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HomeMy WebLinkAboutSUBMITTED PAPERSM w3w ?I1-1 V— OFFICE USEDATE FILED: PLAN REVIEW FEE: . I RECEIPT NO.: / `► PERMIT NUMBER. 74� CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.: 1. 2. 3. 4. 5. 9. 10. 11. 12. 13. 14. 16. ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Avenue i3 Ft. Pierce, FL 34982-5652 -�� C , n ej/ 772-462-1553 (ix- q . off-. APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION SCANNEDBY LOCATION/SITE ADDRESS:P-LD St' Lucie County PROJECT NAME: Mt aWN 4 RD SITE PLAN NAME: PROPERTY TAX ID #: 34aJ 1 Qa4000C9 LEGAL DESCRIPTION (attach extra sheets if necessary): PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE: TYPE OF CONSTRUCTION (Check all appropriate boxes) [] [] [l NEW CONSTRUCTION RESIDENTIAL OTHER (SPECIFY) _ [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [ ] COMMERCIAL [ ] INDUSTRIAL DESCRIPTION OF PROPOSED USE: SQ. FT OF CONSTRUCTION: VALUE OF CONSTRUCTION: $ 15. SF. FT 1st FLOOR: 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 of Commencement must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 OWNER INFORMATION N Al R 1\17- . ADDRESS: CITY: PHONE (DAYTIME): L_) STATE: ZIP: Email: 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): (_ ) CONTRACTOR INFORMATION STATE: ZIP: ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT #: / `p BUSINESS NAME: QUALIFIERS NAME: t�aM i1V. SWAe,4 ADDRESS: M W 1 ?1j -'risr(L- CITY:STATE: yZ ZIP: 5 I Z PHONE (DAYTIME): &�j _ 93(4• CDERS FAX NO. C;15' Email: ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): �) BONDING COMPANY: N 11A r ADDRESS: CITY MORTGAGE LENDER: N ADDRESS: CITY: STATE: ZIP: STATE: ZIP: 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 as indicated, and to obtain a certificate of capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application. St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all t)pes), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non- residential use. NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OWNER OR CONT CTOR SIGNATURE STATE OF FLORIDA �n �, ! I� i1�G jJ� COUNTY OF ji ` ( J/ (� The foregoing instrument was acknowledged before me this = day of 20 �� by who is personally known or has produced CONTRACTOR SIGNATURE STATE OF FLORIDA /1 COUNTY OF " (7We— The foregoing instrument was acknowledged before me this___ay of /—it' • 20 by �i rs 16 1 EkL;--el who is personally known or has produced L - _06— ( 1 as identification. 1� %' l t as identification. an n Signature of Notary Signature of Notary 'toy.�.`a MAITE MARTINEZ MAITE MARTINE COmmiSS1U i�L •\Iv .= Public - S(>&tS�l)Florida Com s in -Vie State 040 a • ; : • My Comm. Expires Jun 27, 2015 ' �° • My Comm. Expires Jun 27, 2015 Commission # EE 91416 �r =;�, a;• Commission # EE 91416 Bonded Through National Notary Assn. %.,;f of FAQ.