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Home My WebLink AboutSUBMITTED PAPERSor;usEr�z:�j �' DATE FILED: PLAN REVIEW FEE: CEIPTNO.: 23l)4 PERMIT NUMBER: /676,—(QRc�j 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 as Ft. Pierce, FL 34982-5652 . 772462-1553 AYY1b1UA'1'10N for BUILDING PERMIT e- CERTIFICATE Of CAPACITY/ZONING COMPLIANCE't JUNNNEp PROJECT INFORMATION BY 1. LOCATION/SITE ADDRESS: °L 6 V 4" , &tnSt. Lucie county � �� , 2. 3. 4. 5. 9. 10. PROJECT NAME: SITE PLAN NAME: PROPERTY TAX ID #: 3 a �bG 13 5 o o Z LEGAL. DESCRIPTION (attach extra PLAT BOOK 6. PAGE NO. PARCEL SIZE (ACRES/SQ FT.): COMPLETE DESCRIPTION OF Pd� ib -2 -Ar, ► SETBACKS (ACTUAL) FRONT: 7. BLOCK NO. LOT DMNSIONS: OR WORK /3ZR: BACK: -4— RIGHT 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [) NEW CONSTRUCTION P� EXPANSION/ADDITION [ J RESIDENTIAL [) COMMERCIAL [ ] OTHER (SPECIFY) S. LOT NO. CTIVITY: t7&I 4 GL )ELEFT SIDE: [ ] INTERIOR RENOVATION [) INDUSTRIAL DESCRIPTION OF PROPOSED USE: 4 SQ. FT OF CONSTRUCTION: `/ 15. SF. FT Ist FLOOR: VALUE OF CONSTRUCTION: 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 most be submitted with this application. SLCCDV Form No.: 001-02 -Vj UPDATED 6/25/09 j6-4 UAfve � 22'9 li OWNER INFORMATION NAME: ADDRESS: Z a� ' CITY: ' _� , Aq,/LL'� STATE: ZIP: PHONE (DAYTIME):/ — v` % 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: STATE: ZIP: PHONE (DAYTIME): U CONTRACTOR INFORMATION ST. ofFL REG.CERT #: BUSINESS NAME: QUALIFIERS NAME:. ADDRESS: ,CITY: PHONE (DAYTIME): L� ARCHIT/ENGINEER ADDRESS: CITY: PHONE (DAYTIME): L� BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER ADDRESS: CITY: STATE: -'AX NO. STATE: STATE: ST. LUCIE COUNTY CERT #: ZIP: Email: IMPORTANT NOTICE: When a permit is issued and it is not picked up it will be voided and returned to you by mail mu AV ZIP: nn*O days after notification OFFICE USE ONLY i `B- J: SECTION �j TOWNSHIP RANGE L� MAP NO. 3 S ZONING LAND USE LOT CVG % I 1gg TAZ NO. FLOOD ZONE. FIRM MAP # Isr FLR ELV MAX HGT 7 CONST TYPE OCCUP TYPE MAX OCCUP # OF FLRS WATER SEWER SPRINKLERS STORMWATER LOT OF REC LOT OF REC LOT SPLIT LOT,SPLIT Before 111990 After 111990 REQUIRED APPROVED REPORT HABITABLE RADON PERMIT CODE AREA FEE FEE LIBRARY PUBLIC BID PUBIC BID PARKS IMPACT IMPACT FEE IMPACT FEE CORRECTION J FA FEE i SCHOOL ROAD DIT Y N LAW ENF IMPACT AAA& IMPACT FEE FEE i FEE FIREAMS DRIVE AY DI�VEWAY ADMINISTRATIVE IMPACT REQ VARIANCE FEE FEE I SPECIFY MECHANIC r . R NON NFORMING MISCELLANEOUS SUBS ELECTRIC GAS LOT F RECORD FEES REQUIRED PLUMBING FEES DATE SENT TO ADDRESSING: ! / REVIEWS FRONT ZONIN SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER VIE REVIEW REVIEW REVIEW REVIEW REVIEW DATE • . 