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HomeMy WebLinkAboutSUBMITTED PAPERSDate: Fee Due: (U I RRee' t# ermit # Planning & Development Services `'. J1 = = Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 _ (772)462-1553 SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2. Parcel ID Number: '' 13 Z "voY"� - aov—i SC Sy t. Lucie county Iwo &%4MSNLgJVMJL4W&4Z��%�IlifflM 3. Complete Description of Project or Work: % 11 slog�✓ ,"7 4.�—' 4. Owners Information 5. Contractors Information Name: % /1/%�y L • �, %/r�/,,� FL Reg/Cert #: Address: �i//�/ /J/� y1 '-� County Cert#: City: �-'/e 0 State: L • Business Name: Zip: ySy6 Phone: 772%�l 'O6 &hone• Fax: 6. Value of Construction: $ r � 0 - ��Eo E5 OWNERS AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be ogeW compliance with all applicable laws regulating c g}cti nand zoning. = z s PRINT OWNER OR CONTRACT NAMESIGNATURE OF OWNER OR CONTRACTOR o STATE OF FLORIDA, COUNTY OF /y� �.�t,� ACKNOWLEDGED BEFORE ME THIS DAY OF 2011_ BY _/ / 4?A: WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDE ICATION. `' all SIGNATURE OF NO TYPE OR PRINT NAME F 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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00 «.i , •,, AUDREY B. HUNIPHHF_"Y I+ '2 MY COMMISSION k DO 6,' 7 Revised 04/26/2010 =� ` EXPIRES: MarCh 6, 2011 Y'.: •'�Pr e��.•' Brn,!p,' 7hu Nnt3ry, PuMiO Undaprri'•±rs � NOTICE TO OWNER: FAILUB I RECORD A NOTICFJ OF CON3AENCEM NT IV ZESULT IN YOUR PAYING TWICE FOR IMPRO�,;,.,�NTS TO YOUR PROPERTY. IF YOU INTEND ,� OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $5,000. INSTRUCTIONS Please complete all information in the space provided. All information must be printed (use black or blue ink only) or typed. This permit application is to be used only for those activities that are not otherwise included under a primary building permit. This application may not be used for any activity that includes structural alteration. The infonnation to be provided with this application includes: 1. Location/Site Address 2. Parcel ID Number 3. Description of Project or Work Activity 4. Owner Information 5. Contractor Information 6. Value of Construction Indicate the street address or general location of property where the building activity is taking place. Indicate the tax identification number of the property where the building activity is taking place. Fully describe the activity to take place. Indicate the name and address of the owner of the property on which activity is taking place. Indicate the State of Florida registration number (if applicable), St. Lucie County contractor license number and the name of the business doing the work. Indicate the total value of the work to take place. Total cost of construction includes all current retail material and labor costs associated with the building/construction activity. Construction value is used to determine the permit fee. 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. ❑ Gas Attach 2 piping schematics with tank size,location, and BTU of each appliance ❑ Shed: Attach 2 plot plans, 2 copies of DCA letter and plans, 2 anchor specifications ❑ Fence Attach 2 plot plans showing location of fence height of fence and type of fence ❑ Siding Attach 2 copies of manufactures specifications ❑ HVAC Attach 2 residential energy studies, 2 manual J calculations. 2 sets of duct layouts for new system or full replacement This application can be submitted to St. Lucie County Building and Zoning, 2300 Virginia Avenue, Fort Pierce, FL 34982. All permit applications must be filled out completely before submission. No applications will be accepted for processing after 4:30 P.M. For assistance in completing this application, please call (772) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. NOTE: Emergency electric service change out inspections will not be performed after 3: 00 PM without special arrangements and additional fee paid. Upon issuance of this permit, required inspections can be scheduled by calling (772) 462-1261. St. Lucie County 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 applicable laws, ordinances, building codes, and zoning regulations. Initi_Z1 I understand that the building official and inspectors are not there to design or give advice on how to 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 the cost of the license. Initial 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 %' 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 Departmepi to the Florida State Department of Professional Regulation. Signed and acknowledged on this day of of 20 r L Owner/Builder Signature STATE OF FLORIDA A0 COUNTY OF The foregoing instrument was acknowledged'' before me this it day of 20�, by MOZ4 t who is personally known to me, or who has produ as identification. Signature of No#y" Type oriKrint Name of Notary (Seal) Title: Notary Public Commission Number T FA AUDF?I_y 6. FitJly , , �p,'f ty,or MY FXPfH Gnndad ES: h9�rCh C,1011 Tfln� N^i�ry Nab!r: Urnp wr,'tpra R. N. Koblegard, III, Attorney 200 S. Indian River Drive Suite 201 Ft. Pierce, FL 34950 Bill To FPUA/Annexation Agreements Finance Department Re: Annexation Agreements Description Prepare AA for Williams, John - 2306 N. 49th St NO-[' Prepare AA for Williams, John - 2114 N. 42nd St Prepare AA for Williams, John - 5106 Juanita Ave Recording \1) Total Invoice