` Bonded Through National Notary Assn. NOTE: 2) SIGNAT Q D. EACH SIGNATU ING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist. OVFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # 1ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC Before 1/1990 LOT OF REC After 1/1990 LOT SPLIT REQUIRED LOT SPLIT APPROVED REPORT CODE HABITABLE AREA (RADON) RADON FEE PERMIT FEE LIBRARY IMPACT FEE PUBLIC BLD IMPACT FEE CORRECTION PUBIC BLD IMPACT FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE ROAD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS REQUIRED MECHANIC ROOF ELECTRIC GAS PLUMBING NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: REVIEWS FRONT COUNTER ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION REVIEW SEA TURTLE REVIEW MANGROVE REVIEW DATE RECEIVED DATE COMPLETED INITIALS DOMIT-1 OP ID: JT ,nco�o� CERTIFICATE OF LIABILITY INSURANCE �.---�` DATE/ 08/0707/2013Y) 013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 954-883-2900 Tanenbaum Harber of Florida 2900 SW 149th Avenue Fax: 954-517-7400 Miramar, FL 33027-6605 Pat Murphy CONTACT PHONE FAX A/c No Ext : A/c No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Hartford Fire Insurance Co. 19682 INSURED Domital Corporation 8850 NW 18th Terrace Doral, FL 33172 INSURER B : Sentinel Insurance Company Ltd 11000 Hartford Casualty Insurance Cc INSURER C : 14397 INSURER D : Twin City Fire Insurance Co. 29459 INSURER E : Liberty Surplus Lines Ins Cc 10726 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE A POLICY NUMBER MMIDDkJR Y EFF MMIDD OLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR 21UUNNX4077 I 01/14/2013 01/14/2014 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 JEmp Ben. $ 1,000,00 B AUTOMOBILE LIABILITY X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 21 UUNNX4077 01/14/2013 01/14/2014 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Perac.Z' $ ' C X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE 21RHUNX3073 01/14/2013 01/14/2014 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED :X I RETENTION$ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 21WEAE1077 01/08/2013 01/08/2014 X I WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 E POLLUTION UBE-NY-1044440-113 $10,000 DEDUCTIBLE 03/22/2013 03/22/2014 Per Incid 1,000,000 Aggregate 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION STLUC01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 5t. Lucie County tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Planning & Development Service Building & Code Reg. Division 2300 Virginia Avenue Ft., FL 34982 AUTHORIZED REPRESENTATIVE !Q ' 1 4PT4a V. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ' 08/06/2013 13:28 772462,1(1ST LUME COUNTY,^ PAGE 01/02 r mil/ M IOW Qs�l a-o pLA,NNIlYG AND DEVELQPIVIENT SERVICES DEPARTNMNT Building sued Code Regulations Dir►is (m 2M VMGU41A AVE. iRMT PIER, FL 34M PERNRT REN19WAL REQUEST ADDRTSS: O M IP -t--:) PERMIT NUMBER: 121 O �t I n11►C-- a,�.-leyy� Z�M t 1�, AM REQUESTING THAT TIIE AWVE PER>.1+ICt' 13 XMV=. I UNDERSTAND THAT I MUST SCREDDLE "D PASS Ate. MQUIRED INSPECTIONS FOR THE FEINT TO = FINALED. FDR'I'HER, I UNDERSTAND THAT THIS IS A QU MW NRD . L AND TIM PERMIT SHALL EXPIRE SROULD I NOT RECEIVE A PASSING INSPECTION DURING ANY SIX MONTHS PERIOD DURING THE RENXWAL PERIOD`. U 0VWEPALARO)kl70 RMCMRSMNATM DATE STATE OF FLORIDA, Caanty of / ' ACXNOWLEDGED DEPOlttlE ME THIS ,= DAY OF t3 BY r%) t) !