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Home My WebLink AboutSUBMITTED PAPERSPR #: PERMIT NUMBER: DATE: 0, 3 11 1. LOCATION/SITE ADDRESS: 2. 3. ST. LUCIE.COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 34962-5652 561-462-1553 APPLICATION FOR ABOVEGROUND POOL PERMIT PARCEL ID NUMBER: S L41 ( -- E I b _ ojn-b I - ow - s SECT TWP RNG MAP ZNG LU Pitf INIT S/D LOT I BLK I TAZ I REPORT CODE: 0907 POOL DIMENSIONS: LENGTH ��WIDTH HEIGHT OF POOL ABOVE GROUND LEVEL: q,-� -Acf (MUST BE 10 FEET FROM OVERHEAD POWER LINES) FENCE: YES NO FENCE PERMIT #: DESCRIPTION OF POOL LADDER: 1NT/J )0)OIL, 4. OWNERS INFORMATION Name: I TI-nm A 0L94 Address: 3 p x N, . f 0� -14 4vv City: ,oUr -,:� L-VC�/ State: F, Phone: � %q 0,3 0 Zip: 7 9, O7\ 5. CONTRACTORS INFORMATION FL REG/CERT #: COUNTY CERT #: Business Name: 6. VALUE OF CONSTRUCTION: $ --17�`��, FEES DUE: 10 q,cv RECEIPT: OWNER'S I certify that all of the information contained in this application is correct and that all work will be Pone in compliance with all applicable laws regulating construction and zoning. o PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER a STATE OF FLORIDA, COUNTY OF S) L7 L� IZI; IS DAYOF 9$ o m THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME ,WHO c IS RSONALLY KNOWN T E OR WHO HAS PRODUCED AS IDENTIFICATION. ;, v s/ �pit 1*1F-A o `� SIGNATURE O OTARY PE O RINT NAME OF NOT ye- (seal/ � NOTARY P LIC TITLE COMMISSION NUMBER DIAGRAM ON BACK ST. LUCIE COUNTY ABOVEGROUND POOL PERMIT PLEASE GIVE LOT SIZE DIMENSIONS AND SHOW SETBACKS FROM PROPERTY LINES TO POOL ON DIAGRAM BELOW. 85 V1 7f FRONT PROPERTY LINE ON ROAD n All applications for Aboveground Pool Permits are to,be,submitted to the St. Lucie County Department of Community Development - Growth Management Division, St. Lucie County Administration Building, 2300 Virginia Avenue, Fort Pierce, FL 34982. All applications for Aboveground Pool Permits must be complete and filed with the Department no later than 4:30 P.M. each business day. No applications will be accepted for processing after 4:30 P.M. For assistance in completing this application, please contact the St. Lucie County Department of Community Development - Growth Management Division, at (561) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. Following the issuance of this Aboveground Pool Permit, the scheduling of all required inspections may be made by calling (561) 462-1261. SLCCDV FORM NO: 018-00 PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 BUILDING PERMIT SUB -CONTRACTOR SUMMARY iyiqj y LP1 ,5- will be using the following sub -contractors for the (CompanyAb& dual'NAme) project located at 3/8' /V " E 14011V Ue P— S_ L . 3 L fqS (StreetAddrgss or Property Tax ID # ) It b understood that if there is any change of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St Lucie County. - ---.----.- Trade --- _.... Name of Company/Contractor St. Lucie County/ - ----'State- of -Florida °— License Number ® '1`*p Electrical Plumbing HVAC/ Mechanical Roofing Gas J PERM I ISSUE DATE: NUMBER: PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION UNTY BUILDING PERMIT • ^ I SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State ofFlorida Certification Number ufapplicable): 45 have agreed to be the :(Company Nameli t ''tiG _111atu ' It is understood that, if there is any change of status regarding our participation with .the above mentioned project, I will immediately advise the.Building and Zoning Department of St. Lucie County by personally filing a Change of Contractor notice. _(Form: SLCCDV No. 004-00) BUSINESS. QUALIFIER Q (Name of the Individual. shown on the Contractors License) ORIGINAL SIGNATURES ARE REQUIRED iQNA�TUEAMM NAME D Business Name: Address: &6 Ave City/state/zip: _ V7_C L q��ZPhone: Planning & Development Services Department Building & Code Regulations Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-1553 Owner Builder Affidavit — Electrical Contracting DISCLOSURE STATEMENT F.S. 489.503 (6) EXEMPTIONS State law requires electrical contracting to be done by licensed electrical 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 electrical contractor even though you do not have a license. You may install electrical wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical wiring in a commercial building the aggregate construction costs of which are under $75,000. The home or building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease more than one building you have wired yourself within 1 year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your electrical contractor. Your construction shall be done according to building codes and zoning regulations. 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. Failure to do so may result in a liability for you! To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit application. 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 be reported by the Community Development Direclor to the Florida �tate Department of Professional Regulation. Signed and acknowledged on this 3'` day of r� OWNER/Bi DER SIGNATURE STATE OF FLORIDA A ' Z - COUNTY OF The foregoing instrument was acknowledged before me this day of 4&, 20 // , by Yj hAQ,N i/�.�-�% , who is personally known to me or has produced 04('� Signature of Not ft — v (]Vrint name of N Title: Notary Public Commission Number SLCPDSD Revised 7/23/2010 St. Lucie County Owner Builder Affidavit -Electrical Contracting RUDREY 9. HUMPHREY MY COMMISSION # DD 633047 :ems EXPIRES: March 6, 2011 '" ..t(jontl3djhruNotary PubMLinderxriters St. Lucie Coun:;,7 Building & Zoning Department 2300 Virginia Avenue Fort Pierce, Florida 34982 (772)462-1553 OWNER/BUILDER AFFIDAVIT DISCLOSURE 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 applicably laws, 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 tp meet the minimum code. Initial it 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 the cost of the license. Initiali� _ I understand that if any person that is unlicensed and uninsured gets injured on my construction project - they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related medical cost, which could include loss of wages during recovery from their injury. Initial :17L— 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 be reported by the Building and Zoning Department Jo the Florida Stat Department of Professional Regulation. Signed and acknowledged on this ? day of of 2044-al Owner/Builder Signature STATE OF FLORIDA COUNTY OF ily. 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