41m � / I �� . RECEIVED l�/ . , DATE �y f� COMPLETED INITIALS r, CERTMCATION: _ 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 types), 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. OWNff OR CONIRA OR SIGNATURE STATE OF FLORIDAA, STATE i� :; _J. . O0. The foregoing instrument was acknowledged before me this D day of 20� by who is personally known U orRhas ) ppr///^oJ�J��dyucce/d/ �L,_ �5_ Iq'r ViL7 lYCflLLc n) . The foregoing instrument wasacknowledgedbefore me this 8' day of Y-9—k 20 /,;,— by who is personally known or has produced as identification. Signature of Notary Signature of Notary ry �? � DAWN MILONE �,pV�,, pAWNMIIA�IE i MYCOMMISSION#DD852587 Commission No. §Faljy COMMISSION# DO 2013 softer March 22, 2013 Maf�u 'QZun ®�itere Commission No. ry uric urroerwrVteis =ri .3 SXPIRSS: Note P BundodihroNds, NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING 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 WELL BE REQUIRED FOR 'ALL OWNER/BUILDER APPLICANTS. For specific instructions see appropriate permit checklist. Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1678 PROPERTY INFORMATION Address: 204 SMALLWOOD AVE City / State / Zip: FORT PIERCE Parcel#: 3403-805-0135-000/2 Zoning: RS-4 APPLICATION INFORMATION Permit Number: 1202-0083 Activity Type: Addition Permit Type: Building (Miscellaneous) CONTRACTOR INFORMATION Contractor Name: Business Name: Business Addr: City / State / Zir REVIEWS AND COMMENTS Review Comments Owner(s): JAMES OGDEN FL 34982 Jurisdiction: St. Lucie County Lot # : 15 AND Block: 7 Page 1 Application Type: Master Permit w/subs Other Activity: Stories: 1 Automatic Sprinkler System? ❑ Review.Type Status Reviewed By Documents Missing Pending Dawn Milone b2/08/2012 1 Comment NEED NOC 02/08/2012 2 Comment NEED SCALED PLOT PLANS Front Counter Review Complete Dawn Milone Fax Number - - To Be Reviewed by Zoning Complete Paula Bushby Date Started Date Complete Date Released 02/08/2012 02/08/2012 02/08/2012 02/20/2012 02/21/2012 Zoning Review Incomplete Paula Bushby 02/20/2012 02/20/2012 1 Comment Please provide us with a plot plan to scale. We need the setbacks from the structure to the lot lines on the sides of the property. These are the comments from Zoning and Permitting. The Plan Review may have additional comments Sent to James Ogden 2/21/12 4 " MRMINIX. WDO Application_- Record Customer lP- nef 06;1/ (-A F f Address f� /'% ,/J) !t} I fts Ko Date of Application / / Time In 3-� Time Out City e,r -41-6 State, ` ffr Zip �'b > � Applicator(s)/Certif. #_ Phone'7r6j f �' Contract # Supervisor/Certif. # ------------------------------------------------------- j --- ❑Original Treatment TerminixAddress Y% 5' 611V P 31v.�3� �❑ Complete Treatment City ( �tc" �'�'��;T• State Zips r`7 ❑ *Wind Speed *MPH from the Y/ of ❑ Retreatment ❑ Limited Treatment. Plus Target Pest ;USubterranean Termites ❑ Drywood Termites ❑ Old House Borers ❑ Powderpost Beetles ❑ Wood Decay Fungi ❑ Product Applied Chemical Manufacturer ❑ Advance Termite Bait Diflubenzuron Whitmire Micro -Gen ❑ Bora-Care (SL) Disodiumoctaborate Nisus ❑Bora-RAM (SL) Disodiumoctaborate Sostram ❑ Cy -Kick (A) Cyfluthrin Whitmire Micro -Gen ❑ Phantom (SC) Chlorfenapyr BASF ❑ Premise Foam (A) Imidacloprid Bayer ❑ Premise Gel (B) Imidacloprid Bayer 9Termidor SC (SC) Fipronil BASF ❑ Termidor 80 (WG) Fipronil BASF ❑ Tim-Bor Disodiumoctaborate Nisus ❑ T-Max II Termite Bait Diflubenzuron Terminix ❑ Fast Out CS Foam Cyfluthrin Whitmire Micro -Gen The following are by Corporate approval only: ❑ Prelude (EC) Permethrin Syngenta ❑ Premise 75 (SP) Imidacloprid Bayer ❑ Premise 0.5 SC (SC) Imidacloprid Bayer ❑ Pro Build