-vr ' L� W WHO IS PERSONALLY TTO ME , , OR HASPROVIDED % l , l� L- C - As M ENTIFICALTION. STATE Op' 7/777 of �' �1a� ���`,,o- ter, SIGNATURE CORNMION NUM MAITE MAD46 Notary Public -S • My Comm. Expire ,,,111",0;: Commission FOR OFFICE USE ONLY. 1°F s` Banded Through Nat RENEWAL IMF.: $ No. of Open IRRMC&O 4 ToW No. of IngwtWo — (S 6 of Open 1hopeellims). Oriomld Fermi! Fee z Open uspedims (%) � = S (Renewal Fee)L Ex mplc [15 Z3 .6S(%)] $17100(pexnuit fee) z .65(%) _ $113.75 (Rene" Fee) SLCMM REV 41UI2011 Midway Rd Planning and Development Services Building Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-2165 Fax 772-462-6443 Hold Harmless/Indemnity to Cancel or Transfer A Valid Permit Permit # SLC-1210-0174 Property Address 5690 Midway Rd, Ft Pierce Pr Tax ID # 3406-501-0040-000/5 Attorney m F�c� Owner American Towers, LLC Address 523 N SAM Houston Pkwy E Ste 400 Contractor Zip 77060 Phone/Cell Address IZip Phone/Cell Contractor State License SLC License email Commercial X Residential As legal Property Owner or Contractor (circle one) I, Check one: Cancellation Transfer of Permit Number SLC-1210-0174 Issued to the following circumstances: X request on Nov. 26 , 20 12 due to Non -Performance of Contract X Transfer to New Contractor or O/B Abandonment of Contract Contractor is Deceased Contract Disputes Further, I understand that the replacement contractor will assume responsibility for any/all work performed under this permit. I hereby agree to re -apply as Owner/Builder or Authorize, Domital Corporation to apply for such permit(s) as may be necessary to'construct or comple a constr�j ion at the prope listed herein. INDEMNIFICATION: I, �o IG6.Ct6 AO"Noe-rty Owner or Contractor), hereby indemnify and hold harmless St Lucie County, its officers, agent, and employees (including by not limited to Building Official(s), from all costs, fees, or damages arising from any and all claims of action for any reason, which may arise from or pertain to this permit cancellation and re -issue request. (Note: A copy of this notice will be sent via regular mail to the prior contractor or owner, where applicable.) Refund Requested: —Yes No Amount Signature of Contractor Date Print Name State of Florida, County of St Lucie The following instrument was acknowledged before me this day of 20 by , who is personally known to me, or who has produced _ as ID. Signature of Notary Date !/ F11%,i iQl u i Vice President Legal Signature of�g.eN4 izm6f , i fn Print Na tY I ese X State of �� Coun of SEtneie M ` (� The following instrument was acknowledged before me this i 4i` ' day of AVdU+ 20 13 , by Gild who is personally known .�, o�� pr ced Signature of Notary Date *Attorney -in -fact pursuant to Easement Agreement dated July 7, 2009 0 SUSANA P. RIBEIRO * bfic commonweafthNotary of Massachusetts VV�% My Comrrtlsslon E)pIres March 16, 2018 08/06/2013 13:28 772462V, -e1 i ST LUME COUNTY PAGE 02/02 Permit # "1 r%i/j " VZO Planning and Development Services Cj�„ r- A Building Division c l C4? cc, J 2300 Virginia Ave Fort Pierce, FL 34982 772-462-2165 Fax 772-462-6443 Hold Harm less,/indemnity to Cancel or Transfer A Valid Permit Property Address O r­�— Property Tax ID # 1C)(:A-CMQyQff QyQ Owner Address Zip Phone/Cell Contractor Address BeCS7 t4W t S MQM= Zip 3 t Phone/Cell Contractor State License 66-iC161 Z$5"ZD SLC Ucense email Comm=bj Res/dendal_.