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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: � ;� . j _ \ -4 DATE FILED: II O 0 " T PLAN REVIEW FEE: 0 - RECEIPT NO.:-. ,. PERMIT NUMBER: CONCURRENC`YTEE: , . RECEIPT NO.: CERT. CAP. NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT.SERVICES DEPARTMENT BUII;DING & CODE REGULATIONS DIVISION - t 2300 Virginia Avenue ®�,j o eo t),q'n Ft Pierce, FL 34982-5652 SCANNED M462-1553 � DY P St. Lucie County APPLICATION for BU]1LDEYG PERMIT - CERT MCATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: l (0 I S 2. PROJECT NAME-. SITE PLAN.NANE: / 3. PROPERTY TAX ID #: 3 © -3 q�l - 8 00 - 000 4, GAL DESCRIPTION (attach extra sheets if necessary):D l�2 0�3Cd �S 8 2 AID C o -.2602 2 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. S. LOT NO. 9. PARCEL SIZE (ACRESISQ FT.): /2 +" k res LOT DIlVIENSIONS: 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WOWIC� ITY: nS�tu� r oc` `` i1��©Sure sarlr Cc (! g 11. SETBACKS (ACTUAL) FRON� BACK: RIGHT SIDE: LEFT. SIDE..Py 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] WI S OOR OTHER ( EPS C1FY)R RENOVATION [ ] [ ] COMMERCIAL [ l [] n / 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: 1,11 SE 15. SF. FT 1st FLOOR: STRUCTION: $ d O 16. VALUE OF CON The value of consimcdiou 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 it is demonstrated that the submitted figures am not consistent with similar types of construction activities. Ifthe value is $2500 or more, a REWRDEDNotice ofCommencement must be submitted with this application. SLCCDV Form No.: 001-02 11 UPDATED 6125109 OWNER INFORMATION< i� I n0 NAME: a ADDRESS: 0o- CITY. 4�7. &-sS ( to u4�% STATE: o _ _ PHONE (DAYTIME):,'&,ff Email: IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. l % FEE SIMPLE TITLEHOLDER: ADDRESS: CITY. STATE: ZIP. - PHONE (DAYTIME): C-j CONTRACTOR INFORMATION ST. of FL REG.CERT #: "BUSINESS NAME: f a QUALIIaIERS NAME: or 39!: ST. LUCIE COUNTY CERT #: U CITY: (-_- STATE: t- / . ZIP: 3 Y 7, g -!3 PHONE (DAYTMEM): aZ 9 — z Y Yd FAX NO. f j _ 0 ll 8 Email: ARCHIT/ENGINEEIL CP D n xe- �1 , K 4 e Ce l�at �' t �"I i Qf� e Q% n C ADDRESS: 321" ' L`A ,kj'r- k ! 'Sfy-e- Six 1 f'e CITY• , �' .� o STATE: F zip: _3 3 0 PHONE (DAYTHAE): (E () 106 3 ' - / y BONDING COMPANY: ADDRESS: Cfi'Y: MORTGAGE LENDER: ADDRESS: CITY: STATE: i ZIP: STATE: ZIP: MORTANT 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. CATION: CERTIFI This appHeaiion is hereby made to obtain a permit to do the W0&4sad 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 andthat all work will be performed to meet the standards of all laws regulating constraction in this jurisdiction. I undeistand 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 deedfoi. any restrictions which may apply. -Tbe—following=bnilding:.permit applications are exempt from' undergoing a full cone irrency review: room . additions, accessory stractures (all types), swimming pools, -fences, walls; -signs, seieen rooffis, utility substations & accessory uses to another non- residential use.___-- = --- - - - - r- - ----- --- - ------ NOTICE TO -OWNER.------ ---YOUR FAMURE- TO. RECORD A NOTICE OF C131111VI1;N CENIENT MAY RESULT IN PAYING TWICE FOR I&a'ROVEMENTS TO YOUR PROPERTY. A NOTICE OF - --- ---Coll TVE NC�LMHST BE -RECORDED -AM POSIMD ON-M JOBSM BEFORE THE FIRST INSPECTION: IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CONaNIENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACBhaNT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN �GQ(1D FAITH TO DELIVER A COPY OF TILE CONSTRUCTION LIEN LAW NOTICE TO TBE PERSON WHOSE PROPERTY IS SUBJECT TO 1�1TT &CHMENT. Opel, OWNER R CO CTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF. The foregoing instrument was acknowledged before me this QP` day of by ���. ��4.