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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: a110 DATE FILED: PLAN REVIEW FEE: RECEIPT NO. :��gERMIT NUMBER: ' CONCURRENCY FEE: RECEIPT NO.: CERT. CAP: NO.: ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue I�p,� j S F� � Ft. Pierce, FL 34982-5652 -G1 P 5772-462-1553 tv()G cm V ,r C� APPLICATION for. BUILDING PERMIT q� CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION V 1. LOCATION/SITE ADDRESS: K'-- ; tfr uf-i 0-4-- 2. PROJECT NAME: F-t ArecQ t-i®V-GC SITE PLAN NAME: C (grs`_c� Ctu LI-CS-C 3. PROPERTY TAX ID #: -3q©( 3 l q 0061 c o o / 5__ SCANNED 4. LEGAL DESCRIPTION (attach extra sheets if necessary): i BY -- I. Lucie County. 5. PLAT BOOK _ 6. PAGE NO. _ 7. BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): % ;Z LOT DIMENSIONS: , Od �C I �I S - _U 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK A 'TIVITY: FrDP0S e—j' -k) eLo t 11. SETBACKS (ACTUAL) FRONT: 153, BACK .3 RIGHT SIDE: .� x LEFT SIDE: I 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ �/ + 1 � ` 9 D4 NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [?� RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [ ] OTHER (SPECIFY) 1�(( / 13. DESCRIPTION OF PROPOSED USE: l cluw-s,+ AO U-S E ✓ 14. 16 SQ. FT OF CONSTRUCTION: S F 15. SF. FT 1 st FLOOR: VALUE OF CONSTRUCTION: $ l �2 _ D,51, ®O 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 ofCommencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 i OWNIER INFORMATION NAME: K A b r-C /A- 40. e- ADDRESS: _[�, G COLD i\- CITY: Chp�, h,�'t ;�q STATE: Q4:FVZ yOr K ZIP- O Q 7 PHONE (DAYTIME): (2f 2) % S'? - (G ((� I ( Email t-�as�c��ecayC�'�'� rvcQe�e�oarnea� cci:1 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: CITY: PHONE (DAYTIME): L__) STATE: ZIP: CONTRACTOR INFORMATION ST. of FL REG.CERT #: C C_ (�. R I ST. LUCIE COUNTY CERT BUSINESS NAME: re-V4 i C i �+�► � C9�_o��i_ i Cz.C.l1.&r5- QUALIFIERS NAME: ' ADDRESS: ------- CITY: � - i STATE: -t-- ZIP: --_�� PHONE (DAYTIME): 772 FAX NO. 712 $7 - D i l o Email: Ce-rf ARCHIVENGINEER: ?e-ax- el 4- L e-60 ,CC' ADDRESS:. l n ^ - CITY: 'FOCI+ P i e_f'C-.P- . STATE: Ft , ZIP: — PHONE (DAYTIME): 7 7-416 0 -- b 018 BONDING COMPANY: N l A ADDRESS: CITY: STATE: ZIP: MORTGAGE LENDER: ADDRESS: CITY 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 if applicable, for the permitted work. I certify that no work or installation has comr, work will be performed to meet the standards of all laws regulating construction in may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this t St. Lucie County makes no representation that its granting of a permit will auth which is in conflict with any applicable Homeowner Association rules, bylaws structure. Please consult with your Homeowner's Association and review your dt I indicated, and to obtain a certificate of capacity, =ed prior to the issuance of a permit and that all is jurisdiction. I understand that separate permits tURNACES, BOILERS, IlEATERS, TANKS, ilding permit application. :e the permit holder to build the subject structure any covenants that may restrict or prohibit such 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, utilitV substations & accessory uses to another non- residential use. NOTICE TO OWNER: NOTICE TO APPLICANT: X- YOUR FAILURE TO RECORD A NOTICE 0: PAYING TWICE FOR IMPROVEMENTS TO COMMENCEMENT MUST BE RECORDED. FIRST INSPECTION. IF YOU INTEND TO C LENDER OR AN ATTORNEY BEFORE REC COMMENCEMENT. IF IT IS NOT YOUR RIGHT, TITLE, AND ATTACHMENT: AS A CONDITION OF I GOOD FAITH TO DELIVER A,COPY OF THE PERSON WHOSE PROPERTY IS SU SIGNA STATE OF FLORID STATE OF COUNTY OF Se .IA- COUNTY( The foregoing instrument was acknowledged before me this 5\\ \\ ` day of N64 20 \D , by who is personally known , or has produced as identification. Signature of Notary G pe ®® was Commission No��lc I&MMISSION # DD798130 EXPIRES June 09, 2012 (407 391L0153 FloricbNotaryService.com COMMENCEMENT MAY RESULT IN YOUR 'OUR PROPERTY. A NOTICE OF ND POSTED ON THE J013SITE BEFORE THE ITAIN FINANCING, CONSULT WITH YOUR RDING YOUR NOTICE OF' 3REST THAT IS SUBJECT TO ONCE OF THIS PERMIT, YOU PROMISE IN CONSTRUCTION LIEN LAW NOTICE TO 7 TO ATTACHMENT. 