HomeMy WebLinkAboutSUBMITTED PAPERSe
Date: J ne Dw-.- Recei t# ermit # .
Planning & Development Services
Building & Code Regulations Division CAIUJVe p
2300 Virginia Ave. BY
_ �_ -- = Fort(772)462-1553 982 St. Luclg CQntv
SPECIALTY PERMIT APPLICATION
❑ Electrical 01phumbing ❑ HVAC ❑ Fence
❑ Shed ❑ Demolition ❑ Gas ❑ Siding
Seepage 2 for instructions and additional paperwork required for specialty permits
1. Location/Site Address: VN 0 U r EN tiAV E� PID A-D
2. Parcel ID Number:
-b13 - 133- DW2^ ooc)/()
3. Complete Description of Project or Work: Lqy �J 6- /L S n -M
.AT Tip
4: Owners Information 5. Contractors Information
Name: ZhA ro P—E r(= L W-ap— FL Reg/Cert #:
1 ACl*tl �l2.E F oFL �/2
Address: `-J (OC> C-DjCN �� Ea County Cert#:
City �ba Pl —:'-Y2CE State: rL— • Business Name:
Zip:
34a.45
6. Value of Construction: $
Phone 11 2- 2 )1 8S Phone:
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application F/a,that all work will be done in
compliance with all applicable laws regulating construe ' n and
JAmcS %���' `�
PRINT OWNER OR CONTRACTOR N SIGNAT OWNER OR C R
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20� BY
LWHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED ! ZfJnL —
aAS,NTIFICATIONN. _ :: ( n ,,DAWN NWK
O ARY TYPE OR PRINT NAME OF NOTARY �a MY COMMISSION # DO 852587
!. EXPIRES: mar6h 22, 2013
'• Z''
COMMISSION NUMBER?I, Ended Thm Notary PublicUndetwrilers
SY.��•Y
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 `�,. ORD A' -NOTICE OF CONAIENCEMENT MAY L 1T 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 Indicate_the street address or general location of
- property where the building activity is taking place.
2. Parcel ID Number
Indicate the tax identification number of the
property where the building activity is taking place.
3. Description of Project or Work Activity
Fully describe the activity to take place.
4. Owner Information
Indicate the name and address of the owner of the
property on which activity is taking place.
5. Contractor Information
Indicate the State of Florida registration number (if
applicable),_ St. Lucie County contractor license
"
number and the name of the business doing the
work.
6. Value of Construction
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 thdsubmitted 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.349,82.All permit applications must be filled out completely before submission. No applications will be
accepted for processing after 4:39 P.M. For assistance in completing this application, please call 772
462=1553; duringregular 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.
FEKTEw� •
St. Lucie C 4
Building & Zoning Department
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (1) 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
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 liab a fo he
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 relate meal
cost, which could include loss of wages during recovery from their injury. Initial I
117
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 acici} wled e
day of DECem,sErL of 20 10 /
Owne#111der Sign
STATE OF FLORID -
COUNTY OF
The foregoing instrument was acicrlQwl dgel
by 4P* �� ro CCt—E'er
—produced
iS gyre of Notary
Title: Notary Public
I before me this ( ` day of , 20 ,
�0, Cw'ho is personally known to me, or who has
_TS&,)0 as identification. j
DAWN MILONE
Type or Print Name of Notary = �`'_ (SINtOMMISSION 4 DD 852687
Commission Number ;:; EXPIRES: March 22, 2013
Bonded Thru Notary public Underwriters
Fort Pi( -.e Utilities Authon
"Committed to Quality"
Key Accounts
206 S. 6th Street Q O
P.O. Box 3191 `T
Fort Pierce, Florida 34948 3.191 Phone (772) 466-1600
Fax (772) 465-6984
Invoice Number KA-13.8-10
Job Location - 1760 COPENHAVER ROAD
Account Name RACHEL TREFELNER
Contact Name RACHEL TREFELNER
Billing Address -
Telephone
Fax
