HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due:
Planning & Development Services
Building & Code Regulations Division
2306 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553
Permit #
130� -d05 i
SPECIALTY PERMIT APPLICATION
❑ Electrical ❑ Plumbing
❑ HVAC
❑ Fence
SC
, AB teen
❑ Shed . ffDemolition
❑ Gas
❑ Siding
St 4c/
Cie County
Seepage 2 forninssttructions and additional paperwork required for specialty permits
1. Location/Site Address: �(/� O s
OCG4n9 AL *
3 0 cT&✓7I en Se i4
3Vff
2. Parcel ID Number: (��/ " 8/0
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Office Use
Only
Section
Township
Range
Map Page
Zoning
I Land Use
Initials
3. Complete Description of Project or Wa
11 P :;e 9 0Yi fi i
4. Owners Information 115
55. Contractors Information
�i p Name: !21f)nl d' 6,1mi,14 11 sylAhJ-ylq FL Reg/Cert #: 613(f
Address: & ;O�-YOI County Cert#: 7 o"3
City: J"J" _8e,6A State: /Cli Business Name; �� �f� �OJ�i/ sLIL %JC.
Zip: 3!'�/ ,�% Phone:7%Z5/).51-09 Phone:Z;V )&0,37%h Fax: 77-22-3; 2/ 9/
6. Value of Construction: $ igloo
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is corre d that all work will be done in
�c liance with all applicable laws regulating co tion an
J�41-7
PRINT OWNER OR CONTRACTOR NAME SIGN URE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF 0 q i4 n
ACKNOWLEDGED BEFORE ME THIS `tJ� DAY OF 210 BY ,
WHO IS PERSONALLY KhIOWN TO ME OR WHO HAS PR DUCED F _-- ♦Zf qzt 5 1iC �n�tiS
AS
CORLENE EDLUNDCHEF
NOTARY PUBLIC
-- - — :irnttFtOlilDl
OF NOTARY TYPE OR PRINT NAME OF NOTARY Comffi# EE209993
COMMISSION NUMBER E7 im 6/2012016
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 TO OWNER: FAILURE 'T(" _ 'CORD A NOTICE OF COMMENCEMENT MA" 'ESULT IN YOUR PAYING TWICE FOR
IMPROVEM , . { TO YOUR PROPERTY. IF YOU INTEND' )BTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOL.: v.0TICE OF COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WrM 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
lication may not be used for any actiidtv that includes gtructural
alteration. The information to be provided with this application includes:
1. Location/Site Address
2. Parcel ID Number
3. Description of Project or 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:34 82, All permit applications must be filled out completely before submission. No applications will be
accepted -%oar p',r'ocessm after 4:30 P.M. For assistance in completing this application, please call (772)
= ---- _
4625duruig;regular office hours (8:00—A1VI 5:00 P1Vl),"1VlondaytliroughFriclay
-'NOTEs'Erriergency'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.
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1111�
Planning& Development Services
Building & code Regulation Division
2306 Virginia Avenue
Fort Pierce; FL. 34982
Phow(772)462-2172 Fax:(M)462-6443
September 05, 2013
ASBESTOS NOTICE
Asbestos Notice to Contractor
ADAM SMITH BOBCAT SERVICE INC
ADAM SMITH
661 NE SPENCER ST
JENSEN BEACH, FL 34957
RE: Building Permit Number 1309-0051
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notify the Department
of Environmental Protection of any intentions to remove asbestos when applicable in accordance with state and federal
law.
Signature
Date
9/5/2013 11:06:22 AM