5. SIGNATURE The forego' instrument.was acknowledged before me this \,Zg y of -�t 20 \ o , byLL'�� who is perso ially known ✓ or has produced as identification. Signature of Notary Commission NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MU THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNEI THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL ON For specific instructions see appropriate permit checklist. GAOL CARRUTHERS Y C(*A%SION # DD79613 EXPIRES June 09, 2012 BE NOTARIZED. IF APPLYING FOR UST PERSONALLY APPEAR TO SIGN IS APPLICATION. :RBUILDER APPLICANTS. OFFICE USE ONLY BP #: SECTION TOWNSHIP ?J}-� RANGE Lj0 MAP NO. ZONING 2 LAND USE �S LOT CVG % TAZ NO. FLOOD ZONE ,., fj; r LQ lT FIRM MAP # 21 A I' FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER �C SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT SPLIT Before 1/1990 After 1/1990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE (RADON) LIBRARY PUBLIC BLD PUB PARKS IMPACT IMPACT FEE ACT IMPACT T FEE CORRECTION FEE FEE GENERAL SCHOOL RO CREDIT Y N LAW ENF IMPACT ACT IMPACT FEE FEE FEE FIRVEMS DRIVEWAY Y N DRIVEWAY ADMINISTRATIVE IMPACT REQUIRED FEE VARIANCE FEE FEE _ SPECIFY MECHANIC �_ ROOF NON -CONFORMING MISCELLANEOUS SUBS ELECTRIC GAS LOT OF RECORD FEES REQUIRED PLUMBING 7— FEES DATE SENT TO ADDRESSING: / REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE AREVIEW RECEIVED DATE COMPLETED INITIALS -�7Zc'Zq7�*/) INSULATION INSTALLATION CERTIFICATE, Gale Insulation BUILDER: )1[tr�jcAU SUBDIVISION: JOB ADDRESS: 10 t SCITY: PERMIT #:C% LOT/BLOCK: The undersigned hereby certifies that insulation has been installed i the above described property as follows: �(eC(ivn K'0I'( .7S(r 1.Exterior CBS walls has been insulated with _ ),'X ( to a th.pkness of inches, which according to i'Yr will yield an "R" valtic of__��1,.• Exterior frame walls has been insul�te8 with to a thickness of inches, which according to will yield an "R" value of _ I'W pr- 2. Ceilings (flat) has been insulated with 4- to a thickness of A% 21' ches, which according to /2 r will yield an "R" value of Jn Ceilings (vaulted) has been insulated with to a thickness of _inches, which according to will yield an "R" value of 3. Interior knee walls has been insulated with _ _ to a thickness of ^_inches, which according to will yield an "R" value of 4. Garage partition walls adjacent to conditioned living space has been insulated with a fiberglass batt to a thickness of inches, which according to will yield an "R" value of General Contractor/Builder Signature Insulation Contractors Signature License # CGC'1512I79 THE AFFIANI•, Paul__ W. Hash IS PERSONALLY KNW ON TO ME Sworn to and subscribed before me this `,� day of #_� s t _2Q .ice , ... .. :.: ts,:ry,., Notary Public, State of Florida_ m. 3601-A CROSSROADS PARKWAY > FT. PIERCE, FL 34945--:' ANe{ FT. PIERCE (772) 465-9191 - VERO BEACH (772) 5$9.1514 ^ STUART (772) 283-3151 - FAX (772) 489-675 L00/400In NOI,LVINISNI S'IVD 84L968t'ZLL XVJ 6Z:60 TTOZ/50/90 Contractor Services Gale Insulation CERTIFICATE OF CORE FILL 0_ JOB ADDRESS: BUILDING PERIVIM a -03� 6U'(9 #Zwlft This letter is to certify that Gale Insulation has installed square feet of Core Fill in accordance with Florida Building Code. al. my 6WIj INSULA rri.ON CC # CGC1512179 Gale Insulation CERTIFICATION DA,r.E-. 8-- S_ (/ THE AFFIANT, A4S/-, IS PERSONALLY KNOWN TO ME Sworn to and subscribed before me this�day ofJJIL,�� 20 Notary Public, State of Florida— ............. . . . ......... ... . . .... .... ..... .......... 01601 -A CROSSROADS PARKWAY FT PIERCE, FL:3,1945 -72) 589 1 -FAX (772) 489-675,8 FT. PIERCE (. 772� 1165-9 9 1 - VERO BEACH (71 -15 14 STUART (7 L001900 In MOUMSNI HUD M96MLL XVA 01::60 TTOZ/90/90 901 P�.].ILDING '� �. 8049565064 { 31G48804) �•� .; Ticket Page 1 of 1 <_... Ticket # 1 of 5 requestCd r% e . . k agm Lowing: To Jal Atr�vA Jab: Sant Wrrlaaed: F1111mh GruU -JE Ui•LDINS -CONTRACTORS-iNC �i,.wya:raae►�,a,wr t P1°i�' PoC�JCL bIWaK Mood PA pk~. ! OGIll 1 .,.3 INDIAN RIVER' DiRlVE I .i M �alMantlanx • r ' I U17e►F.OM &. m,B &,7=&QJT - mwAPETRICK Tiftt Nar4hty 31648804 WWAD ClMUlA71YG a Lue�ukCQ�1e PRaouotiawdtl.CtpYtok 11aiN e�nsPNC6 Au►attdtt L-00 . Caen C:hektiAuthtloft chath 1847448 FU—FL 8UReH(%R0E' -'9v, icWW49 .ENV I -RUNT+ ENTAL CHARGE ELtWl�tr.,e ,- komm or rvs Arwft v. cwvmm mkxwwv w�aam�. way aaw�at xhrrdapraryrum tmrprnyw ra>d emr M�a1 vaaa�te. ovrr..m.�arn �etl •�etWetyantnaWdeyatwrtlwaarlp•gennMelL .. WATER ADM: GAL YraRCIS IN DRUM:._ WHEN ADDED. mvlatur�e CURD LINE CR175SE0 AT W lWlllAG9Nr$ KQUEST: &aNv�iURE 0 LOAD WAS TESTED Y7 __.. _,SW daalikutmbut ire t+Hapaabult tPr Ih"wLyllkqRNAll ImPe4ywtOntlWedMMMMMgrMaaewt.*.a.IL 0Uw I.,.lI .an►fYworMsardiilaadadaal dlr(eianaJraaC0.lAoaUndM weMafMtlrcanOMaowsell,,gmw W to bowah'm & w& xd.y ft. P^vwtgpbh WAIL M a" kr u.tow-Aa%ftw ORIGINAL � 05/16/2011 13: 56 7 ZQ790110 •CERTIFIED .IUILDING PAGE 07 /�cmcx 53378967 Ooatift; TO JOIN I Arriveiope I S$tVtUnloatl: Flai'*hUnload: I L1AVOJOtr: I Rabpmptanfe i 3022975 LCERTTIFIED 'IM11.16I G CONTRACTORS INC cowwwco* cuslmmwr mwm wmhnnlmr Ide rrfuvnnrr. Pe*0 Caen Arun rams Proien O, htirber. OW06/11 6101 a rtuDIAN RIVER DRIVE 7,"Om& OffrWA*V*": rYf► f�pA ..s. � +� ;SriAery W>DeG'�F 394 4S/06,111 12143 Otder P Q, Numbw,, E72 278828017 "wMilw MwwpWwK tpw MPETR£CK Dhoambmr �:wnl",48�17 au r0 �aer� •�a�c Ian 3000 i�E6�O°�'nnrsNceesctvwna�► '�'i3 J'firlrr" �� m `�ImouKr 1.00 12471318 FUEL 9UREHARGa.Iw 1.00 12OR749 • EIqW i RONMENTAL irHRRSE cb m abmm tl rn h mft �I1mWan o1 Omar ICeealwn� °wr cprl, w.,+t+tc Cb�cu WA-MRADDEI :-'._ Ae GIRL MOS IN DRUM:_ a� }` fi WHEN ADDED. ' ce3:`? storrtiruas ia to CURB UNIE CROSSED AT OWNERSIAMNT'S RLOUEST: , _ IiIONAIIdl9E 11 WAD WAS TESTED BY: NomPp; C+u• dMva�a Wtl t n RYUY IBM w pmm. ffYlit wm w"e IN. Eer7e11Nr tl t,�. h17111� aaratW. TlplvlNr; e+a•,bwQadoa 4 panlar..