Mobile
PCN 231313300020000
FBI #
M (�.«. ...,
06-3-060-43701-0000
'[: '.:a
1
• 70}k
0
N.dTi ^gtLi. N d iSh warm,
Water Meter and/or Service^ Installation
.785.00
-062-000-235.0.0,00.00_
___ -,-- - -----------_ ---
Cust. Type
� Commercial
Residential
T.__-------------Water-Security-Deposit-- - - —
- - - - - - - -- -
-----60:00- - -
06-3-060-48800-0000
Water Initiation of Service
40.00
06-3-060-43702-0000
Water Capital Improvement Charge
Water ERCs
1
$1,841.00
06-3-060-49525-0000
Water Accrued Guaranteed Revenue Charge
$394.65
Meter Verification Fees
0.00
06-3-060-43701-0000
City Limits
O Inside
� Outside
DDC
0.00
08-2-000-23500-0000
Wastewater Security Deposit
0.00
08-3-08048800-0000
Wastewater Initiation of Service
0.00
08-3-08043702-0000
Wastewater Capital Improvement
Wastewater ERCs
0
- 0.00
_08-3-08049525,00.00
*_Wastewater Accrued -Guaranteed Revenue Charge -
$0.00
06-3-06043701-0000
Lien Fees
$127.00
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_.�ic �i'k�/�Ik
0.00
0.00
*Water and Wastewater AGRC fees are..good until:the .end: of the month. If not received by-fhe end ,of Down Payment 650.00
the month, new fees will apply. Please.contact:our office for updated fees. Invoice Total 2,597.65
Description for Service Order INSTALL 518 X 3/4" WATER METER AND SERVICE - NO SEWER
Total Paid Date Paid Check Number ` o
Customers will be assessed wastewater charges the day they connect to the wastewater system or within 365 days from date wastewater Connection Charge is paid -
whichever is first. The cost of the service line from the point of delivery at the property line to the house/building is the responsibility of the customer and is not included in
this invoice. State laws require that a permit from the Health Department must be obtained prior to initiating a septic tank abandonment. Contact the Healh Department at
(772)873-4931.
Construction cost estimates are based on current labor, equipment and material prices. Actual costs of construction will be determined at the completion of the project.
Should unforeseen circumstances be encountered during construction, including but not limited to adverse weather conditions and construction conflicts, the customer will
be responsible for increased costs. Additional costs incurred by the customer shall not exceed fifteen (15) percent of the total estimated construction costs shown above.
Estimated costs paid by the customer that exceed the actual cost of construction will be refunded by Fort Pierce Utilities Authority.
Key Accounts Rep.
Customer's Signature
Printed Name
Date 11/3/2010
Date k 1 `3 l � o
Fort Pierce Uti,l- Authority Capital C.ha;J --�e 4nstallment Payment
•� "Committed to wuality' Agreement
206 South Sixth Street (34950)
Post Office Box 3191
Fort Pierce, Florida 34948-3191
(772) 466-1600
THIS -AGREEMENT, made this 3 day of NOV-EMBER 20 10 by
and between JAMES & RACHEL TREFELNER
whose address is
1760.COPENHAVER,.ROAD, FORT PIERCE,.FL34945
hereinafter referred to as "Customer", and CITY OF FORT PIERCE, FLORIDA, a municipal corporation, for the use and
benefit of THE FORT -PIERCE UTILITIES AUTHORITY, 206 South -Sixth Street, Fort Pierce, FL 34950, hereinafter referred to
as "FPUA".
- -- - RECITALS - -
WHEREAS, the Customer is the owner of that certain real property located at
1760 COPENHAVER ROAD, FORT PIERCE, FL 34945
hereinafter referred to as "the Property", more -particularly described as follows, to -wit:
--PCN-2313=133=0002=0000 SEE ATTACHED
and
--WHEREAS, the Customer -owns an existing residential -structure and has applied to FPUA for -
WATER utility service; and
WHEREAS, the parties hereto represent and warrant to each other that this Agreement is valid and binding to
each other.
NOW, THEREFORE, the parties hereto agree as follows:
Section 1. That the recitals stated herein are true and accurate and are part of this Agreement.
