIGNATUREdOF NO Y PUBLIC TYPE OR PRINT NOTARY
A� O�A COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
DEANNA GIVENS
Notary Public - State of Florida
My Comm. Expires. Dec 16,2016
Commission # EE 858761
Bonded Through National Notary Assn.
o rower rote /. All Lot 01men5tons 5nuwo uia pce y.u. u...aaa
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kVlicant has been advised NO structures
c,in bd erected within any easement or
Ttrrof way unless o se approved.
Applicant Initials l
FRdsiT
SIDES
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FILE COPY
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LOT 185
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60• RA.* - 20• ASPHALT ROAD
INDIAN BENDLANE
d BEND LANE -
Certi-t ied to: Peter Keyer do Vno M. Keyer
tic Land Desi ns
9
Group One Mortgage. Inc.
Chelsea Title, a divtston of FNT of Florida
treasure Coost. L87468
Chic000 Title Insurance Co.
n Beach Blvd. Jensen Beach. Ft 34957
1 hereby certify that the survey shots hereon is true and correct
Mailing Address:
old is based on actual meoseuremats taken in the field. This
.1421 Jensen Beach, FL 34958
survey meets the Winiam Technical Standards of Chapter 5J-17 ist
3Qgmail.com (772)398-4290
Florida odninistrative code. ����rrcrE
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LOT 183
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60' R.O.W.- 20' ASPHALT ROAD
INDiAN BEND LANE
NU L/'AN t: Cer t i t i ed to: Feter Meyer dt Gina M. Meyer
.and Deli ns croup One Mortgage, Inc.
9 Chelsea Title, a division of FNT of Florida
ur a Coos t , L87468 Chic000 Title Insurance Co.
Blvd. Jensen Bew%. it 34957 1 hereby certify that the survey sho*n hereon is true and correct
ng Address: and is based an actual measeuremenis taken in the field. This
ensen Beach. FL 34M8 survey meets the Winimum Technkof Standards of Chapter 5J-f7
Floridaladministrative code. �,-M3
�il.com (772j 398-4290 IAmPS A_ o1s"h br tiCeshoa'
Ken Pruitt
PROPERTY APPRAISER • Saint Lucie Count
Y ®��
2300 Virginia Avenue, Fort Pierce, Florida 34982-5652
NAME: Gina M Reyer & Peter Reyer
ADDRESS: 5001 Indian Bend Ln
Fort Pierce, FL 34951
PARCEL ID: 1312-800-0015-000-5
CLERK: pereza
DATE: 9/4/201310:17:16 AM
LOCATION: pereza
1111111111111111111111111101
4426
Your application for a property tax exemption is being held in a suspense file, pending the receipt of further information
checked below. Please return this form along with copies of the following as soon as possible to complete your application
process.
Florida Drivers License F)_ J I/6-6
_ eclarahon of Domicile*
❑
Electric Bill ❑
Florida Vehicle Registration
❑ Probate Documents*
❑
Death Certificate ❑
Florida Voters Registration
❑ Final Judgment (Divorce)
❑
Marriage License ❑
Social Security Number
❑ Power of Attorney
❑
Entire Trust ❑
Alien Registration Card
❑ Guardianship Documents
❑
Affidavit ❑
State Benefit Affidavit signed by applicant and spouse (if married)Uc�/�
Verification of no residency based propertytaxexemption on property located at:
Other:
*DOCUMENTS MUST BE RECORDED WITH ST. LUCIE COUNTY CLERK OF COURT
Disability Exemption
VA Disability Letter ❑ Income Affidavit (DR501A) ❑ Physicians Certification (DR416) ❑
Other:
Additional Exemption for Persons Over 65
Sworn Statement of Adjusted Gross Income (DR501C) ❑
Income Tax Return for tax year ❑
IRS form 4506 ❑
Verification of household income ❑
Other:
PLEASE SUBMIT VIA MAIL/FAX/EMAIL
Mail to:
Ken Pruitt
St. Lucie County Property Appraiser
2300 Virginia Avenue, Room #107
Fort Pierce, FL 34982-5652
Attn: EXAP
Phone: (772) 462-1000
Fax: (772).462-1058
Email: PAExemptions@paslc.org
If all information is not received by MARCH 1 *, your application will be
processed for the exemption(s) you qualify for on that date.
*All information requested for the Additional Exemption for Persons Over 65 should be received by May 1 for prompt consideration.
I
• J '
I. THIS STRUCTLRE HAS BEEN OESIGNED IN ACCORDANCE WITH THE '97 STANDARD 12. ALL WIRE SHALL BE 012 THHN SOLID COPPER WITH GROWO. WIRING
BUILDING CODE WITH ALL RCVISIDNS TO CHAPTER 1606 FOR I S MPH WIND VELOCITY. PROTECTED PER NEC 199A ED. FIXTLRE LOCATIONS 5. TYFE MAY VARY.
2. ALL MATERIALS AND LABOR SMALL SE IN ACCORDANCE WITH THE ABOVE COOL AND ALL OTHER APPLICABLE CODES. MANDIS. ALUMINUM WINDOWS - TYPE. 512E OILITY ANLOCATION MAY VARY.