�w own d�k r wcwa aria onl�l�, no�.a Yuonuw CenpMh mmxxm 4In IDrpnn r lue arr"" haft wo mr pmaab � CialWtfwr aws" 90 the 4. k�if ytlMeb 44 W."Im 1�1 ndlAet arse iMln IrmSStOf ale idlmtlo l CAUTIOk IIgLm Lt Smna w( &We am dri*y w d OMNvlo *m&*Im .0 kk dA ID hh ,, bm�ma %#" � oN of ae ffW t� Yasw oow W ywe SSW &W Wkk PPt " n1N b 9W 4tAM of Vt. 00.1 /wf hgaiu. CemOW oft dvinwy, oft om mdy A not 6baw 0 ft RoIYNem4m, ft C" for yY�I lylndaqWmbs-0MBuy"'OPWWO the RAMMilI d�`mbr d Amr mQNk+uf iWamttNa. 4Ad tltiblm fAY Ilm dwmre Wt WWIIlb comer 1¢ lW hi wrkng Ak►YWOR>7E0� bafQmew etq' N1MtJ7m f1C�iy101' hlt0lmlmll. PREUw TR1{I 1cOGiE64i88• r.:i, - L[}WD NLIM1 66UPIPigpiaAL ORIGINAL 13:56 7728790110 CERTIFIED $UILDING PAGE 68 :1. •�r 1ICCI'lUCX .53378969 wfkdb: Cubff rNWW Quomm Job N~l orderca:9Icm 12143 Aojaal cm* O'3/06/11 F i"W NIMM 610 r. S INDIAN FIVER PmW PAL.ff lbo: DRIVE Order P.O. Nuadar E72 2722a01.7 nctM37ota CcgwyAdpjrn; ►VARW Mapkowlwmm _p . "� '" MPETRICK DaY..ry in�arq: �ao.xn.r Yw ml"49007 �419�27re r�: , r�0 �1002r 40 109' 10 JES~F REITER BS,OFSS % EXT SHEL rAn,an,ke: rlMmra 1rnr�NMrmber. orow.hnw+n�k: arF,er�l�mr: �ndu+o: .._. _ _._ AtJU�lft+T 4=M. CAW 000 aw�puy�nIONDEaCRIPTRON' YNRPIUCIt +u10YlYT i.'00 * 11,00 coo • 1247818 FUEL SURCHARGE 1 W2749;kEN:V I RONMENTAU.-CHARSE COD Ordw tul ftrAby WATERADDEO: `-J GAL YARDS INDRUM: WHEN ADDED. 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Jab- i S.tf rtl alo adc *.•�.fffnffr�rq�� Propw 0:61. pratt'a) Raw: 03/06/11 SLOT b INDIAIN RIVER DRIVE �aDOW DAy � .�.�,.���--'^^•• "(n: 53378971 tlrtTc+�d: ! lesw Job: I Ream Plpnt: cwwnw A6NuMbw' FMJW P.Q. Ntt~.. '"230111W • — - 5. 00-16— 1'00957, 60, 10921p9 ' MLVIN WILL,IAM'S IL 1. 00 - 1-00, •�E�lOG11C11t1M o[�WIIFi➢ISM 124781-8• FUEL'-8URCHAA6E -4 • 1 cM2749-'ENV F ROhIKENITAL • CHARGE . 12142 0dw. P.O. Nrr w E72 27228017 map rMw MOPPOMM44Mft MMR I CK Tf wAl&fi 903 SLONS: EXT SHEL 3 j AMOUNT r art GNR rAWNt ISwac 81pfrMw aftt7rwar HroMMrW C"k rt.a.MOCe T*W MO G.drtJ nkmot is CMww4 Csti.dr • � 1KItMaq BMMOY �� Chwp ir WATER ADDED., —GAL YARDS IN WtUIN;,_..�� WHEN AMED. t�s t;•t : �:�^ti � •� P ' f' is= LOC:L'�7 pl:E$ ft9 :.{l 9kiPlAIURfI, _A(zl. 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'Ib Jbbh� Lfiiw JZ I Return Ptetmt: FI 1itb1DING NTRACT S INC 395 /0 ii twtax�raodr. �� ' P lii 6 INMAN RIVER nRIVE 71dw1 pY4K bwmy lkq me CMl1wtYY �ldbAr: 08$ - 5-hGO 100E57% 109208 Ltw An Jalu ww ar• DRtit PRotrtwr Ails u, AAaA pIIMULJ AUAHYTTY pUaM 1.00 1. Ob - Onh Ohm* IF Chbck A ti7 I MA-MMALOMLE c�le�alaa wme.r • Piryeoc p,tl, NUrt� WILLIM DEPINO P(e�ptFeT10N PEBCRIPSbH 12.4784,0 r SURCHARGE ., -- r 1 EOZ74S ENVIRONMENTAL CHAREM T Oip1tHFTR*"ha,o pak cAsbpAwAhwk 04 0M2r=8017 MtaP*1PE Ln¢ LAPWOgPI 31649314 91" wffbK BLDNG: EXT ElMEL (WM I WRTPMGE I AMOQVT • • . � V lirr ti �.�: l'vad WATERADDED: *AL VARo$ IN DRUM: WHEN ADDED. 0- a i :I t-ti _:� Ana �tw � SrW81tl1P� i• ; :��� CURB LINE CROSSED AT OWlhl{rWWP� GEN rS RWUEST: NOULTURE CI LOAD WAJhLED GY, _ _ NatOac ow d4"" 'Aid wpa vary 41mm a Plaam m*"m• wlnn chip oxtxw fts* ta, W a. WAW k �! ouiNom.� vw mk 7wahu h.addYu m loq ax�a+lr rb., �d *-mw creme, m mpw*%ft aw 111 p ftwo : o or otmww aye, o"bow ftn>� b th. ada +ec0 ma eomra` mgale �s �Luc p MOM *h%fi am oul. �aa[ ow !iteelh PAMW nhe 0 tlm 4&xiW at ft MW Ax I 09I03f2009 13:00 7724521570 � ST LUCIE CO PAGE 01 u- "gicSim G� 2300 V IOVa Ave Fort Pierce,, FL 34982 772-462-2172 Fax 772.462�6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #: /o 12, ©6.2c, . ,SOB ADDRESS- 1 � p BClILDER/CONTRAGTOR: - ^.�U !_��i�`7 �c PEST CONTROL CONTRACTOR: F-0ii rm 4 L)' PEST CONTROL LICENSE #: s? 01 We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: Chemicals used: _ Percentage of solution: Date of 7'r trnent, `-3 J&z57f % Footing se Treatment —Re-Treat ` Driveway 1' Treatment —Re-Treat _ —Other. .,,._._V Treatment —Re-Treat Total gallons used: Time of Treatment: ! _ ad I Treatment —Re-Treat 9t ator Note: There must be a completed roan for each required atmen r treatment and this form most be on the job .site to be ply op by the inspector- at time of each iris AM or scheduled inspection will fall and a re -Inspection fee charges! FBC104, 2.6 t;ertxmte of pmtestive Treatment fOr prevention 4f termites, A weaffier resistant, jobsIte posting bo&td Mall be provided to rewivre duplicate Tmattnent Certif,Cates as each required protective tmatment 1s completed, providing a copy for the person bye permit is issued to and another copy for the buf/d/nq permit files me rreatment Celtlfrcate $hallpravlde the product used, identity of the applkwlor, time and date of the treatment, sma locatfon, area treated chemical rased, percent commntmtion and number of gallons used, to establfsh a