�,�►-� who is personally known or has produced as identification. qsipl a of Notary STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this day of , 20 by who is personally known or has produced Signature of Notary as identification. Commission No.> \3 ;1Pw4'P�B�ea�Alp- CARRUTHERS ommission.No. (S�n "= MY COMMISSION # DD796130 "�oF�o?�� EXPIRES June 09, 2012 NOTE: TWO (2) SIGNATURES ARE 3ARE15REQ FU -IIRED.a EACH SIGNATURE MUST' BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNERSUMB1 ' i��u' Si'i`�1Ea� ir?'Z3"�"�'l�utluVN A i i V A DDTi AD TA QifAlU THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WELL BE REQUIRED FOR ALL OWNERMUILDER APPLICANTS. For specific instructions see appropriate permit checklist ,_... Br ` 0 ' OFFICE USE ONLY SECTION TOWNSHIP 6 RANGE �� NO. MAP ' ZONIAiG. LAND USE LOT CVG % . TAZ NO. , FLOOD ZONEM MAP # - - -1P°-FLR ELV -_- - _ __:; :: MAX HGT- - - -- — CONST TYPE -- --- _ - -- OCC[TP E- _NdA7�OGCUP_— -- _#_OFFERS --- - RII4KLERS- _-- --- -- WATER -- -STORMW_ATM _ _-- -- LOT OF-REC LOT OF_REC— --- - T=STLF� REQUIRED - LO�SI'LTI— APPROVED -- Baore l/1990 . - _ : = A&er'l _I _. - - ---- _ - - FEE -_-- ---- — - . FEE REPORT --HABITABLE--_ -COD AREA LIBRARY PUBLIC BID PUBIC ACT PARKS BRACT IMPACT BRACTIEU FEE- FEE' FEE CORRECTION FL SCHOOL ROAD CREDIT Y N LAW EIV . BRACT MACT BRACT FEE FEE F]RF"S DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE VA FEE. FACT REQUIRED FEE .ANCE FEE SPECIFY MECHANIC ROOF NON -CONFORMING MrSCEri-aNEOUS FEES - ELECTRIC. GAS LOT OF RECORD r PLUMBING FEESIRID SENT TO ADDRESSING: / REVIEWS 1 OITNTFR I ZONING REVIEW REVIEW I REVIEW I REVIEW 'VEGETATION I REVIEW I' .REVIEW 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, HEATERS, 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. OWNER OR WNTRICTOR SIGNATURE STATE OF FLORIDA COUNTY OF.�v_4 The foregoing instrument was acknowledged before me this day of 20 �\ , w o is personally known or has produced as identification. Sighature of Notary a geaarn�e gqnrt�¢���—pgggL., p9�]30. LtlY� �b"B1�RU 1 71�tl'Ce�Commission Now ��o e MY(80 )MISSION # DD7961 9?o,Aot, EXPIRES June 09, 2012 (407)398-0153M FloridallotaryService.com CONTRACTbA SIGNATURE STATE OF FLORIDA COUNTY OF s� The foregoing instrument was acknowledged before me this\—k\-',\day of 20 �\ by who is personally known or has produced as identification. Sigdature of Notary Commission No. \ 4,"`<';��) '�`�RRUT�IE'�' MY COMMISSION # DD796 44 EXPIRES June 09, 2012 (407) 398-01f' u PlonOanOtaryaervice.cuiu 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 OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist. - ST. LUCIE COUNTY BUILDING & ZONING 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 772-462-1553 FILLED LANDS AFFIDAVIT 1, the undersigned, am the ow er of the (Tax ID/Legal description/ 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 r� nor liable to provide for, or maintain in any form, adequate drainage off my property which t will not adversely affect the immediate community. �- 0 0-7 ALP.OA, s a s • J t Property Owner Name Property Owner Signature Date STATE OF FLORIDA. COUNTY OF . ACKNOWLEDGED BEFORE ME THIS \ DAY OF �0- BY +, �i I WHO IS PERSONALLY KNOWN To ME OR WHO HAS PRODUCED IDENTIFICATION. SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY (SEAL) NOTARY PU13LIC TITLE ) �� �a 0 COMMISSION NUMBER ioo`t,pv : F�PUIL CARRV 1�i 5:ll�e�,' °- MY COMMISSION # DD796130 EXPIRES June 09, 2012 (407)398-0153 FloridallotaryService.com 09/30/2011 04:33 772589ga59 K.S.M.ENG. PAGE 04/06 ` KS KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. 9C. MARTIN (772) 337-7755 PO. Bpi( 78�1377, SEBASTIAN, FL 32978-1377 SERA URNS (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net ST. URNLUCIE (772) 768-8488 FAX (567) 845-8876 E-Mail: KSM@ICSMENGINEERING.NET PAX (772) 589-6469 C.A.- 5693 September 2.9, 2011 Certified Building Contractors, Inc. 747 SW South Macedo Blvd Port St. Lucie, FL 34983 Re: Asselberg Residence 61 o1 South Indian River Drive Fort Pierce, Florida Permit #: 1012-0041 — Main House KSM Project #: 110277-10d Dear Sir: Enclosed, please find the nuclear density test results performed on the generator slab at the above referenced project. 