HomeMy WebLinkAboutSUBMITTED PAPERSFee Due:
Permit #
Planning & Development Services
Building & Code Regulations DiviSioll
2300 Virginia Ave.
Fort Pierce, FL 34952
_ ....,....... _..,.,_....,,.. (772)462-1553
SCq
St B yNFO
SPECIALTY PLRM1T APPLICATION
❑ Electrical ❑ Plumbing ❑ 11VA.0 ❑ Fence
❑ Shed glAemoiition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperntork required for,specialty permits
,-Tie COUnty
1, Location/Site Address: z.'��'
2. Parcel ID Nutnb r'. � �
fTowusl�lp Rang¢ Map Pnge 7.nning T,nnd Use Tnldals
t7,iee U." Sccrio»
Only
3. Complete Description of Project or Work:
4. Owners Information 5. Contractors Information
Name: ��\ ems, FL Reg/Cert #: ( C-G
f� County Cert#:
Address: --
City. Stater Business Name:},
lip: ���`���`� I'laone• Fax
6. Value of Construction: $
owNER'S AFFIDAVIT: 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 zoning.
pRFW T OWNER OR CONTRACTOR NAME 910NATUFtE OP OWNER O CONTRACTOR
STATE OF FLORIDA, COUNTY OF
ACK'NOWLF,DGL3D BEFORE ME THIS DAY OP c, 20 �^, IIX
WHO IS PMONALLY KNOWN TO ME 3e bR WHO HAS PRODUCED
H LATER
Nolary Public - State of Ftorlda
AS 1DL5NTIFICATION. My COMM. Expires ,tan 23, 2015
c,= • 9� �^ Commlao� �a �F �1278 (scel)
~ 'TYPE O 4� OBo @7r1 bGgh NA11m,11 No15ry A83n
SLONATURE OF NOTARY
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 OATAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICEOF COMMENCEMENT.
EXEMPT: AtC-HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
r
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Avenue ASBESTOS NOTICE
Fort Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Asbestos Notice To Contractor
08/09/2011
DENNIE H NEW CONSTRUCTION CO
NEW DENNIE H
7194 SW BUSCH ST
PALM CITY, FL 34990-5562
RE: Building Permit Numbe 1108-0110
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
OFFICE USE ONLY: - q. 1 1
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: p OJ PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
l l V T. o// 0
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
'S .. J PLANNING &DEVELOPMENT SERVICES DEPARTMENT
COUNTY BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
• - SCANNED Ft. Pierce, FL 34982-5652
BY 772462-1553
St. Lucy County
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
\ \ -"\� PROJECT INFORMATION
LOCATION/SITE ADDRESS:
2. PROJECT NAME:` \�j �� SITE PLAN NAME: p
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary): N ��J ESL` �� - c7
5. PLAT BOOK ��� 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS:
10. COMPLETE DESCRIPTION OF CONSTRUCTIO`NN PROJ T\OR WORK ACTIVITY:
11. SETBACKS (ACTUAL) FRONT: �� BACK: RIGHT SIDE: L\ LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: Qc�i
14. SQ. FT OF CONSTRUCTION: 15. SF. FT 1 st FLOOR:
16. VALUE OF CONSTRUCTION: $ `l o V
The value of construction 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 are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
ADDRESS: '�,3R �An :S
CITY: `�es.1S2 X� ��� STATE: ZIP:
PHONE (DAYTIME): kaC QI � Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER
ADDRESS:
Cal II Wd
PHONE (DAYTIME): C __ )
CONTRACTOR INFORMATION
STATE: ZIP:
ST. of FL REG.CERT #: C-O \`�'�3`� ST. LUCIE COUNTY CERT SZ
BUSINESS NAME:W
QUALIFIERSNAME: N
ADDRESS:
CITY STATE: N ZIP:
PHONE (DAYTIME): �_ (DQ-�>—\\"\�\FAXNO. Email:
ARCHIT/ENGINEER
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER
ADDRESS:
CITY:
STATE: ZIP:
STATE: ZIP:
IMPORTANT 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.
