HomeMy WebLinkAboutSUBMITTED PAPERSDate: /„ '/ Fee Due:)", .�' O(,/ Receipt# % Permit #
Planning & Development Services
Building & Code Regulations Division SCgN/VE®
2300 Virginia Ave. B
Fort Pierce, FL 34982 `St' ku -Y
s count
unty
SPECIALTY PERMIT APPLICATION
❑ Electrical lumbing ❑ HVAC ❑ Fence
0 Shed 2elDemolition ❑Gas ❑Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
�/�Y� �d��ai2 �J�.tve 4
1. Location/Site Address: %2�G� .3 �7 qel,
2. Parcel ID Number: /4(/,L/,-
3.
Office Use
Only
Section
Township
Range
Map age
Zoning
Land Use
Initials
,
Description of Project or Work:
�nl )
4. Owners Informattion �e(42
5. Contractors InformationName:(�� G� FL Reg/Cert #: `1
Address: �j�p �%�/Gz 0&j;a: County Cert#: 161 Z/�
City: State: L Business Name:�%�����/��
Zip: �%� �9 Phone: 7 72-3 2 3-75VfIone: _667 92 7 aft3x• 772 97I y.J
6.. Value of Construction:. $
OWNER'S AFFIDAVIT: I certify that all of the information contaiped in this applicatio work will be done in
compliance with 11 applicable laws re latin c ction a
Ci�
PRINT OWNER OR CONTRACTOR N ME W61r,
SIGN OF O CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF�Au 20 I� BY
J0
WHO IS PERSONALLY KNOWN TO ME %/ OR WHO HAS PROD ED
ENT.I I AINO
9whi
XSITURE OF T E OR PRINT N ME F NOTARY :;4,v P�" = EMWAWSMITH
�j:MY COMMISSION # EE 0266132014
COMMISSION N' ,'�,��` BondedRhru Notary Public September
denvriters
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
Property Appraiser - St.Lucie minty, FL
Page 1 of 1
PROPERTY RECORD CARD
Sondra W Jaksch Record: 1 of 1
<<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
\,UCIE CO
Site Address: 4640 Arcadia Ave
ParcellD: 1416-601-0060-000-3 RG,y
Sec/Town/Range: 17:34S :40E
Account* 7692
Map ID: 14/17S
Land Use: SF Res
City/Cnty: St Lucie County'
Zoning: RS-3
Ownership and Mailing
Legal Description
Owner: Sondra W Jaksch Joseph W Jaksch PLAT OF INDRIO-UNIT 1- BLK 17 BEG AT SW COR LOT 6 RUN NLY
Address: 4640 Arcadia Ave
80.04 FT, TH ELY H WITH N AND S LINES OF
Fort Pierce FL 34946-6409
More...
Sales Information
Assessment 2011 Final Total Land and Building
Date Price Code Deed
Book/Page 2011 Final: 27100 Land Value: 5800 Acres: 0.3
1/7/1993 100 01 WD
0825 / 2177 Assessed: 27100 Building Value: 21300
6/20/1989 0 01 WD
0643 / 0199 Ag.Credit: 0 Finished Area: 728 SgFt
12/1/1982 30600 00 CV
0391 /2508 Exempt: 25000
Taxable: 2100
Taxes: 42.73
BUILDING INFORMATION
Exterior Features
View:
-
RoofCover:
SA - Asph Shingle
RoofStruct:
GA - Gable
ExtType:
HD -HD
YearBlt:
1976
Frame:
-
Grade:
D - D
EffYrBit:
1977
PrimeWall:
BP - Conc Block
StoryHght:
0010 -1 Story
No.Units:
1
SecWall:
-
Interior Features
Bed Rooms:
2
Electric:
AV - AVERAGE
PrmintWall:
DW - Drywall
FullBath:
1
HeatType:
-
AvgHt/Fl:
STD
1/2Bath:
0
HeatFuel:
-
Prm.Flors:
CU - Carpet
%A/C:
0
%Heated:
0
%Sprinkled:
0
Special Features and Yard Items
Land Information
Type
Y/S Qty.
Units Qual. Cond. YrBlt.
No. Land Use
Type
Measure Depth
SDSF - SITE DEV S-F
Y 1
1 AV AV 2001
1 0100-SF Res
210 -Front Ft
80.04 160.56
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://www.paslc.org/paslc/prc.asp?prclid=141660100600003 6/5/2012
y _
STATE OF FLORIDA PERMIT NO. ��l !� 7�✓
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
--- -- -APPLICATION.FOR: -
[ ] New System [� Existing System I ) Holding Tank ( ) Innovative
( ] R_pai= [ :) Abandonment _Temporary
APPLICANT:
AGENT:
MAILING ADDRESS:
'7
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT.. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105 (3) (m)- OR 489.552., FLORIDA STATUTES. IT IS THE
_ APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. '
PROPERTY INFORMATION
LOT: _
BLOCK: SUBDIVISION: I
nd~/ uh
PLATTED: bl�
PROPERTY ID
# : J4L IO ` -OD �� —�Z�
ZONING: 1 C.