TC Cypermethrin Syngenta EPA# % Applied Amount 499-488 ❑ 0.25% ea 64405-1 ❑ 9% ❑ 13% ❑ 16% ❑ 23% gal 72304-10 - ❑ 9% ❑ 13% ❑ 16% ❑ 23% gal 499-470 ❑ 0.1 % oz 241-392 ❑ 0.125% ❑ 0.25% gal 432-1391 ❑ 0.05% oz 3125-544 ❑ 0.001 % grams 7969-210 0.06% ❑ 0.125%P9al 7969-209 /0.06% ❑ 0.125% gal 64405-8 ❑ 10% ❑ 15% gal 499-500-81370 ❑ 0.25% ea 499-523 ❑ 0.1 % oz 100-997 ❑ 0.5% ❑ 1 % ❑ 2% gal 3125-455 ❑ 0.05% ❑ 0.1 % gal 3125-497 ❑ 0.05% ❑ 0.1 % gal I 100-1006 ❑ 0.25% ❑ 0.5% t al - � f Formulation A=Aerosol B=Bait D=Dust EC=Emulsifiable Cone. SC=Suspendible Cone. SL=Soluble Liquid SP=Soluble Powder WG=Water Dispersible Granules WP=Wettable Powder *Application Rate ❑ 4 gal/10 linear feet/ft ❑ 2 gal/10 linear feet gal/10 square ft l 1.5 gal/10 square ft ❑ C � / !t ❑ Applied at less than label rate 4 ❑ Monitoring Stations only (no bait) pjGalSginej*Electric motor ❑ *Diaphragm Pump ❑ *Piston Pump f. p�Rdller Pump ❑ *In -Line Injection System W25 PSI or less at nozzle !❑ *50 PSI or less at t�Ozzle ❑ _*PSI at pump ❑ _*PSI at pump''` ❑ *Hand Duster ❑ *Aerosol Injection ❑ *Compressed Air!Sprayer ❑ C.1 Areas Treated: ❑ See Below ❑ See Contract Graph ❑ See Attached Graph Description of Areas Treated ti been performed on Custome " o Termite' Technicial Manage Bookkeeper Key #31117 Rev.11/08 R/P 4/09 Control Services have- Activity Notice of Treatment Was Posted At or Near Date Posted 5 1 -- ❑ Electric Breaker Box 192iYater Heater Closet J ❑ Bath Trap Access ❑ Beneath the Kitchen Sink 02009 The Terminix International Company Limited Partnership * Complete where applicable. JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY FILE # 3677122 OR B007 -,,365 PAGE 249, Recorded 02/22/2012 a, ?:48 PM NOTICE OF COMMENCEMENT Permit No. I )Da -b S3 Tax Folio No3 46,3 &-0 2-- State of Florida County of St. Lucie The undersigned hereby gives notice that improvement will he made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. Legal Descriptign of Property and street apldress if available)- 26 Y 5m;7 L trood . Xot- ;:i -. f3 c e Le- -Ti14t2 General description of Improvement:_Gff�Jd SCi�e- Ci�n+�t-d Owner information or Lessee Name - ?2nn Le - Address 'L-0-4 C.,.,- If theLessee contracted for the Improvement: Interest in property: ern ^ �L n - Name and address of fee simple titleholder (if different from Owner listed above): �_ontractoes Name: I1r^1J 1n L4- r- JA-)" t Contractor Address; Phone Number: Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $ _ Name and address: Phone number: Lender Name: Phone Number: Lender's address: 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: Phone Number: In addition to himself or herself, Owner designates of to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number of person or entity designated by owner: Sxpiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the .,ontractor, but will be 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR 'MPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of my knowledge and beli lhc— - I ure of Owner or L ee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager (Signatory's Title/Office) �xy The foregoing instrument was acknowledged before me this r� day of , 20�� 3y ,- as. I) - for _ \ e of Person Type of authority (e.g.officer,trustee) Party on behalf of hom instrument was executied J sonally known_or produced Identification DAWNMILONE (Signature of Notary Publicf'1- tateofFlorida) ,�°'s MYCOlON1DD&52557 T I` (Print, Type, or Stamp Commissioned Name of Not t `f EXPIRES:March22,2013 e of Identification produced r "CAL,Yn•'' Bonded Thor Notary Public BMerxr,., STATE DE FLORIDA ,. ST. LUCCIE COUNTY THIS is 3 CChTIF4'THA-M-I;S ISA TRUEAND CQARI.r*;Fr,�tl�}-(;1 T. GRiGhM 1 Date: a_ PLANNING & DEVELOPMENT SERVICES DIVISION BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 BUILDING PERMIT SUB -CONTRACTOR SUMMARY Y ' will be using the following sub -contractors for the (Company/Individual Na project located at 2—I3 (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�-L-- Plumbing HVAC/ Mechanical Roofing Gas OFFICE USE ONLY: PERMIT ISSUE DATE: NUMBER: k yJ�,..yk?-aLei"` �'�`3."• Y�Fr 'r1.'v i�t�; PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Florida Certification Number (If applicable): have agreed to be the (Company Name/In dual Name) L sub -contractor for (Type of Trade) (Primary Contractor) for the project located at 4G t,4- - (P oject 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 SIGNATURES ARE REQUIRED SIG ATURE PRINT NAME DATE Business Name: Address: City/State/Zip: Phone: OFFTC'.F, TTSF, ONLY: email: PERMIT # ISSUE DATE A — � � l Planning & Development Services Department Building & Code Regulations Division 2300 Virginia Ave Fort Pierce, FL 34982 772-462-1553 Owner Builder Affidavit — Electrical Contracting DISCLOSURE STATEMENT F.S. 489.503 (6) EXEMPTIONS State law requires electrical contracting to be done by licensed electrical 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 electrical contractor even though you do not have a license. You may install electrical wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical wiring in a commercial building the aggregate construction costs of which are under $75,000. The home or building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease more than one building you have wired yourself within 1 year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your electrical contractor. Your construction shall be done according to building codes and zoning regulations. 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. Failure to do so may result in a liability for you! To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit application. 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 Community Development Director to the Florida State Department of Professional Regulation. Signed and acknowledged on this _� day of : vb 20—/72--• "A-%'7 WNER/BUILDE IGNATURE STATE OF FLORID j COUNTY OF �` Q� A �� The foregoing instrument was acknowledged before me this U day of .�LJU , 20 by 21S , who is personally known to me or roduced Lts 1 "" 1 - kA Signature of Notary Title: Notary Public SLCPDSD Revised 7/23/2010 as identification. tJ� ((7 (Seal) Print name of Notary „ •,; eve-,, Commission Number 4'° DA1fdN MILONE MY CAMMISSION N DD 852587 a: EXPIRES: Marall 22, 2013 Banded thtu Notary Pubilo Undervrtiters St. Lucie County Owner Builder Affidavit -Electrical Contracting _ PLANNING --&-DEVELOPMENT SERVICES-DEPARTME_ NT - - - J ' kt BUILDING & CODE REGULATIONS DIVISION - - r- BUILDING PERMIT _LL =_ ► _ :_ - --SUB-CONTRACTOR AGREEMENT -----St.