wlyr1ab1a m� of PrOlectfve treatment If the soil chemical barrier method for termite prevention is used, tonal exterior treatment shall be completed prior to final building approval. Sic Lucie Country requires for the: final inspection for Ca, a Permanent Sticker to be placed on Me electrical nanel hnv nnurop_ lae*rw,v nit rww • Termite Inspection • Termite Pretreatment • Pest Control • Rodent Service 7)_ 2-323-7921 for 772 348 5999 Email: Evictabug@gmail.com • Fire Ant Lawn Service Inc. ` 265 SW Port St. Lucie Blvd. #323, • Licensed & Insured Lic. JB175775 Port St. Lucie, Florida 34984 Notice of Preventative Treatment for Termites (as required by Florida Building Code (FBC) 104.26 and Broward County Chapter FBC 105.2.2) PEST PREVENTION I`` FIRE ANT SERVICE' I TERMITE SERVICE I RODENT EXCLUSION & REMOVAL DATE OF SERVICE ."` �7 1 TIME B �°�®i DEVELOPMENT NAME (PROJEC _ CONTRACTORS NAME {� CONTACT PERSON STRUCTURE ADDRESS (LOT/BLOCK) CITY, STATE, ZIP CODE 1 �} .C�OUNdTY } X �P C 1 + �C i 4 +' f P� d r'"r >" CONTACT PHONE NUMBER NOTES TREATMENT TYPEIAREA ❑ FLOATING GO MONOLITHIC ❑ PATIO ❑ GARAGE ❑ DRIVEWAY ❑ STEM WALL ❑ ADDITION ❑ CUTOUTS ❑ FOOTER ❑ FRONT ENTRY ❑ EXTERIOR PERIMETER FOR RENEWAL ❑ OTHER 6 TAMP & TREAT ❑ TREAT ONLY ❑ FINAL ❑ RETREAT ❑ BORA CARE TREATMENT PRODUCTS .O BASELINE ❑' PROBUILfD TC ❑ DRAGNET ❑ DEMON TC ❑ TERMIDOR TC ❑ BORACARE ❑ OTHER �t � V it ACTIVE INGREDIENT t 0 CONCENTRATION t7 06% ❑ .12% ❑ .25% ❑ .5% ❑ .23% ❑ OTHER SQUARE FOOTAGE S LINEAR FOOTAGE SQUARE FOOTAGE VERIFIED I r0`'s �. d` � ❑ NO ❑ MEASURED OR VERIFIED PER PLANS JOB READY CONDITIONS MET �a YES El NO DETAILS11 GALLONSAPPLIED 13 As per 104.2.6 FBC - If soil chemical barrier method for termite prevention is used. Final exterior treatment shall be completed prior to final building approval. Certificate of Compliance: The building has received a complete treatmentfor the prevention of subterranean termites. Treatment is in accordance with rules and laws established by the Florida Department of Agriculture and Consumer Services. (Per the Florida Building Code.) If this notice is for the final exterior treatment, initial and date this line FINAL STICKER ❑ ELECTRICAL PANEL ❑ WATER HEATER ❑ OTHER _ Payment Terms: Payment due at time of service. Date Date KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 P.U. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEER]NG.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 April 20, 2011 Certified Building Contractors, Inc. 747 SW South Macedo Blvd Port St. Lucie, FL 34983 Re: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida Permit #: 1012-0034 — Garage KSM Project #: 110277-6d Dear Sir: Enclosed, please find the nuclear density test results performed on the column pads for the g�gggelett,the above referenced project. t�ttal�questions, please feel free to call. pelw�66 19 HIM Fax and Mail to: St. Lucie County Building Department - 772-462-6443 Fax to: 772-879-0110 JEK:km Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 K S M KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 P.O. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 SOIL COMPACTION REPORT ASTM D 1557 and ASTM D 2922 DATE TESTED: April 19, 2011 KSM JOB #: 110277-6d/SH/km PERMIT #: 1012-0034 — Garage CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida MATERIAL: Gray Sand ITEM TESTED: Column Pads for Garage --------------------------------------------------------------------- TEST LOCATION DEPTH MOIS- PEN DRY MAX. DRY PERCENT OF SAMPLE TURE READ DENSITY PROCTOR COMPACTION -------------------------------------------------VALUE --------------- 1. S. E. 0" —12" 10.3 37 105.7 106.3 99.4 2. S.W. " 11 36 104.2 1198.0 3. N.W. 36 104.7 98.5 4. N. E. 37 104.3 98.1 Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 PO, BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 MOISTURE -DENSITY RELATIONSHIP MODIFIED PROCTOR (ASTM D 1557) DATE TESTED: April 19, 2011 KSM JOB #: 110277-6p PERMIT #: 1012-0034 — Garage CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida 107 T--T--7---1---I---r--T---�--, I I I I I I I I I I I I I I I I I 106L__1__1__J___I__ __1 _1__J I I I I I I I I I 105+ — — ---I U I I I I I I I I I a H 104 2 I I I I I I I I I 1034---4-----_4---I---I-------�---1 I I I I I I I I I I I I 1 I I I I I I I I I I I I I I 102---t--rt---y---I---t- T--I _1 I I I I I I I I I I I I I I I I I I 101 ---------�---------------�--� 7 8 9 10 11 12 13 14 15 Moisture - Percent of Dry Weight Soil Description: Gray Sand Max. Dry Density: 106.3 P.C.F. Optimum Moisture: 12.4 Percent Julie E. Keller, P.E. Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 Planning & Development Services Building & Code Regulation Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-2172 Fax 772-462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #: 10 o ek —o t 39 JOB ADDRESS: (83o S, GtS 1 ?I-S fy W c�i sc BUILDER/CONTRACTOR: M C,1�AtAOA PEST CONTROL CONTRACTOR: PEST CONTROL LICENSE #:_ J1316 We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: Percentage of solution: ,ems Date of Treatment: _3k I 11 -I Footing 4'Pgdef, ��1" Treatment Re -Treat Driveway 1st Treatment Re -Treat Other., 1st Treatment Re -Treat Chemicals usedL_Z_/724,oc?o /-z; 4dde�'4940n Total gallons used: Time ,of Treatment: Slab 15t Treatment Re -Treat Pools 15t Treatment Re -Treat Perimeter for Final Inspection Signature of Exterminator Note: There must be a completed form for each required treatment or re -treatment and this form must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re -inspection fee charged. FBC104.2.6 Certificate. of Protective Treatment for prevention of termites A weather resistant jobsite posting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed, providing a copy for the person the permit is issued to and another copy for the building permit files. The Treatment Certificate shall provide the product used, identity of the applicator, time and date of the treatment, site location, area treated, chemical used, percent concentration and number of gallons used, to establish a verifiable record of protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on the electrical panel box cover, listing all the treatments and dates of applications. KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 PO. BOX 78-1377 SEBASTIAN FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 April 13, 2011 Revised: May 3, 2011 Certified Building Contractors, Inc. 747 SW South Macedo Blvd Port St. Lucie, FL 34983 Re: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida Permit #: 1012-0039 KSM Project #: 110277-4d Dear Sir: Enclosed, please find the nuclear density test results performed on the compacted foundation fill for the guest house pad at the above referenced project. ShR t.'''Y1111Llilr6"bowy questions, please feel free to call. e No. 68366 PIP Fax to: 'St'." Ubie County Building Department Fax to: 772-879-0110 JEK:km Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 K SM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 P.O. BOX 78-1377 SEBASTIAN FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 SOIL COMPACTION REPORT ASTM D 1557 and ASTM D 2922 DATE TESTED: April 6, 2011 KS JOB #: 1102774d/ES/km PERMIT #: 1012-0039 CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida MATERIAL: Brown Sand, Slightly Clayed ITEM TESTED: Compacted Foundation Fill for Guest House Pad --------------------------------------------------------------------- TEST LOCATION DEPTH MOIS- PEN DRY MAX. DRY PERCENT OF SAMPLE TURE READ DENSITY PROCTOR COMPACTION -------------------------------------------------VALUE --------------- 1. N.E. 0$'—12" 7.4 44 111.3 113.5 98.1 2. Center Is 8.8 40 110.9 97.7 3. S.W. 9.2 48 110.0 96.9 Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 PO. BOX 78-1377 SEBASTIAN FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 MOISTURE -DENSITY RELATIONSHIP MODIFIED PROCTOR (ASTM D 1557) DATE TESTED: April 6 throuth 11, 2011 KSM JOB #: 110277-4p PERMIT #: 1012-0039 CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida 1147--7— 77 71---1---r--7 - -1 I I I I I I I I I I I I I I I --1IIIIIIIIII, ---IIIIIIIIII —4IIIIIIIIIII ---4 u� L_L 1104---+— —+-4——IIIIIIIIIIIII I I I I I I I I I I I I I I I I I I I I I I I I I 109---- --- -- ------ ---�--4---4 6 7 8 9 10 11 12 13 14 Moisture - Percent of Dry Weight Soil Description: Brown Sand, Slightly Clayed Max. Dry Density: 113.5 P.C.F. Optimum Moisture: 11.4 Percent Julie E. Keller, P.E. Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 ' K S M "KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING INC. MARTIN (772) 337-7755 P.O. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 April 19, 2011 Certified Building Contractors, Inc. 747 SW South Macedo Blvd Port St. Lucie, FL 34983 Re: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida Permit #: 1012-0039 -Guest House Permit #: 1012-0036 - Cabana KSM Project #: 110277-5d Dear Sir: Enclosed, please find the nuclear density test results performed on the guest house column pads and cabana footers at the above referenced project. \\\`011111 n Shcd��gaa:hv6a'�f,�questions, please feel free to call. ec u 366 _ .. z P /z (4/< < ir-ax to: St. Lucie County Building Department Fax to: 772-879-0110 JEK:km Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 KSM ~� _KELLER, SCHLEICHER &-MacWILLIAM ENGINEERING AND TESTING IN C. MARTIN (772) 337-7755 PO, BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 SOIL COMPACTION REPORT ASTM D 1557 and ASTM D 2922 DATE TESTED: April 18, 2011 KSM JOB #: 110277-5d/SH/km PERMIT #: 1012-0039 - Guest House 1012-0036 - Cabana CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida MATERIAL: Gray Sand ITEM TESTED: Guest House Column Pads and Cabana Footers ------------------------------------------------------- TEST LOCATION DEPTH MOTS- PEN DRY MAX. DRY PERCENT OF SAMPLE TURE READ DENSITY PROCTOR COMPACTION -------------------------------------------------VALUE --------------- Guest House Column Pads 1. North 0" -12" 10.3 36 104.6 106.3 98.4 2. N. Center 37 105.7 99.4 3. S. Center 37 105.5 99.2 4. South _ 36 104.2 98.0 Cabana Footers 5. N.W. 0" -12" 10.3 37 105.2 106.3 99.0 6. N. E. 36 104.5 98.3 7. S. E. 36 104.3 98.1 8. S.W. 37 105.9 99.6 Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 NKELLER, SCHLEICHER & �acWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 PO. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX (561) 845-8876 E-Mail: KSM@KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 MOISTURE -DENSITY RELATIONSHIP MODIFIED PROCTOR (ASTM D 1557) DATE TESTED: April 18, 2011 KSM JOB #: 110277-5p PERMIT #: 1012-0039 —Guest House 1012-0036 - Cababa CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida 107-17—_T__ 7---1---,---r--T--7---� I I I I I I I I I I I I I I I I I 106L--1--1--J---1-- --1 --1--J I I I 1 I I I I I p I I I I I I I I a I I I I I I I I I �— 104 I __ I I __ I I I __ _—_I___I __ I __ I __ I = I I I I I I CD I I I I I I I I I w I I I I I I I I I 103-1---a------a---I---I--- �.---1.---I I I I I I I I I I I I I I I I I I 102T---7--------1---r--- 1----r--, I I I I I I I I I I I I I I I I I I 101-----------------�-------�---� 7 8 9 10 11 12 13 14 15 Moisture - Percent of Dry Weight Soil Description: Gray Sand Max. Dry Density: 106.3 P.C.F. Optimum Moisture: 12.4 Percent Julie E. Keller, P.E. Ronald G. Keller, P.E.: 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 04/"19/2011 04:23 772589�469 K.S.M.ENG. PAGE 01/03 KELLER, SCHLEICHER & MacWILLIAM ENGINEERING ,AND TESTING, INC. MARTIN (772) 337-7755 PO. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) W-7445 wwwAsmengineering-net MELBOURNE (321) 708-8488 FAX (561) 845-8876 E-Mail:'KSMOKSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 11 FAX (772) 589-6469 April 19, 2011 Certified Building Contractors, Inc. 747 SW South Macedo Blvd Port St. Lucie, FL 34983 Re: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida Permit #: �3i'=quesHos, Permit #: 1012-0036 - Cabana KSM Project #: 110377-5d Dear Sir: Enclosed, please find the nuclear density test results performed on the guest house column pads and cabana footers at the above referenced project, io t#0vy,6,IVYawe any questions, please feel free to call. Y�♦ l No_ 65366 Fax%".r't7 it"i County Building Department Fax to: 772-879-0110 JEK: km FIECF-IVED APR 19 2011 public Works St. Lucie County, Fl- Ronald G. Keller, P.E.: 37293 / SI Llo. No.: 860 f Julie E. Keller, P.E.: 68366 04/19/2011 04:23 772589 469 K.S.M.ENG. PAGE 02/03 K S M KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC, MARTIN (772) 337-7755 PO, BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 569-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321)'765.8488 FAX (561) 845.8876 E-Mail: KSM' @KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 SOIL COMPACTION REPORT ASTM D 1557 and ASTM D 2922 DATE TESTED: April 18, 2011 KSM JOB #: 110277-5d1SH/Km PERMIT k 1012-0039 —Guest House 1012-0036- Cabana CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida MATERIAL: Gray Sand ITEM TESTED: Guest House Column Pads and Cabana Footers 7EST LOCATFON 59151 _ ^ - PI S- PEN QRY- - T MAX 13RY P-EI_cE_NT + OF SAMPLE TURE READ DENSITY PROCTOR COMPACTION ----------------- ._ �_,�---------------�,-----VALUE --------------- Guest House Column Pads 1. North 0" —12" 10.3 36 104.6 108.3 98.4 2, N. Center "9137 106.7 99.4 3, S. Center 37 106.5 99.2 4. South 36 104.2 98.0 Cabana Footers 5. N.W, 0" — 12" 10.3 37 105.2 106.3 99.0 6, N.E. 36 104.5 98.3 7. S.E. 36 104.3 98,1 8 SW " 37 1.05.9 " 99.6 Ronald G. Keller, RE-- 37293 / SI Lic. No.: 860 / Julie E. Keller, P.E.: 68366 04/19/2011 04:23 7725e0" S9 K.S.M.ENG. PAGE 03/03 KSM KELLER, SCHLEICHER & MacWILLIAM ENGINEERING AND TESTING, INC. MARTIN (772) 337-7755 RO. BOX 78-1377, SEBASTIAN, FL 32978-1377 SEBASTIAN (772) 589-0712 PALM BEACH (561) 845-7445 www.ksmengineering.net MELBOURNE (321) 768-8488 FAX ($61) 845-8876 E-Mail: KSM®KSMENGINEERING.NET ST. LUCIE (772) 229-9093 C.A.: 5693 FAX (772) 589-6469 MOISTURE -DENSITY RELATIONSHIP MODIFIED PROCTOR (ASTM D 1557) DATE TESTED: April 18, 2011 KSM JOB* 110277-5p PERMIT #: 1012-0039 — Guest House 1012-0036 - Cababa CONTRACTOR: Certified Building Contractors JOB LOCATION: Asselberg Residence 6101 South Indian River Drive Fort Pierce, Florida 107-r---7--7--,---1---r--7---T---i I I I I I I 1 I I I I I I I I ! I 106L__1__1---J------I-- �_ l _1__J I I/H1111 I I 1 1 I i I_ I- .. r,.,,,—I,,,-- — I 1 I I II104 L-----_�..� I I 103I_��I I I I I I I 102-r--T---T---1---I---r----I----r---y I I I I I i I I I I I P I I 1 I I I 1o1--------------------4---I 7 8 9 10 11 12 13 14 15 Moisture - Percent of Dry Weight Soil Description: Gray Sand Max. Dry Density: 106.3 P.C.F. Optimum Moisture: 12.4 Percent Julie E. Keller, P.E. Ronald G. Keller, P.E.: 37293 / SI Lic_ No_! 