HomeMy WebLinkAboutSUBMITTED PAPERSCOUNTY
F L O R I D A
❑ Electrical
❑ Shed
Planning & Development Services
Building & Code Regulations Division SCAN
2300 Virginia Ave. By Fp
Fort Pierce, FL 34982 St
(772)462-1553 ��Cie C...,
SPECIALTY PERMIT APPLICATION
$'Plumbing ❑ HVAC ❑ Fence
❑ Demolition ❑ Gas ❑ Siding
See page 2 for instructions and additional paperwork required for specialty permits
1. Location/Site A
2. Parcel ID Num
3.
L;(f: C
Only
Section
Township
Range
Map Page
Zoning
Land Use
ials
Description of Project or Work:
4. Owners Information 5. Contractors Information
Name: JCO h-4— lvi�rt° FL Reg/Cert #:
Address: �S� .S��a�'E �riy� County Cert#:
City: State: /452i Business Name:
Zip: 3y�/f� Phone: Phone:
e0
6. Value of Construction: $ 2S2 '
OWNERS 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 regulator ction an zonin .
PRINT OWNER OR CONTRACTOR NAME SIGNATURE OF OWNER OR CONTRACTOR
STATE OF FLORIDA, COUNTY OF //))
ACKNOWLEDGED BEFORE ME THIS DAY OF 20 /vBY
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED
AS E CATION. ®R DEPOSIT ONLY
AA _1 1 v� ,ST LUCIE COUW BOARD
SIG NOTARY TYPE OR PRINT NAME OF NOTARY F COUNTY COMMISSIONERS
COMMISSION NUMBER BUILDING & ZONING 2415
2000050999M
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 COMMENCEMENT.
EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER $7500.00
Revised 04/26/2010
NOTICE TO OWNER: FAILURE TO R---RD A NOTICE OF COMMENCEMENT MAY RI T 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 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 information 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.
34982
St. Lucie County - pCIS
12-07-2010 12:48:12
BOUR1081SCOTT66
DOW SPRUCE DR
FORT PIERCE
FL 34982
Amount Tendered: 470.00
Amount Paid:
470.00
Change Due:
0.00
Thank You
User ID: WARDD
$ TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
UU JU(U C U-)
1j r7 :2
SUBDIVISION I::,- LOT 3i BLOCK /
1
BILLINGADDRESS _5A,, y ? E Is, q6)oL-_
,( r-�
PHONE # �'T-r}"J 60I 1 MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOS TS ARE NON NEGOTIABLE OR TRANSFERABLE.
' SOCIAL SEC/
FED ID 5 _?0 G %
SPOUSE SOCIAL SEC.
NAME %.JL.(_.) 1
ACCT. # IN I
SERVICE ADDRESS
�r r OFFICE USE ONLY
DATE RECEIVED �J�T% CASH CHK # RECEIVED BY,
COuN
St. Lucie ---Minty
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. Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet
the minimum code. Initial ira,—
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 Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
'7 day of AEC of 201112';pill Oil
ner wilder Signature
STATE OF FLORIDA
COUNTY OF .ir L ul /A -
The fore g instrument w�f acknow)ed
by C-6 / �J r 1� f
Signature oTNotary
Title: Notary Public
before me this d day of , 20 lb ,
_who is personally known to me, or who has
as identification.
Type or Print Name of Notary
Commission Number
Property Appraiser - St.Lucle County, FL
Page 1 of I
Scott Bourke Record: 1 of 1
Property Identification
Site Address:
5500 SPRUCE DR
Sec/Town/Range.
11:36S:40E
Map ID
34/11N
Zoning.
RS-4
Ownership and Mailing
Owner Scott Bourke
Address: 5500 Spruce Dr
Fort Pierce FL 34982-3861
PROPERTY RECORD CARD
«Prey Next» Spec.Assmnt Taxes Exemptions Permits Home Print
r �\)�CIE CO
ParcellD: y Gy<
Account #: 38258
Land Use SF Res
City/Cnty. St Lucie County
Legal Description
INDIAN RIVER ESTATES -UNIT 09- BLK 73 LOTS 3, 4 AND 5 (MAP
34/11N)(OR 1293-2687: 1794-2290)
Sales Information
Assessment 2010 Final
Total Land and Building
Date
Price
Code
Deed
Book/Page
2010 Final:
68400
Land Value: 30500 Acres 0.71
8/15/2003
100
01
QC
1794 / 2290
Assessed:
68400
Building Value 37900
4/18/2000
70200
01
DE
1293 / 2687
Ag.Credit
0
Finished Area 1771 SgFt
6/5/1998
0
01
CT
1153 / 0270
Exempt:
43400
2/28/1995
69000
00
WD
0943 / 1908
Taxable
25000
12/1/1986
63000
00
CV
0525 / 1433
Taxes:
670.07
2/1/1982
10000
01
CV
0423 / 1719
11/1/1976
8700
01
CV
0259 / 2127
BUILDING INFORMATION
Exterior Features
View
RoofCover
TN - Metal
RoofStruct:
GA - Gable
ExtType,
HC- - HC-
YearBlt:
1977
Frame
Grade:
C- - C-
EffYrBlt:
1977
PrimeWall:
WS - Wood/Sheath
StoryHght.
0020 - 2 Story
No.Units:
1
SecWall:
Interior Features
BedRooms:
2
Electric:
MX - MAXIMUM
PrmintWall:
WP - Plaster
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/FI:
1/2Bath:
0
HeatFuel:
ELEC - Electric
Prm.Flors:
CU - Carpet
%A/C:
100
%Heated.
100
%Sprinkled.
0
Special Features and Yard Items
Land Information
Type Y/S
Qty. Units Qual.
Cond. YrBlt.
No. Land Use
Type
i•ae;.a>;.. :
1 0100-SF Res
215 -Front Ft
80 125
2 0100-SF Res
215 -Front Ft
80 125
3 0100-SF Res
215 -Front Ft
68 160
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
littp://www.paslc.org/prc.asp?prclid=340261000860002 12/7/2010