� As legal Properly Owner or conbactor(circle one) I, request Check one: Cancellation Transfer X of Permit Number - l;40 -- 0t-1i+ Issued to on _ 1rUW a b F 201a due to the following circumstances: Non -Performance of Contract Y_ Transfer to New Contractor or 0/8 'Abandonment of Contract Contractor Is Deceased _ Contract Disputes Further, I understand that the replacement contractor will assume responsibility for any/all work performed under this permit. I hereby agree to re -apply as Owner/Builder or Authorize, to apply for such permit(s) as may be necessary to construct or complete construction at the property listed herein. INDEMNIFICATION: 1, (Property Owner or Contractor), hereby indemnify and hold harmless St Lucie County, it, officers, agent, and employees (including by not limited to Building Officlal(s), from all costs, fees, or damages arising from any and all claims of action for any reason, which may arise from or pertain to this permit cancellation and re -issue request. (Note: A copy of this notice will be sent via regular mail to the prior contractor or owner, where applicable.) Refund Requested: —,— Yes No Amount approved: $ re Date Print Name /r State of Florida, County of St Lucie The following instrument s acknowledged before me this day of 20& by —L who i person y known to me, or who has produmd amass I01 1 . MAI"iE MARTINEZ Fa -Lary Public -State of Florida • • My Comm. Expires Jun 27, 2015 ` -' ��' Commission # EE 91416 ,4i,?"``',,,. Por"I Through National Notary Assn. Signature of owner Date Print Name State of Florida, County of St Lucie The following instrument was acknowledged before me this day of _ . 2a _. by _ _ . who Is personalty known to me, or who has produced as Ib. Signature of Notary date Please send me a copy of my license/ registration via email Thank you! Domital Corporation 8850 NW 18th Terrace Doral, FL 33172 P. 305.594.0873.101 F. 305.694.0817 maite.martineza-domital.com www.domital.com 09/05/2013 02:08 305-59( ``17 DOMITAL CORPORAT I PAGE 01 11 OFFICE USE ONLY: DATE MED; PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: CONCURRENCV FEE: RECEIPT NO.: CERT. CAP. NO.; ALL INFO 1V VST BE COMPLETE & FILLED IN TO BE ACCEPTED .� j = PLANNING & DEVELOPMENT SERVICES DEPARTMENT * BUILDING & CODE REGULATIONS DMSION a 2300 Virginia Avenue Ft. pierce, FL 34992-5652 772462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITYIZONING COMPLIANCE PROTECT INFOMUTION 1, LOCATION/SITE ADDRESS: 66410 pD 2. PROJECT NAME: Ni iY Q�p _ SITE PLAN NAME: 3. PROPERTY TAX ID #; 4. LEGAL DESCRIPTION (at*h extra sheets if necessary): 1•(� C2i�� S. PLAT BOOK 6. PAGE NO. 7. BLOCKNO, 8, LOT NO. 9. PARCEL SIZE (ACRESISQ PT.):.___. � LOT DIMENSIONS: _ 10. COWATE DESCRIPTION OF CO STRUCTI PROJECT OR WORK ACTIVITY,,, _ / _ 4Z C-&7,11 s - 11. SETBACKS (ACTUAL) FRONT: BACK_ _ GHT SIDE; LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [I NEW CONSTRUCTION [ ] EXPANSION/ADDITION [I INTERIOR RENOVATION [' ] ,ICESIDEI MAL ( COMb4ERCIAL [ ] INDUSTRIAL [ OTHBR (SPECWY) pa 13. DESCRIPTION OF PROPOSED USE: 14, SQ. FT OF CONSTRUCTION: 16. VALUE OF CONSTRUCTION: $ 1 0. IS, SF. FP 1st FLOOR: 'ilk value of construction is used to determine the amount of petrnit fees to be asso9std. St. Lucie County reserves the right to gacgtion and/or modify the indicated value of consauction if it is demonstmted that tha,wbmitted figures are not Consistent with