860 / Julie E- Keller. P.E.: 68366 January 28, 2011 Mr. Don Bergman Peacock & Lewis Architects & Planners Second Street Station 210-A North 2nd Street Ft. Pierce, FL 34950-4406 Re: Asselbergs Residence Project No.: 447.454 We have received the wood truss shop drawings prepared by East Coast Truss. The shop drawings were signed and sealed by the specialty engineer responsible for the wood trusses. The layout and imposed loads on the supporting members are acceptable to us. The shop drawings were checked only for general conformance with the design concept of the project and the general compliance with the information given in the contract documents. Any comments made are subject to the requirements of the plans and specifications. The contractor is responsible for: dimensions, which shall be confirmed and correlated at the job site; fabrications process and techniques of construction; coordination of his work with that of all other trades and the satisfactory performance of his work. Please feel free to contact this office should you have any questions regarding this matter. O'DONNELL, NACCARATO, MIGNOGNA & JACKSON, INC. Tolliver J. Frazier, P.E. Vice President TF/t7c 321 LA Kirksey Street, Suite 200, West Palm Beach, FL 33401.2732 1 Tel: 561.835.9994 1 Fax: 561.835.8255 1 www.onmi.net Florida West Palm Beach Pennsylvania Philadelphia, Lehigh Valley New Jersey Princeton Washington, D.C. November 5, 2010 Project: Asselbergs Renovations & Additions Address: 6101 South Indian River Drive, Ft. Pierce, Florida Authorized Agent To Whom It May Concern: This letter is to certify that Steve Torres and Bob McCreary of Certified Building Contractors, Inc. are hereby authorized agents to sign for and process all necessary permits for the above referenced project. Robert Asselbergs - ner Date The foregoing was acknowledged before me this y:s�— of November, 2010 by Robert Asselbergs who is personally known to me or produced,!�,y�%- k%Q Nk-A as identification and who did not take an oath. Notary Seal: MY C(JP,RAISSiON # DD796130 � gmFti EXPIRES June 09, 2012 PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982-5652 (772)462-1553 FILLED LANDS AFFIDAVIT I, the undersigned, am the owner of the following described property, (Parcel Id#/Legal description/Address) F�, NearC e l F ( . for which I have applied to St. Lucie County for a Final Development Permit. In �oi�— accepting this Final Development Permit, BP Numbe �,�,336 3813/, 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 nor liable to provide for, or maintain in any form, adequate drainage off my property which will not adversely affect the immediate community. , � e rt— Property Owner Name (Please Print) 9!Qg , Property er Signature - s C, STATE OF FLORIDA, COUNTY OF 9% ACKNOWLEDGED BEFORE`` ME THIS `\�p\ DAY OF eY�.s. 120 `\ BY�cl��n �, �+^s<wHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED N\V� ��� AS IDENTIFICATION. SIUNATftFOFNOTAIRY PUBLIC COMMISSION NUMBER TYPE OR PRINT NOTARY . i'4pFY Pp„�. - i7�'91 :•: �[t _ 4sI RUTHEFtz ` MY COMMISSION # DD796130 �F,,,� ,��`�� EXPIRES June 09, 2012 (407;398-0153 �bAdoNofe ryServicexom SLCPDSD Revised 08/24/2010 PLANNMG & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 VIRGR41A AVE • FORT PIERCE, FL 34982 GUEST HOUSE AFFIDAVIT I hereby affirm that Building Permit # /D is to be issued for a guest house which will not be used for rental purposes, seasonally or annually, under any circumstances. Print Owner's Name Si store of O STATE OF FLORIDA COUNTY OF S� The foregoing instrument was acknowledged before me this a� day of _ 20 \� by personally known to me or who has produced �y as identification. GAIL CARRUTHERS '= MY COMMISSION # DD796130 EXPIRES June 09, 2012 (407) 398-0153 FluddallotaryService.com SLCPDSD Revised OWU2010 Signature of Notary Commission Number Notary stamp AFTER RECORDING -RETURN TO: _ JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT SAINT LUCIE COUNTY FILE # 3544369 12120l201Oat 04:25 PM OR BOOK 3254 PAGE 2957 - 2957 Doc Type: NC RECORDING: $10.00 PERMIT NUMBER: NOTICE OF-CylynvlExur Nimn-r The undersigned hereby, given notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida statutes the following information is provided in the Notice of commencement. 1. DESCRIPTION OF PROPERTY (Legal description and street address) TAX FOLIO NUMBER:3E 6( -39fy-Dwi-oco-14 2. GENERAL DESCRIPTION OF 3.OWNER INFORMATION: r, ew c. interest in propertybun—per d. Name and address of fee simple titleholder (if other than owner) ( n 4. CONTRACTOR'S NAME, ADDRESS AND PHONE NUMBER: rri c i —A �csti 1CXi G9t� otS , V 0 �.KJr �c ho-c.� 11 VA • Rote Slyp , LL1«L'. t, E1. 3 Iu193 5. SURETY'S NAME, ADDRESS AND PHONE NUMBER AND BOND AMOUNT: _ N I A 6. LENDER'S NAME, ADDRESS AND PHONE NUMBER: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1)(a) 7., Florida Statutes: NAME, ADDRESS;AND PHONE NUMBER:y 8. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as provided in Section 713.13 (1)(b), Florida Statutes: NAME, ADDRESS AND PHONE NUMBER: 1l�i 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) , , 20 St caner or Print Name and Provide Signatory's Title/Office Owner's Authorized Officer/Director/Partner/Manager State of Florida County of C-* k-oa.-&_ The foregoing instrument was acknowledged before me thisday of , .20 `, By S��Jfe�cAQ.F�ES , as N . ( ame of person) (Type of authority...e.g. Owner, officer, trustee, attorney in fact) For �OOisit..� �4SEt`l�Q.QS (Name of party on behalf of whom instrument was executed) Personally Known_ or produced the following type of ID: .�jj1Y P n _ `• GAIL CARRUTHERG �^ A` C_�� `1 • c\ :"_ MY COMMISSION # DD796130 (Printed Name of Notary Public) (Signature of Notary Public) . ,ta�� t EXPIRES June 09, 2012 (407) 3 (3- 163 FlorldatdotaryServico.com Under penalties of perjury, I declare that I have read the foregoing and that the facts in it are true to the best of my knowledge and belief (section 92.525, Florida Statutes). f Owner or Owner(s)' Authorized Officer/Director/PFartner/Manager who signed above: By: By Rev. M3/ worth PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave 7 - - - - Fort Pierce, FL 34982 BUILDING PERMIT SUB -CONTRACTOR SUMMARY tl be using the following sub -contractors for the (Company/Individual Name) J (}� �j project located at ���� S; .1rj}� ,a� I i"otzi— br'je- (Street address or Property Tax ID #) It is 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 Electrical ` i�c�r �ti�•�rrzc©cs, Lr�Gt �� P� ` n 1rl 2g3©.z/ AC 13W3316 1179 SW i3� (f txer� Spa sue208 Psi F:(' 3yc?IF Plumbing i1- frC�V� i 0ACJ COO � Pi 6LK6'( n3 _ _ Z3 3 Fnc 11 .3 q6 3 I3VAC/ A rlr\e> A, �o►���-bv���� � �in�,. ;z 10/ Ae lg4yY�6 Mechanical Jgl 9e_60_S't"a1XFjtUe�� Se6m-s is&T l • .32951 Roofing i P i d Con cJ i ot�+ po�� 2�,q o7 c cC c�57686 -Taal u I i he A P• S , 1-. •, �t Gas )FFICE USE' -ONLY: PERMIT ISSUE DATE: NUMBER: O 2 G ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: `1 State of Florida Certification Number (if appiicabie): DO I g! -1> i" Q tag 1 ZwW4wea(4qcs � �e have agreed to be the (Company Name/Individual Name) E) e c+o- i 0 L sub -contractor for (Type of Trade) (Primary Contractor) for the project located at ject Street Address or Property Tax ID #) lD C% 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 (Name of the Individual shown on the Contractor's License) ORIGINAL, SIGNATURES ARE REQUIRED GNATURE i PRINT NAME DATE Business Name: 4,L Q� Address: !'e�i� . e U e City/State/Zip: � tg Ir L .Phone: TI P 4 R en v 5V? 3 Q email: CE USE ONLY: PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERNM SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: V 3 ,iks Jam✓' 5 State of Florida Certification Number (If applicable): 0 F— c:, 5-7 1 6 n -:L 1 o <J ra c_ c rr =mac , ,,it .r Pw r-Y,�1 have agreed to be the (Company Name/Individual Name) i�Lu �tc�1r.A� sub -contractor for i k.i_6 rJ-1-, (Type of Trade) (Primary Contractor) for the project located at (Project Street Address or Property Tax ID #) 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) QUALIFIER (Name of the Individual shown on the Contractor's License) SIGNATURES ARE REQUIRED ► - rl,`TPRINT NAME DATE Business Name: Address:) City/State/Zip: 3 N ti 5.3 Phone: '7 -7 - :9 H 3. --? email: ._� Y M ,1--7— f<— r,) s t. OFFICE USE ONLY: PERMIT # ISSUE DATE '= ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: 249004 ( f State of Florida Certification Number (If applicable): G r C 1,3 I f i (/[ 66 Arnold Air Conditioning Inc. have agreed to be the (Company Name/Individual Name) Mechanical sub -contractor for Certified Building Contractors. (Type of Trade) (Primary Contractor) for the project located at 6101 S., Indian River Drive, Fort Pierce (Project Street Address or Property Tax ID #) 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 QUA7.RES (Name of the Individual shown on the Contractor's License) ORIGIN/h, ., SIGNATE REQUIRED Steven A. Arnold SI�ATURE PRINT NAME Business Name: Arnold Air. Conditioning Inc. Address: 181 Sebastian Blvd. City/State/Zip: Sebastian, Florida 32958 Phone: 172-589-1063 OFFICE USE ONLY: 1 1. /') 2 /7l11. llr DATE email: .a, moldairsebastian@gma PERMIT#' ISSUE DATE; 7 2 "zs,,.. PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: OR 01 ©-1 State of Florida Certification Number (If applicable): c G L Z ,31; c coy% rj-3, 4SLao (Company Name/Indivi al Name) agreed to be the o v sub -contractor for l ,a Pf l F,- ec) (Type d Trade) (Primary Contractor) for the project located at 6l ©1 S , T_rr of i wv. 9 ,Q_f 1� r ,,e (Project Street Address or Property Tax ID #) 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 (Name of the Individual shown on the Contractor's License) ORIGINAL, SIGNA URES ARE REQUIRED G ATURE 7 PRINT NAME DAT Business Name: Address: City/State/Zip: Phone: lei tiCAL C' 5 4 • 4- 1'4,ilf '779,1 Ll 39Y OFFICE USE ONLY: email: :^ PERMIT# ISSUE DATE