0. BUILDING CLASSIFIED AS RESIDENTIAL L-AWN STORAGE/LIGHT COMMERCIAL STORAGE. '
SO/12S PSF FLOOR LOAD. NOT FOR HABITATION.
L. WRITTEN DIMEHsIDNS SHA" TAKE PRECEDENCE OVER SCALED DIMENSIONS-
S. OUTSIDE OVFRALL DIMENSIONS CAN -VARY P RFTWFN LIMITS AS SHOWN. BUT METER
SPACING SHALL NOT EXCEED LIMITS AS INDICATED.
6. ALL LUMBeR TO Be r2 SYPID
7. ALL WOOD WITHIN 6' OF GRADE OR IN CONTACT WITH MASONRY SHALI- BE TREATED
TO .-0 RETENTION PACT OR IN ACCORDANCE WITH AVVM-LP-22.
L -%LSS ZE51GNED -C SUP®CR' :-L- _. :S PSF. -
i. AL- AL-"INLM SIDING:RCOP'�G -C BE TOO:. ALL+Y'---NPCRM'NG A5-M 3-2o9
52.000 MINIMIAM YIELD 5"ENGTH.
IO. USE as X 3/6• TYPE A SHEET METAL SCREW FOR ALL CONNECTIONS BETWEEN
AJ1E
1N1JM LAP SIDING AND FRAi'+e. LASE -• X 1 WlTH.1/=' AL.UM. BACK NCOFRNE
WA9lALIATTACHW oN COf++ECT101J3 BCTMR'EH ;ROOF .Y•D FRAME.
SPACING AS FCLLOIIY31
ROOF - PERIR4ERAL. MCMERS r OC
Roof' -INTERIOR mak LRS r OC
s1DING L• OC FIELD I IZ- OC, BOTTOM PeRw111yox
IL DOOR SMALL BE Z 1/I.' X 11/16- ALUMITARI E4TRUDCD FRAME WITH AN ALUMINUM
PANEL INSEAT.-ALIJMMA+M M TRIM AND ALUMtHUMA NG HINGE ATTACHED WITH
ALUMINUM RWITS. DOOR ATTACHED TO VERTICAL ZXL. OP`T10NAL DOORS INCLUDE
DCLmLi ALLl11HLM DOORS. GARA4e DOORS. AND PREHLI4G STEM DOORS. TYFE.
SIZE. oUI&WITY AND LOCATION MAY VARY.
it.. OPTIONAL EXTM41OR-WALL COVERINGS INCLUDE CORRUGATED ALUMINUM."
MESA ALUMINUM. A• LAP ALUMINUM. 5/8• PT T.111 SIDING. VINYL SIDING
WITN ENERGY BRACE BACKER 6 'PLEKO' STUCCO ON Ilia* DENSE GLASS
GOLD. Root' COVERINGS INCLUDE A&_UMINI.M OR SHINGLE ROOF OVeR 5/8.
PI.YW000 WITH 2 "YeRS Ot' 15 LH. PELT.
IS. USE 7/le• X 1 S/L• 16 GA. STAPLE FOR ALL CONNECTIONS BETWEEN WOOD
SIDING/ROOF AND FRAME.
16. IX/. SYPKD TBG FLOORING SLRFACED STAPLED WITH 7116• X 1 311.' 16 GA.
STAPLES a/.' OC OR PLYWOOD FLOORING STLE AP6. OC EDGE /'0. OC FIELD,
17. FOUNDATION. FOOTING ANO ANCHORING OF UNIT WILL Be THE OWNER'S
RESPONSIBILITY 7- 0 CHECK WITH LOCAL CODE AUTHORITY :O VERIFY SP5CIFIC
REQUIREMENTS IFFEC-ING THE INSTALLATION, SETt.P AND UTILITY
CONNECTIONS -O THIS BUILDING, 'HE PURCHASER ASSUMES ALL
RESP+DINSIBIL..'f FCA COMPLIANCE 'MIT4 LOCAL. -_DUNT'• OR I.-IJNICIPAL :ODE
REQUIREMENTS FOR THIS STRUCTURE.
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`ROBIN BULDIM INC.
PO BOX 1"7
LAKE WALES. FL. 33833
(941) 676-1i9f.
RUffY
CLASSIC
AMERICANA
RCA 96
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FILE CU P,
L TED'jS S_ _. DS, INC.
MANUFAC i URER'S
CERTIFICATE OF ORIGIN
PORTABLE UTILITY BUILDINGS
The undersigned manufacturer hereby certifies that the new
TED'S SHED described below, has'been transferred to:
Ted's Sheds of Malabar
whose address is 1044 U.S. Highway 1
Malabar*, FL 329500000
on Invoice No N/A
Serial No. 144492
Size & Style 10 X 12 CLASSIC
Date of Manufacture October 2000
Month Year
Said manufacturer hereby certifies that this written instrument
constitutes the first conveyance of said shed after its manufacture
and that the manufacturer's serial number set fortl-s above has not
been and will not be used by the manufactures on any other shed
manufactured by said manufacturer, and that there are no other
manufacturer's certificates issued by the manufacbuirer for the
described above. r'
By
President