similar types of eonstnuouon aodvities. Ifthe value is $2100 or more, a RECORDED Notice of Commencement must be j ibmitred with this application SLCCDV Form No.: 001-02 09/05/2013 02:11 305-594- 'IL7 DOMITAL CORPORA77"11 PAGE 01 01'FIC8 USE ONLY: DATE FILED: PLAN REVIEW FEE: RECEIPT NO.: PERMIT NLM k, CONCURRENCY FEE: RECEIPT NO.: CERT. CAI'. NO.: _ ALL INFO MUST BE COMPLETE & FILLED IN TO HE ACCEPTED -j PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 4 2300 Virginia Avenue Ft. Piercc, FL 34992-5652 772462-1553 APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONIlNG COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 1p m i pp 2. PROJECT NAME:_ N1.IY4!,jM V-p SITE PLAN NAME: 3. PROPERTY TAX ID #: t 4. LEGAL DESCRIPTION (attwh extra sheets if necessary): % r_ — S. PLAT BOOK 6. PAGE NO. 7. BLOCK NO. & LOT NO. 9. PARCE..L. SIZE (ACRES/SQ FT): � � LOT DIMENSIONS: _ 10. COMF TE DESCRIPTION OFfiCOSTRUCTIW. PROJECT OR WORK ACTIVITY � 11. SETBACKS (ACTUAL) FRONT: � BACK: ....... GHT SIDE: � LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) 13. 14, I G_ [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION (] INTERIOR RENOVATION [ J.,RBSIDENIIAL [ COS E�! RCLAL (j INDUSTRIAL [ FY} [OTBEER (SPECI,ter DESCRIPTION OF PROPOSED "USE: SQ. FT OF CONSTRUCTION: VALUE OF CONSTRUCTION: $ I Lna) 15. SR FT Ist FLOOR: The value of consttuedott is used to determine the Amount of permit fees to be assessed St. T.ucae County reserves the right to question prWor modify the indicated value of construction if it is demonstrated that the submitted llgures are not consistbnt with similar types of conmuction activities. If the value is $2500 or more, a RECORDED Notice ofCommencement must be submitted with this application, SLCCDV Form No.: 001-02 UPDATED WSM9 09/05/2013 02:11 305-594(- -'`47 DOMITAL CORPORA-71 PAGE 02 OWNER INFORMATION NAME: /Q 4- cf- CITY: :�50�ccf f� CITY: PHONE (DAYTIME): C5 E Email: IF T Ht FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ,ADDRESS BL'L.OW. FEE SIMPLE TITLEHOLDER: ADDRESS: CITY; STATE: PHONE (DAYTIME): {�) ............. CONTRACTOR INFORMATION ST. of FL REG.CERT #:.Zd'qC..IGI 1,5 C7 ST. LUCIE COUNTY CERT #: BUSINESS NAME: ' �� %E;2g=&T } 0r4 QUALIFIERS NAME: bpmlNlt= -swp'ai_.- ADDRESS: NW i ?;," -REr4L- ZIP: CITY'- �� _ _ - STATE: ZIP: 1 4Z. PHONE (DAYTIME)_ (�) Sjq FAX NO. g5l E..il: ARCHITIENGINEER: ADDRESS: CITY: STATE: PHONE (DAYTIME):) _ _.... ___ _..... ZIP: BONDING COMPANY: &J LA r ADDRESS: CITY: STATE: ZIP: MORTGAGE LENDER: �- ADDRESS: CITY: STATE: ZIP: MPORTANT NOTICE: When a permit is issued and it is not picked up within JO alls after notification it will be v2Wjd and returned to you by ma% 09/05/2013 02:11 305-594j717 DOMITAL CORPORATT^kI PAGE 03 'Telecom August 28, 2013 Saint Lucie County Building Department 2300 Virginia Avenue Fort Pierre, FL 34982-5652 Subject: Special Inspection Letter AT&T Site No.: Midway Site Address; SW W Midway Road Fort Pierce, VL 34981 CALTROP Job No: 120-561.39 Dear Sir or Mariam: Mr. Michael A. Phillips, P.E. of CALTROP Corporation (CALTROP) has performed a. reviewed documentation obtained from a recoot tower climb performed by a certified tower climber as well as from CALTROP personnel for the AT&T installation at the above-referexced