Section 2. Deposit. The Customer has made a deposit in, the amount of $650.00
receipt of which is acknowledged by FPUA, toward the total of the applicable installation charges, Contribution In Aid_(CIA) and
security deposits, as set forth on. Invoice Number KA 138-10 attached hereto as Attachment 1 and made a
part of this Agreement.
Section 3. AGREEMENT TO MAKE INSTALLMENT PAYMENTS. For value received, the
undersigned Customer jointly and severally promises to pay FPUA at 206 South 6th Street, Fort Pierce, FL 34950 or at such
place as FPUA may designate in writing, the principal sum of $2597.65 payable as follows (check one):
0 (a) Twelve (12) equal consecutive monthly payments of principal only, in the amount of
each, for a total principal payment of
Options B and C Water and Wastewater Only
✓0 (b) Thirty-six (36) equal consecutive monthly payments (last payment may be slightly adjusted), including
principal and interest at the rate of the rate of 6 per cent per annum, in the amount'of . $79.03
each, for a total payment of principal and interest in the amount of $2,845.08
❑ (c) Sixty (60) eqt Dnsecutive monthly payments (last paym,, nay be slightly adjusted), including principal
and interest rate of 6 per cent per annum, in the amount of each, for a
total payment of principal and interest in the amount of
The sum bereby agreed to be paid by Customer shall be in addition to all monthly utility bills charged to the Property.
Section 4. ELECTRONIC FUNDS TRANSFER. All payments set forth in Section 3 above will be made by
electronic funds transfer utilizing the Customer's, designated.bank.account.--The-Customer-agrees-to-complete and --sign the-
=fZPay AuthorizationAgreement, a copy of which is attached hereoo as Attachment 2 and made a part hereof. The Customer
and FPUA further agree that the Capital Charge Installment Payment Agreement is -contingent upon.'successful processing of
t-e=electronic.funds-transfer_according to the signed-EZPay-Authorization-Agreement.-- - - - - - -
Section 5. RESPONSIBLE PARTY. FPUA.recognizes that the.Customer-may lease, rent or otherwise allow
the occupation 'of the Property by others who may request utility service from FPUA.. FPUA shall not -be considered a party to
any agreement -between Customer and any present or future -occupant who may request utility service from-FPUA. -The
Customer shall remain responsible for the monthly payment, which will be billed separately from the occupant's utility bill.
Section 6. DEFAULT AND ACCELERATION. Non-payment of any installment due under this Agreement
will be considered a default, and if is not corrected within ten (10) days, the account will be assessed a Late Payment Charge in
'accordance with the FPUA's Service Charges Resolution in effect as such time the charge is applied. -Overdue accounts shall
- also -be -charged -the -maximum -rate of -interest -allowed -by-law on any overdue balance in addition -to the Late Payment Charge.
Furthermore, at the option of FPUA,, the entire sum shall at once become due and payable, without notice. Failure -of FPUA to
exercise this option shall not constitute a waiver of the right to exercise the same at a later time for the same or any subsequent
default. In the event of default of any payment under this Agreement, the Customer hereby agrees to pay all costs of collection.
FPUA may utilize a collection agency for the purpose of collecting the entire remaining balance.
Section 7. PREPAYMENT RIGHT. The Customer shall have the right to prepay, in whole or in part, the
unpaid balance of the amount due under this Agreement, without penalty.
Section 8 Water and Wastewater Only
-Section -8.- ANNEXATION AGREEMENT. Unless previously executed, the Customer shall execute a
standard_ Annexation Agreement providing that the Property shall be annexed into the city limits of the City of Fort Piece as soon
as such annexation may legally occur. The Customer further agrees to sign any and all necessary documents to effectuate the
annexation upon request of the City of Fort Pierce or FPUA. The Customer further waives any and all objections to such
annexation by the City of Fort Pierce and agrees that this document shall be construed to satisfy the requirements of law for
consent or approval of such annexation now or hereafter acquired.
Section 9. PROOF OF OWNERSHIP. The Customer represents and warrants that he is the legal owner of
the Property. A copy of the deed conveying title to the Customer shall be provided to FPUA as proof of ownership. Said
property constitutes his/her homesteading under Florida law.
..Section 10. ADDITIONAL TERMS AND CONDITIONS.