-Lucie County -Contractor Certification Number: - - - -- -- -- - - - - - - -State of Florida Certification Number (If applicable): - - - - -- have agreed agreed -be the- - =-= - -- t.Lr-.-------- - -- - (Company Name/Individual e) __ sub -contractor for -- (Type of Trade) (Primary Contractor) for the project located at 2b�� (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 SIGNATURES ARE REQUIRED C "ii (�w SIN TURE PRINT NAME DATE Business Name: Address: - - -- City/State/Zip:' Phone: email: nT-r T11 T cT, n TT V. viU Y` X%-X! aJ._7i. vr� u t . PERMIT # ISSUE DATE 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 orke s' compensation for that employee, all as prescribed by law. Your construction must comply with all applic b 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 h e t the minimum code. Initial I understand that as an owner -builder that any contract disputes with sub -contractors and I must�e 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 requ umto licensed in this jurisdiction. If for some reason they do not possess a license, I maybe responsible and lia le f 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 relat d in ca 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 reporte by the Building and Zo Dep t t the Florida State Department of Professional Regulation.. Signed a d cknowledged on this day of of 20 / Z. C�mjrfbuilder Signatur STATE OF FLO Tq COUNTY OF Q/ Th oregoing rostrum t was acknowledged before me this U day of , 20 I �, by who is personally known to me, or who has pr ed as identification. 'DAWNMILONS #= MY COMMISSION # DO 852587 Signature of Notary Type or Print Name of Notary mil) EXPIRES: March 22, 2ot3 Title: Notary Public Commission Number ;, Bonded Thru Notary Public Underwriters 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, L L t— (Parcel for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number , 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. 4AIM ,IZroperty Owner Name Me t) p rty OM-MerSiVmt6re Date STATE OF FLORIDA. COUNTY OF ACKNOWLEDGED BEFORE ME THIS DAY OF 20 BY `1r ; nna O I\,' 044WHO IS PERSONALLY KNOWN TOME OR WHO HAS L 1:� U AS IDENTIFICATION. 'ARY POBLIC TYPE OR PRINT NOTARY COMMISSION NUMBER ff SEAL) DAWNMILUN D 15 +& MY COMMISSION # DO 852587 EXPIRES: March 22, 2013 0onded Thru Nola ry public Undenvdiern SLCPDSD Revised 08/24/2010 / 1 I ro{ _ 1 FIRC P. 34.7' I z < H. t0 0, - -- 32.4_ FXF oga.. CONCRETE DRIVEWAY --- 34.2' — LOT 17 Block 7 (OCCUPIED) N 00'30'00" E 141.30' C CLF L � rr ice•• M • V ' ----80.- - d -- ---- - --- --- -----1 26.2' ' LOT 9 LOT 16 I I Block 71 IEGAL DESCRIPTION: i 12 Block 7 z (OCCUPIED)' LtjTs I5 end LOT 18, BL&X 7, RUHLMANj SUBDIVISION, occording to the m p or plot thereof, as recorded in Plot B6ok• 9, atPage 55, of the Public m OQ Q .Recorde of St. Lucle County,' Florida. Nm rn Cl $1 C LOT AREA-. t4;128 Sq. Ft.; 0.32 Acrawk LOT 16 S Z ` LOT 15 -- STREET ADDRESS: 204 Smallwood AvenUo,'Fort Pierce, Flarldo. n 70 12 68.' rn ; .4 .................... -- ----- --- ---7 - - --- --- ---- - S RVEYORS NOTES13 : .. 