site. The purpose of this review was to inspW the installation of the following: Connections of three proposed antennas. • Connection of six Remote Radio Head (RRII) units_ • Connection of one fiber distributor/ surge suppressor. • Connection of relocated CC equipment cabinet. • Connection of proposed RBS 6301 equipment cabinet. Mr. Phillips reviewed the connection of the above mentioned installation(s) and compared them with the approved construction drawings prepared by CALTROP dated October 9, 2012. Based on the review of the aforementioned documentation by Mr_ Phillips, to the best of our kwwledge and belief, this installation was performed in substantial compliance -with these drawings. Should you have any questions or wish to discuss any aspect of this latter, please'do not hesitate to contact the undersigned. Sincerely, CALTROP Corporation Michael A. Phillips Principal Ettginmr Florida Registration #68312 CAt.7ftQP �JttakeNlteNde �ir11 W. �a`•'., N` $`.:.:tid�N�t�r°j;:'i,,fn.; i';<iii't�<•i3 �48f18111/1 " �.. a,too X /LV1J VL.11 �k7b—by4—dS17 DOMITAL CORPORATION PAGE 63 emu 4 c -'. Teleco n - =_— A - ---- - - - — _ - -, --- =- — - -- -Saint Lucie -County 23QO V4inia.Avenue.- - - - - - - - _.= 0ZV ie �-34982_% _ _ Subject: Spe¢iru Inspection Letter - -AT&T-Sine No.:. Miidw. y =---------------------- Fort Pierce, -:FI: 34981 CALTROP Job lYo: 126 41.39 1 - : Dear Siuor Madam: _.. _ .. Mr. Michael A. Phillips, P.E. of CALTROP Corporation (CALTROP) has performed a. reviewed documentation obtained frown a recent tower climb performed by a certified tower climber as well as from CALTROP personnel for the AT&T installation at the above -referenced this r�viEnc, site, " l%e puapose of was to inspw the installation of�the following; • Connection of duce proposed antermas. • Connection of six Renl:Qte Radio Head (RRii) units. • Connection of one fiber di stributorL.surge suppressor. • Connection ofrelocaied CCl equipment cabinet. • Connection of proposed "S 6301 equipment cabinet. Mr. Phillips reviewed the oonnection of the above mentioned installation(s) g6d con4x1jad them with the approved construction drawings prepared by CALTROP dated Oetober 9, 2012. based on the review of the afommentioned documentation by" Mr. Phillips, to the best of our knowledge 'and .belief, this installation was Performed insubstantial compliance with'these drawings. Should.you have any questions or -wish to discuss any aspect of tWs letter, .pleese•do not hesitate to contact the undersigned. Sincerely. --CALTROP Corpwation Michael A. Phillips Principal Engineer Florida Registration #68312 • ,•�• 1l 7 •• dry .Y •;' �Ir�:r , f��i''E:r":dti�� f?�rkyf:��; !�.: ,a;<�ri��i>i,;�j;: 081e30/200?9 13: 26 Date: rCOUfaTY F l 0 R I D A 772466:;` Fee SEACOAST AC - I , Receipt# Peru it PlanlningA DeveloF meat Services Building & Code Regulations DiviSIOD 2300 Virgin a Ave. Fort Pierce, 34982 (772)4g2-JS53 SPECIALTY 17 Electrical ❑ Plumbing UPRyA Ci Shed ❑ Demolition ❑ Gas See Me 2 for &Wmcdoas and sdUMOrel pgwwork , I. Loc2tion/3ite Address: 2. Parcel ID Number: , Off, re Use Src:ior only APPLICATION 1 ❑ Fence ❑ Siding �r sp�ecia�q, perms Raa�e "Ap Page Zorn nand Uw PAGE 01 3. Complete Description of project or Work: r 4. Owners Intortnation 5- Contractors;Certf- Address:Iformatiod Name-, 3 k'I. Re ' f7(J �` 0 11� `11%� .