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.
nu 4 .mil rev+ —
6WNER 05ik CINNTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this �_ day of J 20
byQ
who is personally known✓ or has produced
identification.
Signature of Notary
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF v-\cw k •�
The foregoing instrument was acknowledged before
me this ID day of ��.� � � ,20 \\ ,
who is personally known or has produced
Signature > ry.
as identification.
17-7
Commission No. - r°oI� il)c Commissi n> f
(xplres JLN
23 201` c'. ;hl(t'
Co�,,IISSlon s f1218MYCornrn"'i� EpneSJan 2,BOn(1e(1 Thu Jqh N7,.:..ti'j� ASs^ '�� �i�`�d CORrt11Is Srbn ?. 701
Bonded T' # f F 3 ��'A
' i" "'
NOTE: TWO (2) SI A R QUIRED. EACH SIGNATURE MUST B IFN�LPi>EX G FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY O 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.
OFFICE USE ONLY "' BP #: I 1 0 •y Il C)
Sl.(`IION
TOWNSHIP
RANGE
MAP NO.
ZONING
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FI.R ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
Before 111990
LOT OF REC
After 1/1990
LOT SPLIT
REQUIRED
LOT SPLIT
APPROVED
REPORT
CODE
HABITABLE
AREA
(RADON)
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FF,E
PUBLIC BLD
DAPACT FEE
CORRECTION
PUBIC BLD
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FRFJEMS
IMPACT
FEE
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMINISTRATIVE
VARIANCE FEE
SPECIFY
SUBS
REQUIRED
MECHANIC ROOF
ELECTRIC GAS
PLUMBING
NON -CONFORMING
LOT OF RECORD
FEES
MISCELLANEOUS
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
INITIALS
Property Appraiser - St.Lucie (nty, FL
Page 1 of 1
Gregory Jeltema Record: 1 of 1
Property Identification
Site Address: 1195 NETTLES BV
Sec/Town/Range: 02 :37S :41 E
Map ID45/021
Zoning. HIRD
Ownership and Mailing
Owner
Address:
Sales Information
Date Price
4/26/1999
25000
5/1/1984
30500
2/1 /1978
15000
1/1/1974
8000
PROPERTY RECORD CARD
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,,\,UCIEco
ParcellD: 4502-501-1382-000-9 Q G2�
Account #: 120967
Land Use: Vac Res t J
City/Cnty: St Lucie County
Legal Description
Gregory Jeltema
NETTLES ISLAND INC, A CONDO -SECTION II PARCEL 1195N AND
3870 Smokey Hollow Ct
PRO-RATA SHARE IN COMMON ELEMENTS (OR 1221-1
Grand Rapids MI 49525
More...
Assessment 2010 Final Total Land and Building
Code Deed
Book/Page
2010 Final 42000 Land Value: 42000 Acres: 0.04
00 WD
1221 / 1576
Assessed: 42000 Building Value: 0
00 CV
0438 / 0534
Ag.Credit: 0 Finished Area 0 SgFt
00 CV
0281 / 1483
Exempt:
00 CV
0229 / 2703
Taxable:
Taxes: 872.95
No .1,S)kot-,.h
Available
Exterior Features
View
ExtType.
Grade.
StoryHght:
Interior Features
BedRooms:
FullBath:
1 /28ath
%A/C:
BUILDING INFORMATION
RoofCover:
YearBlt:
EffYrBlt:
No.Units:
Electric: -
HeatType: -
HeatFuel -
%Heated:
RoofStruct:
Frame: -
PrimeWall: -
SecWall:
PrnlntWall:
AvgHUFI:
Prm.Flors: -
%Sprinkled:
Special Features and Yard Items Land Information
Type Y/S Qty. Units Qual Cond. YrBlt. No Land Use Type Measure Depth
1 0000-Vac Res BI -Unit 1
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://www.paslc.org/prc.asp?prclid=450250113820009 8/9/2011