1.Beornga,shown hereon 'are based on tha'Narth right;of way line of Smallwood Avenue as plotted and Ie assumed to beror;N 80100'00"E. _ 2.1 Whitten dimensions take precedence aysr'$coled dimensions and distances are not to be seded'for conahvction and/or design purposes. LOT 10 3.� All distance's end bearings are as field measured and are coincident with LOT 15 qq `PLAY and description doto unless otherwise noted. R Block 7 41 ThIs drawing is not valid without the signature and origtnal raised seal of a V Black 7 Flerido licensed Surveyor do Mapper, 26.2' - _ -- 80.9' ------ --- ---- ---�- (OCCUPIED) 5.1 This surveyils based upon a description furnished by the client, there has ---- 4' CLF q been no scorch of the public racorda done by. this office. ow (CLEAR) I Iry 81 Property lies In Flood Zane "X" as scaled from the National Flood Insurance m`, _, -I r- Mo o Program Rate p, Community PanelNumber 12111COZOO F, with an effective %ize E dote of August 19, 1991. 7.1 This survey;ie not covered by profeselonal liability insurance. „ , 8! City water is available. 'sewer is not available in this area. N 00'30 OD E 141.30 Fl 9! No undergr6und utilities or improvements' were located unless otherwise shown. LOT 14 A LOT 11 . CERTIFIED;' TO: Block 7 I Biock 7• JAMES OGDEN: (OCCUPIED) (OCCUPIED) C, ICAGO TITLE INSURANCE COMPANY; I LOT8' Block 7 { (OCCUPIED) OCTOBER 14, 2011 Date of Signature WILUAM B. SENNETT Profeeelond Surveys E: Nopper . Florida CerlNioob No. tiS33 .. LB No, 7608 LEGEND -OHE- a OVERHEAD UTILITY LINES CONC CONCRETE ® SANITARY ACCESS LID pf TELEPHONE RISER ® a SANITARY CLEANOUT • WATER METER 0 WOOD POWERPOLE X " CABLE TELEVISION RISER E— = POLE ANCHOR CLF = CHAIN LINK FENCE CL CENTERLINE RIGHT OF WAY ttF + WOOD FENCE EP EDGE OF PAVEMENT DUE - DRAINAGE k UTILITY EASEMENT FIRC = FOUND 5/8" IRON ROD FIR = FOUND 5/8' IRON ROD do CAP (NO 1.0.) A/C - AIR CONDITIONER PAD H2o . WATER TREATMENT PAD t " PLUS OR MINUS WELLS FARGO BANK, NA and SVICELINK' oat. er La" fire--.,1n/1A/pn11 W e0enneft �tlfltllt Surverin9. (tie. Ftodu Beodt Cndee>ti Flsltda 33418IFIlild-1,LM in-mQ.46i; fine injumnr-* 1 email: bennidyi vey4p0yahoo.cornaoht ' Holt sip r pan oft e 0 K O order 8ervicelink Job .No,: 11-1010 WB WIN 10 14 2011 1 =20 Sfneh l of l A C� It OFFICE USE ONLY: DATE FIDLED: REVISION FEE: 'S�-Q& 2. 3. 4. 5. LOCATION/SITE ADDRESS: P WMT ERMWffr RECEIPT# PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE' FORT PIERCE, Fl, 34982-5652 (772) 462-1553 .j FOR APPLICATION FOR BUILDING PERMT REVISIONS PROJECT -INFORMATION , DETAILED DESCRIPTION OF PROJECT I L CONTRACTOR INFORMATION: STATE of FL REG./CERT. ST. LUCIE COUNTYliT,--. BUSINESS NAME: QUALIFIERS NAME: ADDRESS: STATE: PHONE (DAYTEWE). FAX: OWNER/BUILDER INFORMATION: NAME: ADDRESS: CITY: PHONE: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: PHONE (DA SLCCC: 9/23109 Revised 04/26/2010 AX: ZIP: FAX: F�' A V 'A Xyii "T f z t,Z? • �M O N 22 to Z a o I o °.