10.1. The obligations and benefits under this Agreement shall extend to and shall inure to the benefit of the personal
representative, heirs, successors and assigns of the respective parties to it.
10.2. No waiver of a breach of any of the covenants in this Agreement shall be constructed to be a waiver of any
succeeding breach of the same covenant.
10.3. The Customer shall promptly execute and comply with all statutes ordinances, rules, orders, regulations and
requirements of the Federal, State and City governments and of any and all their departments and bureaus
applicable -to the Property and/or office business.
10.4. Wherever used herein, the term "Customer" shall include singular and plural, male and female, heirs, legal
representatives and assigns'of individuals, wherever the context so admits or requires.
I have read and acknowledge receipt of a copy of this Agreement, by my signature.
IN WITNESS WHEF' 4F, the parties hereto have executed this, lital Charge Installment Payment
. Agreement on the 1 .. 'gay of 20
Witnesses as to FPUA:
Witness Signature
Printed.Name _
CITY OF FORT PIERCE, a municipal
corporation, for the use -and benefit of FORT
PIERCE UTILITIES AUTHORITY
Witness -Signature -
William G. Thiess, Director of Utilities
Printed -Name
STATE OF FLORIDA
COUNTY OF ST. LUCIE
The foregoing instrument was acknowledged before me this day of 20 ,
by William G. Thiess, on behalf of the City of Fort Pierce, a municipal corporation, for the use and benefit of the Fort
Pierce Utilities Authority, who is personally known to me.
Witnesses as to Customer:
Wi . s Si ature.13
,Jn,tco ,
i✓ L
Printed Noe
it ess Signatur d,
Printed Name
STATE OF FLORIDA.
COUNTY OF St. LUCIE
The fore oing instrument
by S °- 1
who produced EL
1ogl Al, Notary Public State of Florida
Joyce E Easterday
My Commission DD961864
$F of f`ao- Expires 0211512014
acknowledged
Notary Signature
Printed Notary Signature
cus mer Signature
Printed Name
�Zday of !V o ae 20 /4
N#N Sigoature
J
Printed NoWjy Signature
as identification.
Fort Pic e Utilities Authority
206 S 6i:�-, Street -1
Fort Pierce, FL 3.4950
On Behalf--of-
RACHEL S TREFELNER
1760 COPENHAVER-RD
FORT PIERCE FL 34945
USA---- - - -
Receipt Number: PYMT00002517508
Receipt Date: 11/3/2010
- Customer- ID: 22-541-2 ---
Location ID: 10005349
Re Service Address:
1760 COPENHAVER RD
FORT PIERCE FL 34945
-- - USA -
Total Amount Received by Check $60.00
Fort Pi( e Utilities Authority ` J
206 S 6Lcc Street `J
Fort Pierce, FL 34950
Receipt Number: PYMT00002517509
Receipt Date: 11/3/2010
Customer ID-: 2254-12--_
Location ID: 10005349
On Behalf of : -- . _...- _-.___...-------- _--
- - - - - ---
RACHEL S TREFELNER
17 6 0- COPENHAVER RD - 17 6 0 - COPENHAVER- - RD
FORT PIERCE FL 34945 FORT PIERCE FL 34945
-USA-- - ----._ - = - - - USA --
Total Amount Received by Check $590.00
Raymond Chladny
9600 S. Ocean Drive, Suite 201
Jensen Beach, FL 34957 (772)631-5709
Letter of Observation — Concrete Header Install
May 04, 2011
St. Lucie County
Building Department
Plan Review
Re: Rio Arcade
6649 S. US Hwy 91
Permit Number: #1101-0137
To Whom This May Concern:
Pleas. n on April 28, 2011, I did personally observe the installation of the anchor bolts, rebar
and form work before the concrete was poured and found it to be per our drawings and to meet
"'fthe current Florida Building Code. Work was completed to acceptable trade standards.
If you have any questions, please contact me at any time.
Thank you,
JUL 14 2011
Raymond Chladny, Public Works
B.arch.Sc., M.arch, AIA "` LuC1e county, FL
MAAA, MFAID, NCARB