Date Invoice'# 1/7/2011 12126 Amount 50.00 50.00 50.00 30.00 $180.00 Property Appraiser - St.Lucie 1--rity, FL Page 1 of 1 Join A Williams Jr Record: PROPERTY RECORD CARD <Frev Next Spec Ass. Property Identification kV\)CIECO Site Address: 2114 N 42 nd St ParcellD: Gy SeciTowniRange 31 :34S :40E Account #: 10954 tk Map ID 14/31S Land Use: SF Res Zoning. RS-4 City/Cnty: St Lucie County �'• ;. Ownership and Mailing Lc -gal Description Owner John A Williams Jr Mary H Miller HARMONY HEIGHTS NO 5 BLK D LOTS 1 AND 2 (OR 3160-2854: Address 2114 N 42nd St 3261-1116) Fort Pierce FL 34946-1508 Sales Informatior, Assessment 2010 Final Total Land and Buildiny Date Price I er.:r Book/Page 2010 Final 47600 Land Value 13400 Acres 0.39 1/18/2011 100 0111 QC 3261 / 1116 Assessed: 35834 Building Value 34200 1/8/2010 100 0111 QC 3160 / 2854 Ag Credit 0 Finished Area 1212 SgFt 7/1/1977 0 02 CV 0270 / 2005 Exempt: 25000 7/1/1977 0 02 CV 0270 / 1946 Taxable 10834 Taxes 225.19 BUILDING INFORMATION - ..s,,........ :� -TsiFZs7.1`r Exterior Features View RoofCover SD - Dim Shingle RoofStrucl GA - Gable ExtType HD - HID earBlt. 1957 Frame Grade D - D ffYrBlt: 1976 PrnmeWall BP - Conc Block StoryHght 0010 - 1 Story Units 1 SecWall: Interior Features BedRooms: 2 Liectric: MIX - MAXIMUM PrmintWall PF - PF FullBath. 1 HeatType. FHA - FrcdHotAir AvgHt/FI: 1/213ath. 0 -,�atFuel ELEC - Electric Prm.Flors. CA - A TL/CON %A:C 100 Heated 100 %Sprinkled 0 Special Features and Yard Iten Land Information Type ond. YrBlt No. Land Use T: r Measure DWC - Driv-Concret Y 1 300 AV AV 1957 1 0100-SF Res 210 -Front Ft 120 141 FEN4 - CHAINLINK 4' Y 1 520 AV AV 1979 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=143180200460003 2/ I 1 /2011 RETURN TO: R.N. KOBLEGARD, III, ES :OURTHOUSE 13OX . ANNEXATION AGREED INDIVIDUAL This instrument prepared by: R. N. Koblegard, III, Esquire 200 S. Indian River Drive, Suite 201 Fort Pierce, FL 34950 Property Appraisers Parcel Identification (Folio) Number(s): 1431-802-0046-000-3 TO: WATER/WASTEWATER ENGINEERING 2114 N. 42No STREET. FORT PIERCE, FL 34946 • FORT PIERCE UTILITIES AUTHORITY Location Address POST OFFICE BOX 3191 FORT PIERCE, FLORIDA 34948-3191 2306 N. 49TH STREET. FORT PIERCE, FL 34946 Mailing Address (if different from location address) Dear Sir: The undersigned does hereby apply to Fort Pierce Utilities Authority for water service and/or sewer service outside the City limits of the City of Fort Pierce, Florida to the following -described property which I own, to wit: LOTS 1 & 2, BLOCK D, HARMONY HEIGHTS ADDITION No. 5, ACCORDING TO THE PLAT THEREOF RECORDED IN PLAT BOOK 10, PAGE 34 OF THE PUBLIC RECORDS OF ST. LUCIE COUNTY, FLORIDA. THE ABOVE -DESCRIBED PROPERTY IS NOT THE HOMESTEAD OF THE GRANTOR. THE GRANTORS RESIDE AT 2306 N. 49T" STREET, FORT PIERCE, FL 34946. I hereby agree that in consideration of my request for water service and/or sewer service to my property, that if my property either becomes contiguous to the City limits of the City of Fort Pierce, Florida, as such term is defined in the Laws of Florida, is subject to a Chapter 171 interlocal service boundary agreement where contiguity has been waived by the County, or may otherwise be lawfully annexed, that this application shall be considered as an application for the annexation of my property (above -described) into the City of Fort Pierce, Florida. I do also hereby for myself, my heirs, successors and assigns approve the annexation of my property into the City of Fort Pierce, Florida and consent thereto in the event that it, or any area including it, is proposed for annexation by election or otherwise. I waive any and all objections to annexation of the property and agree that this Agreement shall be construed to satisfy any requirements of law for consent to, or approval of, such annexation now or hereafter required. I further confirm that this Agreement shall be binding upon my heirs, successors or assigns and that this document may be recorded in the Public Records of St. Lucie County, Florida for the purpose of serving as notice to all persons or entities. In Witness Whereof, I hereunto set my hand and seal this TA day of , 2011. Signed, sealed and delivered in our presence as witnesses: - Jc�, )-^ Witness Signature Susr� r_-, �un� �►n1 Pri MeWitness Signature W ne s 18ignature ac;*uc LAV l-a- V Printed Witness Signature STATE OF FLORIDA COUNTY OF ST. LUCIE gnature John A. Williams, Jr. Printed Signature 2306 N. 49th Street Address Fort Pierce, FL 34946 City, State, Zip Signature Printed Signature Address City, State, Zip I hereby certify that on this day before me, an officer duly authorized to administer oaths and take acknowledgments, personally appeared John A. Williams, Jr., known to me to be the person described in and who executed the foregoing instrument, who acknowledged before me that they executed the same, that I relied upon the following form of identification of the above -named person: Driver's License; and that an oath was not taken. RUBBER STAMP NOTARY SEAL I,SALiE LAVERiR9 .OMMISSION # D0643930 EXPIRES PAay 21 2011 pior,d-t lot-r�,servwe com Witness my hand and official Seal in the County and this TgTr day of JFiN , , A.D. 2011. li: Q05( C.1 F U',T Q 92:-Tu Notary Printed Signature N1ForniffPUMCompleled Annexation Agreements\Wllliams, John . 2114 N. 42nd St.docX Revised 7/9104 per atty.