� e'o i 0 ca O c 0 0 0 vCL.,m :. m to O 0 1 O 00 W a 34.7' m Z 32.4'--+--- 2.0' ------- CONCRETE DRIVEWAY ----------------------i 34.2' i �i i LOT 17 1 Block 7 (OCCUPIED) N 00'30'00" E 141.30' FI LOT 8 Block 7 (OCCUPIED) 01? 4' CLF _ (CLEAR)ti13 C 80.,v x m 26.2' ---------------------------------------T-_ IN ' LOT 9 I i LOT 16 Block 7 o Block 7 m Z (OCCUPIED) -MO 11 rn = O O —Z w _ O O O X w ` LOT 15 x 68.7' x m m--------------------------------=---------i-- � x _ LOT 15 �• �m OC x 26.2' 80.9' I —� --- `011E `-------------------------- OH£ -------1-- C� (CLEAR) 0 � ' �o i ■ x — ■ — x — x ?7 x_�x -- ■ — ■ J` x — ❑yF i ~ ONE ------------� Fl N 00'30'00" E 141.30' LOT 14 Block 7 I (OCCUPIED) OCTOBER 14, 2011 Date of Signature WIWAM B. BENNETT Professional Surveyor do Mapper Florida Certificate No. 6353 LB No. 7608 LOT 10 Block 7 (OCCUPIED) irn n� 0 LOT 11 Block 7 (OCCUPIED) LEGEND -OHE- = OVERHEAD UTILITY LINES CONC = CONCRETE QS = SANITARY ACCESS LID X = TELEPHONE RISER [9 = SANITARY CLEANOUT • = WATER METER 0 = WOOD POWER POLE )f = CABLE TELEVISION RISER t— = POLE ANCHOR CLF = CHAIN LINK FENCE CL = CENTERLINE RIGHT OF WAY WF = WOOD FENCE EP = EDGE -OF PAVEMENT DUE '= DRAINAGE & UTILITY EASEMENT FIRC = FOUND 5/8" IRON ROD FIR '= FOUND 5/8" IRON ROD & CAP (NO I.D.) A/C = AIR CONDITIONER PAD H2o = WATER TREATMENT PAD ± = PLUS OR MINUS 7771 _ NI M�tlw al -Rtl�� c _ yl 1tYh(te city L ' 1—emrsmgaS _ I f TE lV I R,u.ic±n ��— Anit>$1 Cmc=mwai ra a , �' i. Vicinity Map (Not To Scale) LEGAL DESCRIPTION: LOTS 15 and LOT 16, BLOCK 7, RUHLMAN SUBDIVISION, according to the map or plat thereof, as recorded in Plat Book 9, at Page 55, of the Public Records of St. Lucie County, Florida. LOT AREA: 14,129 Sq. Ft.; 0.32 Acres± STREET ADDRESS: 204 Smallwood Avenue, Fort Pierce, Florida. SURVEYORS' NOTES: 1. Bearings shown hereon are based on the North right of way line of Smallwood Avenue as platted and is assumed to bear N 90'00'00" E. 2. Written dimensions take precedence over scaled dimensions and distances are not to be scaled for construction and/or design purposes. 3. All distances' and bearings are as field measured and are coincident with "PLAT" and description data unless otherwise noted. 4. This drawing is not valid without the signature and original raised seal of a Florida licensed Surveyor & Mapper. 5. This survey is based upon a description furnished by the client, there has been no search of the public records done by this office. 6. Property lies in Flood Zone "X" as scaled from the National Flood Insurance Program Rate Map, Community Panel Number 12111CO280 F. with an effective date of August 19, 1991. 7. This survey is not covered by professional liability insurance. 8. City water is available, sewer is not available in this area. 9. No underground utilities or improvements were located unless otherwise shown. CERTIFIED TO: JAMES OGDEN; CHICAGO TITLE INSURANCE COMPANY; WELLS FARGO BANK, NA and SERVICELINK Date of Last field work:10/14/2011 � Boundary Survey e n n ett Prepared on the order of: Bennett Surveying, Inc. Servicelink 10223 Hunt Club Lane Palm Beach Gardens, Florida 33418 tel: 772.33&4933 fax- 772.338>8889 IL email: bennettsurvey'ingOyahoo.com Field: IM BB Job No.: 11-1010 Drawn: WB Date: 10/14/2011 1 Scale: 1 "=20' Sheet: 1 of 1