� _•-- . Cannty CityState: Bntinega Name: 26, f Zip: J�'"1 � Phone: Plyoge: 7� ' f-PFa,x: LD S off „ 60 value of Construction: S owlvlcRIs E#FFIDAVIT: i certify that it of the .plimblation aontam this xr ct aad that all work will be done m compliance with all apgl[oabla laws regtR n PRINT OWN$R OR CONTRACTOR NANg % 9 MAO OWNER O$ CONTR STATE OF FLORIDA. COUNTY OF ACKNOWLEDGED .BEFORE ME 7 I U8' DAY OF $y j� WHO IS PERSONALLY M40WN TO A+ffi ,� WHD HAS PRODUCED AS MAT ON7 � �r sANDRA ,HOHMANN JNOTARY PUBLIC MATURB OF N+DTAItY ✓ ST, OF FLORIDA _ T'YPE OR ,PRINT N OF NbTAdtY Comm# DD094g�q COM I[93ibNNUMBER ��09 9 s s" ENO" 3/14/2014 NOTICE RO OWNER[; FJI URE TO RECORD A NO= OF CO CEMENT MANY RESULT IN YOUR rAMNQ TWKX FOR �OMMNTS TO YOUR PROR"E 'ry W Y 11MM To OBrA N F'aNTANCINC, CQPiBIIi.r zvlTg YdUR LENDXX OR AN A,'X'T'pRNEY BEFORE RECOIiDIIYG OUR NOTICE OF COMjXt4CEMgW. EXEMPT: A/C -HEAT R APL;ACEWNT WnH CONTRACT UIVD R MAW 08/30/2009 13:26 77246J3 Date Fee Due: Recei PUnning & De Building & Code 1 2300 Dart Pi M SPECIALTY C] Electrical 13 Plumbing t ❑ Shed 0 Demolition 0 Smp r2forinstrrr *M and addmonal X, Locatioa/Site Adds: ,� 2. fsrcel ID Number: Office EYE $m Oily 3. Complete Deserlpom of project or w10 rk: 031 AC sent Services tions Division Ave. 34982 tMIT APPLIC.ATION A, 0 Fence s ; 0 Siding t mooed forspeeT 4 penw& ,. t o - 0 0I 03 -- bnD 4. owners ialoMMUOR S. C, Address: 1 City: Zip: Plane: 6. Valve of Cs4stradbne S UWnr MI ApFLAiAVIM. I Cechy that au afthe.infoanaation rOQita�6oe ! compliance wit?: ail app 'Cable laws regal . PRII�OWN RORt70NPR WTORNAM£ 1,. A 9TAI'Jr O$ FJ.(7RIDA. COUNTY OF _ r �L_l- C I(� _ _ ACKNOWLEDGM AEFORis Nth T US Zt—A DAY OF_I�[ L 20„ j WHOIS MRSONALLY• MgOWM To M$ t� WHO HAS FRODUCEU AS CATION ATURHOFNOTAR:f ),>og U [_ TYPE N( MCC'i'OOWNEIL )FAnME TO 11RCORD AI 1Vo"M OF COIN aM0VL?dENTa TO TOUR FROW.M'ry. W LEMMIM OR AN Ai'i RMY DEt?OtRX WCOADI LXEMPr: Arc -HEAT RRFLACCMUff WrM CONTRACI' M uls I PAGE 01 U —... ors!InI(orma�on {� Reg/Cert#: i"� oo 0 '7 1 Names anal that aH work will be dose in SYJ02LP—�fl* OTDRA AttY HMCANN s ,N OF FLORIDA F Nt7rARif Comer# DDMVr,4 EVIrres 3/14/2014 VCOMY MAY REWLT IN YMM PAYMG TWKM FUN MEND To ORMIN MANCING, CONSULT TMM YOWR YOUR XRSBRK CZ OFCOAftNCLMKW. E/I:abed i 8ZST29t:01 3ti'8 9NIld3H S3WIH9:w0J3 Zt7:ST OT02-9T-330 Stlucie County Property A; " `Miser Page 1 of 1 Bohan, James Property Identification Account Number: 006872 Identification M 105020103028 Ownership Location and Mailing Address Business Name; Bohan, ,lames Location: 104 yuma way it 34950 DSA; City; NA Contact Name: James Bohan Current Account Status Account Status; Tax Year; Year Added: Asset Group and Value Asset r MOBILE HOMES Go neral Tax Sketch Map Parcel Q 1433-210-0003-000-9 Territory: 02 Penalty n/a OwnerName; Bohan, James Mailing ddress; 104 Yuma Way 2nd Add ess: City: Fort Pierce State: FL Zip: 34946-6652 Country. Open Edit Co e: 0 2011 susines Type; 7050 T/R Rec ived Lin s i Sub Total Exemption Amount: Total: $1052 $1062 $1052 $0 Incl.in Value: Yes State Code: 914190 Exemption(s) YES Apply: http://www.paslc,org/txtLines.asp 12/16/2010 £/£:96ed 8LST297�o1 9d '8 9NIlti3H S3WIN9:W0ad Lf7:ST OT02-9Z-93a