I/M OR EQUIVALENT.- [ Ye ]
PROPERTY SIZE; DrlV ACRES WATER SUPPLY: ( PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS -SEWER AVAILABLE AS PER 381.0065, FS7 [ Y NQ ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 4640 A `� 1A 1'v e P14Xe,-e
DIRECTIONS TO PROPERTY: wee-(��a-t��- ._
BUILDING INFORMATION
Unit Type of
No Establishment
1 '11 t
2
3
4
[ ] Floor/Equipment Drains
IA401 _/),
SIGNATURE:
[RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms AreaSgft Table 1, Chapter 64E-6, FAC
1013
[ ] Other (Specify).
\=14S
DH 4015, 08/ (Obsoletes previous editions which may not be used)
Incorporated 64E=6.001, FAC
DATE: �A 0
Page 1 of 4
STATE OF FLORIDA
- DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
.. .i EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION
JWnz
APPLICANT:Q
-CONTRACTOR / AGENT:
PERMIT #
- - - LOT::---- _BLOCK-:.,._:, _� ._,_..._ .SUBDIV_:. ((o — (o7OlID#sue OO--'—tenO - - /y y1� W`-��---
--a avaaaaaaaaaaaaaaaacaanaaaaa=aaaaaanaaaaaaaaavaamaaaaan���aa�a�a�aa��_a eaaamaaa
-TO-BE--COMPLETED--BY -FLORIDA REGISTERED-.-E_NGINEER,--DEPARTMENT--EMPLOYEE, SEPTIC -TANK.:- TANK= CONTRACTOR- OR
OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBZ41TTED DOCUMENTS. COMPLETE ALL APPLICABLE ITEMS.
COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE'CERTIFIED.
EXISTING TANK INFORMATION
[ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: " MATERIAL: 1. W��BAFFLED:' [Y / N] ----
[ ] GALLONS -SEPTIC TANK/GPD ATU LEGEND: MATERIALs ..BAFFLED:.[Y / N]
[-----] GAfiONS-GREASE-INTERCEPTOR-- L-EGEND- MATERIAL:— — --
[ ] GALLONS DOSING TANK -LEGEND: MATERIAL: # PUMPS:[ ]
a aaaaaaaaaaaaaaaaaaanaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaanaasaaaaaaaaaaaaaaaaaaa�aasaaaaaaaa
I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON / / BYE
THE VOLUMES SPECIFIED AS DETERMINED BY [ DIMENSIONS / FILLING / LEGEND ], ARE FREE OF OBSERVABLE
DEF=*EAKS, AND A SOLIDS F E TION D ICE O LET FILTER DEVICE ] INSTALLED.
SIGN URE OF L CENSED ONTRACTOR BUSINESS NAME DATE
axaaaaaaa agaaaaa�avnaaaaaaapaaaaaaaaaaaaaaaaaaaaaaaaaavaaaaaaaaaaaaaaaaaaaaaaanaaaa�aaaaaaa
E- aSTING DRAINFIELD INFORMATION
[ ] SQUARE 'FEET
PRIMARY DRAINFIELD SYSTEM
NO. OF TRENCHES [
] DIMENSIONS: X
[ ].SQUARE FEET
SYSTEM
NO. OF TRENCHES [
] DIMENSIONS: X
TYPE OF SYSTEM: [ ]
STANDARD [
] FILLED [
] MOUND [ ]
CONFIGURATION: [ ]
TRENCH [
] BED [
11
DESIGN-: [
)HEADER [
] D-BOX [
] GRAVITY SYSTEM
[ ].DOSED -SYSTEM
ELEVATION OF BOTTOM OF DRAINFIELD
IN RELATION TO
EXISTING GRADE
INCHES [ ABOVE / BELOW]
SYSTEM FAILURE AND REPAIR INFORMATION
[ ] SYSTEM.INSTALLATION DATE TYPE OF WASTE [ ] DOMESTIC [ ] COMMERCIAL
[ 7 GPD ESTIMATED SEWAGE FLOW BASED ON [ ) METERED WATER [ ] TABLE 1, 64E-6, FAC
SITE [
] DRAINAGE STRUCTURES
[
]
POOL
CONDITIONS: [
] SLOPING PROPERTY
[
]
NATURE OF [
]HYDRAULIC OVERLOAD
[
]
SOILS
FAILURE: [
] DRAINAGE / RUN OFF
[
]
ROOTS
FAILURE [
] SEWAGE ON GROUND
[
]
TANK
SYMPTOM: [
] PLUMBING BACKUP
[
]
REMARKS/ADDITIONAL CRITERIA
[ ] PATIO / DECK [ ] PARKING
[ ) MAINTENANCE
[ ] WATER TABLE
[ ] D BOX/HEADER
[ } SYSTEM DAMAGE'
[ )
[ ] DRAINFIELD
u m
SUBMITTED BY: TITLE/LICENSE-(lDATE: ✓
DH 4015, 08/09 bsoletes revious editions which may not be used)
Incorporated 6-6.001, FAC Page 4 of 4
Planning & Development Services
Building & Code Regulation Division
Permitting Department ASBESTOS NOTICE
2300 Virginia Avenue
Fort Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578
Asbestos Notice To Contractor
06/05/2012
SONDRA W JAKSCH
4640 ARCADIA AVE
FORT PIERCE, FL 34946-6409
RE: Building Permit Numbe 1206-0069
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