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Home My WebLink AboutSUBMITTED PAPERSi Y Fee Due: Receipt# Pi t # v COUNTY F L O R I D A Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SCANNED St. BY l.uc eCOunt Y SPECIALTY PERMIT APPLICATION ❑ Electrical 13--*#Mft" ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding Seepage 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 4" 1- A'0'Q h 2. Parcel IDNumber: !�f cc tJse Only Section Township Range Map Page Zoning Land Use Initials 3. Complete Description of Project or Work: 4. Owners Information 5. Contractors Information Name: (on n:`e (2/42 FL Reg/Cert #: Address: �z !d2 SPgc rA,�� ,� r. County Cert#: City: F71, R'elr e State: �/ / Business Name: Zip: Vg8,9-- Z;16,a PhoneCF'o)Si7-A7o3 Phone: Fax: 6. Value of Construction: $ C' 0 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 regulating constructio and zoning. PRINT OWNER OR CONTRACTOR N - SIG OWNS R CONTRACTOR STATE OF FLORIDA, COUNTY OF / ACKNOWLEDGED BEFORE ME THIS s DAY OF 20 BY (1' WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED — _ DAWN AS IDENTIggg TION. _*• - MY COMMISSIONI k Op 852587 /l/(� EXPIRES: March 22,2013 der �Pf,��`� ��NotaryPublicUndenvriters SIGNA NOTARY TYPE T NAME OF NOTARY COMMISSION NUMBER NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. EXEMPT: A/C -HEAT REPLACEMENT WITH CONTRACT UNDER S7500.00 Revised 04/26/2010 NOTICE TO OWNER: F/_....._ZE TO RECORD A NSCE OF COMMENCEMI AAY 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 $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. St. Lucia County - PCIS 12-30-2010 09:51:49 10950/5018 CAMP, LANCE 5312 SEAGRAPE DR FORT PIERCE FL 34982 Amount Tendered: 470.00 Amount Paid: 470.00 Change Due: 0.00 Thank You User ID: GESSNERJ L. ST. LUCIE COUNTY UTILITIES - P.O. BOX 728. FT. PIERCE. FL 34982 NAME ACCT. # SERVICE ADDRESS ' SUBDIVISIONj7 - LOT X _BLOCK ---K I BILLING ADDRESS Al/ e PHONE 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 DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE. k1-7 .'If �:-�- t - SOCIAL SEC/ FED ID SPOUSE SOCIAL SEC. OFFICE USE ONLY D DATE RECEIVE CASH CHK # RECEIVED BY. St. Lucie County Building & Zoning Department 2300 Virginia Avenue Fort Pierce, Florida 34982 (772)462-1553 OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT F.S. 489.103 (7) EXEMPTIONS State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must provide direct, on -site supervision of the construction yourself. You may build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a cost of under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within one year after the construction is complete, the law will presume that you built or substantially improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicab s, 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 t et 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 liabl r 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-6cdical 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 d acknowledged on this day of /)e c of 20 / 0 . Ow uildp ignature STATE OF FLORID COUNTY OF The fo e I g ins trume Nwas acknowledg by pWluced Sighaulmo f Notary Title: Notary Public I before me this � day of 20_�O, _who is personally known to me, or who has as identification. Type or Print Name of Notary MI�ONE Commission Number ,- MY COMMISSION to DD iL?587 %a'•. EXPIRESMarch 22, 2Ui t bonded Thru Notary Pubis U!xturxnaers Property Appraiser - St.Lucie County FT . Page 1 of 1 Lance Camp Record: 1 of 1 Property Identification Site Address: Sec/Town/Range: 02 :36S :40E Map ID: 34/02S Zoning: RS-4 PROPERTY RECORD CARD <<Prev Next » Spec.Assmnt Taxes Exemptions Permits Home Print ��uclEc0 ParcellD: ollilliff Gy Account #: 37369 Land Use: SF Res City/Cnty: St Lucie County Ownership and Mailing Legal Description Owner: INDIAN RIVER ESTATES -UNIT 07- BLK 48 LOT 23 (MAP 34/02S) (OR Address: 55 i3 n 3253-2916) F Sales Information Assessment 2010 Final Total Land and Building Date Price Code Deed Book/Page 2010 Final: 116700 Land Value: 15200 Acres: 0.34 12/6/2010 97000 0001 WD 3253 / 2916 Assessed: 116700 Building Value: 101500 4/21/2004 175900 00 WD 1953 / 2361 Ag.Credit: 0 Finished Area: 1782 SgFt 7/28/2003 19900 00 WD 1760 / 0759 Exempt: 3/28/1990 13500 00 WD 0685 / 0041 Taxable: Taxes: 2425.52 BUILDING INFORMATION Exterior Features View: RoofCover: TN - Metal ExtType: HB - HB YearBlt: 2004 Grade: B - B EffYrBlt: 2004 StoryHght: 0010 - 1 Story No.Units: 1 Interior Features BedRooms: 3 Electric: MX - MAXIMUM FullBath: 2 HeatType: FHA - FrcdHotAir 1/213ath: 0 HeatFuel: ELEC - Electric %A/C: 100 %Heated: 100 Special Features and Yard Items Land Information Type Y/S Qty. Units Qual. Cond. YrBIt. No. Land Use DWC - Driv-Concret Y 1 800 AV AV 2004 1 0100-SF Res FEN8 - CHAINLINK 8' Y 1 96 AV AV 2004 FNW8 - WOOD FEN 8' Y 1 176 AV AV 2004 Jot 11 ZC9§ __ RoofStruct: HP - Hip Frame: PrimeWall: BS - CB Stucco SecWall: HP - Hardi Plank PrmintWall: DW - Drywall AvgHt/FI: Prm.Flors: CU - Carpet %Sprinkled: 0 Type Measure Depth BCS -Front Ft 117 125 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED. http://www.paslc.org/prc.asp?prcIid=340260802790005 12/3 0/2010