5 to call. �artment - 772-462-6443 Fax to: 772-879-0110 JEK/lcs Rnnnlri G. Keller. P.E.: 37293 / SI LIC. No.: 860 1 Julie E. Keller, P.E.: 68300 09/30/2011 04:33 7725896469 K.S.M.ENG. PAGE 06/06 KS K.ELLER, SCHLEICHER & MacWILL1AM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 P0, BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 wwwAsmengineering.nat MELBOURNE p21) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (7721229-9093 G.A.: 5693 FAX (772) 589-6469 DATE TESTED: PERMIT # CONTRACTOR JOB LOCATION: r Soil Description: Max. Dry Density: MOISTURE -DENSITY RELATIONSHIP MODIFIED PROCTOR (ASTM D 1557) September 29, 2011 1012-0041 — Main House Certified Building Contractors Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida KSM JOB #: 110277-10p 110% _M40 107 I----T—----I—_-�I--r-r---T--�--, I r I I I I 1 1 I I I I I I I I 1 106_L__I I r I I I I I I I I 1 l 1 I I I I I I I I I I I I 1 — —+—— I I I I r 1 I I I I I I I I I 1 I I I I I I I 1 I I 104 --- -- I--_�--Tr--T----I 1 I I I I I I I I I r I I I I I I I 103 I 1 I I I r I 1 I I I I I I I I 1 I I I I I I I I I 102 I---_t--_-t_�,_. —I-- .r__.t.--...r--� I I r I I I I I I 101 I I 1 I I I r I I 7 8 9 10 11 12 13 14 15 Moisture - Percent of Dry Weight Gray Sand 106.3 P.C.F. optimum Moisture: 12.4 Percent Julie E. Keller, P.E. 'resident Ronald G_ Keller, P.E.: 372931 SI Lic. No.: 860 1 Julie E. Keller, P.E.: 68366 09/30/2011 04:33 V x 77258qF;A59 r K.S.M.ENG. \tom/ PAGE 05/06 KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING ANpeBESTIING INC- MARTIN (772) 337-7755 P.O. BOX 78-1377, SEBASTIAN, FL 32978-1377 NIE BASTIA l; (a21) 589-base PALM BEACH (561) 845-7445 wwwAsmengineering.net ST. URNLUCIE (321) 225-9093 FAX (561) 845-8876 E-Mail. KSM@rKSMENGWEERING_NET FAX (772) 229.9093 C.A.: 5893 SOIL. COMPACTION REPORT ASTM D 1557 and ASTM D 2922 DATE TESTED: September 29, 2011 KSM JOB #: 110277-10WESflcs PERMIT #: 1012-0041 - Main House CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Floride MATERIAL: Gray Sand ITEM TESTED: Generator Slab ----------�--_ TEST LOCATION - DEPTH MOTS- PEN- ^ DRY -- MAX ©RY - - - PERCENT OF SAMPLE TUBE READ DENSITY PROCTOR COMPACTION -- ------------------------------------------VALUE _-------------- 1. East 0" -12" 7.6 44 103.3 106.3 97.2 2. West '° 7.5 50 104.1 if97.9 Ronald G. Keller, P.E.: 37293151 Lic- No.: 860 1 Julie E. Keller, P.E.: 68366 s sum aum �1 WOMB lomm N3wm A N19MAfA TO &• :03001 HBLVA i 4:&R�i� �� O mat un n0A P E >ISPAMq imam MA pa m( Ot AIQ l31:1'I *o awn mnwININ 9WI001 3t HUH2 IWIMMOSIAN3 GUMET swaovwrn+rorn � 00 •Z, . 00 •T 00't aWS/M VCHAd OOOZ 0699£2t 00.8 0o -a 0002 r�w.�n ion as A"M#O&XMN . a 9d13 aflNa'18 twwis d tt£bOt 08Sa00t 'S 00,b4 moan mow-" �oaruo�na zs9E£93E w•Nwau N;T45nOII 33S3Id ,,gym maprowsmoo LIOMM 363 aQ V3AIa WIONI 3 1019 IT/90/01 MO MiOrdAM =w•N vdw*w mmv*W avaD�M i 11/90/01 399 0NI SHOLMMIN00 SMICnInG (13I:1I1a33 SL8820£ soy+.wa•�o �aar+�w.v a.�av�op ycaa+.w.v r• �•eawo� �oOPwn :o•�iWlYquli awowns+gQ saorw+w :o t 3 mid XBUO;r Air 6T/TO 3E)Vd lh-- k-m a3IJI1830 OTTO-6L8-ZLL WOT TTOZ/80/ZT 12/08/2011 10:46 772-879-0110 CERTIFIED BLDG '-'1T PAGE 03/19 z - 0 i 53918928 6AWM000c Qdonr►Ilrnr Qd4tir b�Nu�r Of4we"10mr. 13175 t'-uercoe vma v�gd�awbr oarra.rN ••-11/04/11 6101,8 INDIAN FIVER DRIVE D IbfAY - MO �C VE ootNlybYudolR" o�� - 07 a 00 .5. 00 10025754 109E29 ANSM DELATORRE UNASS IBNED oans ae�srow �wornoee wowr F� 1.00 r 4782a FUEL SURCHRRBE 1600 ' ?49 ENVMMMENTAL CHARGE rmn slAmemm go IU dWAMMMditCWe arak - I '•1 do YourCfn"+19 Of adtr '1'�rt�NYhdzarda? .cola we Yourcowes when atvump2 "OLI usa Yoursate* cones? �,•o9her�ivaro? n�f000ndf;• � s W d dMl ad d awam MIL Cw �0 MpO�I� MwR+11101 mod+. alfwfa w 0101"m.eolpC.s �.vr�w tr lw. 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