HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fcc Due: P.eceipt# Permit #
St. Lucie County Building chi Zoning
2300 Virginia Avenue Ft. Pierce, FL34982-5652
" Te1.561-462-1553
�ORt p`
SPECIALTY PERMIT APPLICATION
sc
❑ Electrical. A'"' Plumbing ❑ HVA_C ❑ fence 4440/0 eN�F®
ElShed ❑ Demolition ❑ Gas ❑ Siding 00,
Eee page 2 for instructions and additional paperwork required for specialty permits
1. LocationJSite Address:
2. Parcel ID Number: 340 Z (V 4791 (v ou
Office Use
Section
Township
Ranee
1VIa Page
Zoning
Land Use
Iitin,
Only
I Descriptionof Projector Work Activity:
4. Owners Information
Name: -J CA%ACE:5 C.0„r.�,�
Address: . ( C'i'W�S AVC-
5. Contractors Information
FL Reg/Cent #:
County Cert#:
City: FV State: )'::�c Business Name:
Zip: 3lr 0 2- Phone: 77 2S9- '79p1"P—hone
�. Z
6. Value of Construction: $ -,;?o0 . D f>
_ Fax
OWNER'S AITIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done
in compliance with all applicable laws regulating construction and z i�ng.
PRINT QUALIFILRS/OWNERS NAME NATURE F QUALIFILR/OWNGR
STATE OFFLORIDA, COUNTYOF ACKNOWLL"DCTDnGFOR[-MC"I'IiIs DAY OF
20By ( °�JIiO Is VrRSONALLY KNOWN TO Mf.OR WFIO ]-IAS PRODUCCi�
C. As lD1;N"I'IFICA'1'ION.
hA
SA l NTUI ; F NOTAIz 1'YPIi 1 MUNl' NAM I:0P NfY R
TITLC: NOTARY PUBUC COMMISSION NUMIIIiR
Rt i nrir r'rnmly Fnrrialfv Prrmit Annlirnlinn rcv- R/25/05 dmL*
Planning & Development Serv= Department
v Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(72) 462-1553
OWNER/BUILDER AFFIDAVIT DISCLOS 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 applicabI aws,
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 meet
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 liable for e
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction pr ject-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related edical
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 Y��_
ported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. d and acknowledged on this
rJ u day of aty of 20 ZO. (�
Signature
STATE OF FLORIDA
COUNTY OF
The foregoing insftWent was acknowledged before me this 17 day of b 20 ,;�,,
by who is personally known to me, or who has
produce - as identification.
4.kE�) if
Signature of ary Typ Print Name of NQtv Seal)
Title: Notary Public Commission Number
SLCPDSD Revised 07/22/2010
@l• + ty;.; AUOREY B. HUMPHREY
MY COMMISSION # EE 061159
EXPIRES: March 6, 2015 I.
;I '•col �•,',��`� Bonded Thru Notary Public Underwriters
t�_ �oo�na�.i�nn�m+recmaac�ra�vumssaimJ3
i ..
1�
a
•
-
Gr ,
-z— ry
r -f —'tr'_ .• ._
I. .. _ .i.
j I
_ Vim. _ .�_ 71`* —.:i.:,
.
ST. LUCIE
: I
COUNTY UTILITIES - P.O: •BOX
t
728 FT.
PIERCE FL 34982
SEWER
lam' RES
NAME
-) I
;
METER SZ.
$ ` ,
.ey..IRR
SECURITY DEP ' `
SERVICE
DDRESS
I {
SERVICE FEE
`'Ty (1 V
SAME DAY FEE
OVERTIME FEE
METER INSTALL
CFC/WATBR
SUBDIVIS
BILLING '
ON f `i�� -i° LOT
`
DDRESS �:? `f ®�t?,/ ,C' fl ✓ JS
F J(I-I'C /z
r BLOCK -
/ 4r �_—'�'�
92-•
MOVE IN/CLOSING
DATE
FPUA CFC
PHONE #?
;
CFC/SEWER
l r
$
GUAR. REV.
LATERAL
TOTAL '
This application
services to
rules, and regulations,
the Utility
CUSTOMERS
hereby request and;authorizes the Utility
the premises,described above i*accordance with
which by reference are made a part
promptly for such services in accordance with
DEPOSITS ARE NON NEGOTIABLE OR
to render water and/or sewage. disposal
the Utilities present or future rates,.
of this contract. Applicant.agrees to pay
the established rules and regulations.
TRANSFERABLE.
CUSTOMER. , --'"
SIGNATURE'...
SOCIAL SEC/ r —�
FED ID_� a . '3 7 f .
NAME OF 3PWS,E /
SPOUSE SOCIAL SEC.
/OFFICE USE ONLY.. i
DATE RECEIVED t G%Llx)�--C ASH CHK # �� C�, RECEIVED BY
Property Appraiser - St.Lucie ,,Mty, FL
Page 1 of 1
PROPERTY RECORD CARD
J Charles Couture
Record: 1 of 1
<<Prev Next » Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
&\31111 00
Site Address:
5907 Balsam Dr
ParcellD: 3402-610-0516-000-6 y� G2<
Secrrown/Range:
12 :36S :40E
Account #: 38622
Map ID:
34/12S
Land Use: SF Res
Zoning:
RS-4
City/Cnty: St Lucie County
Ownership and Mailing
Legal Description
Owner:
J Charles Couture Lisa Couture INDIAN RIVER ESTATES -UNIT 09- BLK 87 LOT 20 (MAP 34/12S) (OR
Address:
5401 Citrus Ave
3375-1116)
Fort Pierce FL 34982
Sales Information
Assessment 2011 Final Total Land and Building
Date
Price Code Deed
Book/Page 2011 Final: 46100 Land Value: 6900 Acres: 0.23
3/6/2012
53200 0112 SP
3375 / 1116 Assessed: 46100 Building Value: 39200
10/20/2011
43000 0112 CT
3334 / 2563 Ag.Credit: 0 Finished Area: 1089 SgFt
9/25/2003
99000 00 WD
1810 / 2827 Exempt:
5/1/1986
6700 00 CV
0502 / 2116 Taxable:
10/1/1979
1500 00 CV
0324 / 1488 Taxes: 937.94
BUILDING INFORMATION
(iom 7
m t
OAa fa
Exterior Features
View:
-
RoofCover:
SD - Dim Shingle
RoofStruct:
GA - Gable
ExtType:
HC-- HC-
YearBlt:
1987
Frame:
-
Grade:
C- - C-
EffYrBlt:
1987
PrimeWall:
WS - Wood/Sheath
StoryHght:
0010 -1 Story
No.Units:
1
SecWall:
-
Interior Features
BedRooms:
3
Electric:
MX - MAXIMUM
PrmintWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt1Fl:
1/2Bath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CU - Carpet
%A/C:
100
%Heated:
100
%Sprinkled:
0
Special Features and
Yard Items
Land Information
Type
Y/S Qty.
Units Qual. Cond.
YrBlt. No. Land Use
Type
Measure Depth
DWC - Ddv-Concret
Y 1
720 AV AV
1987 1 0100-SF Res
215 -Front Ft
80 125
FNW6 - WOOD FEN 6' Y 1 258 AV AV 2006
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://www.pasle.org/paslc/prc.asp?prclid=340261005160006 6/7/2012