HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY:
DATE FILED: I` - '
PLAN REVIEW FEE: RECEIPT NO.: , PERMIT NUMBER:
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
Ft. Pierce, FL 34982-5652
772-462-1553
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS: !c300 -Te,!grolo C'
2. PROJECT NAME:a2a�'!�/�Glle�SITE PLAN NAME:
3. PROPERTY TAX ID #:
4. LEGAL DESCRIPTION (attach extra sheets if necessary):�t1L7/AAj lee ye -Al 45�IV-s-WA4,107
S. PLAT BOOK / U 6. PAGE NO. � S;- 7. BLOCK NO. y$ 8. LOT NO. / 7
9. PARCEL SIZE (ACRES/SQ FT.): ,c::/LOT DIMENSIONS: ®"A
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACT TY:/!JC�/t
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
[ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [.I" INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: _��.$'/� -edy e
14. SQ. FT OF CONSTRUCTION: /3a ,Tf�� 15. SF. FT 1st FLOOR:
16. VALUE OF CONSTRUCTION: So
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
NAME: EVq,61j Cis A.tiCZ "Oee'
ADDRESS: S"<o0 y /?7 ry/lj,[e
CITY: �p/QT /10/ P,QC. e STATE: lee—�z ZIP: &-yy8_
PHONE (DAYTIME):W VS73�6 Email: &&� OAe/eo ae-/Id, CQo�-7
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): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: ��C%dC .e STATE: ��• ZIP:
PHONE (DAYTIME): S7� 1 F 73� �Ci FAX NO. Email:��
ARCHIT/ENGINEER:
ADDRESS:
CITY:
PHONE (DAYTIME): ( )
BONDING COMPANY:
ADDRESS:
CITY:
STATE: ZIP:
STATE: ZIP:
MORTGAGE LENDER: AA2/ -
ADDRESS:
CITY: 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.
OFFICE USE ONLY BP #: a • Q) b� f
SECTION
-
TOWNSHIP
_31D
RANGE
vo
MAP NO.
ZONING
2 p I /
LAND USE
V I u
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1 ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
CUP
# 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
Y
HABITABLE
AREA
RADON
RADON
FEE
PERMIT
FEE
LIBRARY
IMPACT
FEE
PUBLIC BLD
IMPACT FEE
CORRECTION
PUBIC BID
IMPACT
FEE
GENERAL
PARKS
IMPACT
FEE
SCHOOL
IMPACT
FEE
ROAD
IMPACT
FEE
CREDIT
Y
N
LAW ENF
IMPACT
FEE
FIREfEMS
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
cp
DATE
COMPLETED
a
INITIALS
kz)
I
I
J#
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 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.
'0/.
-Olt
OWN OR CONTRACT SIGNATURE
,;a•r;
CONTRACTOR SIGNATURE
STATE, OF FLORIDA
.
T
STATE OF FLORIDA
COUNTY OF
c
COUNTY OF
The foregoing instrument was acknowledged before
cn f� m
The foregoing instrume was acknowledged before
me this day of
20��,
QKo'
me this day 20
m
m
,
by ��
,p
(L�, I
by
a
who is personally known]
w�
or has produced
who is per nally known or has produced
�
S•
• ASb �• '�"•Q
1
as identification.
as identification.
Signature of ary
of Notary
Commission No.
(Seal)
Commission No. (Seal)
q
8,gsv
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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 WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE COMPLIANCE DIVISION
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
mg will be using the following sub -contractors for the
(Company/Individual Name)
project located at 3 Q Je-- �1 /G e�e
(Stree ddress 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 ,Q
Plumbing
HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance 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/individual Name)
a sub -contractor for ��9L'/� /�i�✓� /,s���
(Type of Trade) (Primary Contractor)
for the project located at S300 .J e!q
(Project Street Address or Property Tax ID #) 3���.Z
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)
WNATORIGAL SIGNA, AREREQUIRED PRINT NAME DATE
Business Name:
Address: /
City/State/Zip: %1 / r/1L r
Phone: Y1_? V%17JAC JC email:
OFFICE USE ONLY:
" a A"
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 FloridaState Department of Professional Regulation. Signed and
acknowledged on this _�_ day of 20
OWNERIBUILDIJR SIGNATURE
STATE OF FLORIDA _ •
COUNTY OF
The foregoing instrument was acknowledged before me this day of , 20 IC;L,
by "MV j 1_1 K, I,(, P4 , who is personally known
Title: Notary Public Commission Number
SLCPDSD Revised 7/23/2010
St. Lucie County Owner Builder Affidavit -Electrical Contracting
to me or
as identification.
(Seal)
�w
AUDREY B. HUMPHREY
•`:_
MY COMMISSION @ EE 061159
o:
EXPIRES: March F3, 2015
Bonded Thru Notary Public Underwrfters
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
1, F.S. 489.103 M 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 1�,
ordinances, building codes, and zoning regulations. Initial f��
I understand that the building official and inspectors are not there to design or give advice on ho to eft
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 /1
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 —Cape&
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 -medic I
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 ownerlbuilder exemption shall be reported by the Building and
ing Departrn� t to the Florida Sta Department of Professional Regulation. ed and acknowled on this
day of of 20 t�-'
Owner/Bui der Sign e
STATE OF FLORIDA % G
COUNTY OF
Th re o' instrument was ackngwledged before me this day of 20
by H • who is personally known to me, or who has
produced as identification.
i afore of N T or Print Name of No (Burl)
gn ary
Title: Notary Public Commission Number
SLCPDSD Revised 07/22/2010
AUDREY B. HUMPHREY
= F = MY COMMISSION # EE 061159
EXPIRES: March 6, 2015
'> "d Bonded Thru Notary ! t!bi.4•' '•de^�"o' I
Property Appraiser - St.Lucie County, FL
Page 1 of 1
PROPERTY PF!(-nRn rnan
David P Krupa Record: 1 of 1 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print
Property Identification
Site Address: 5300 SEAGRAPE DR ParcellD: 3402-608-0273-000-3 �01C18 co
SedrowNRange: 02.36SAGE AccarN# J/JVJ Q
Map ID: 34/02S Lard Use: SF Res
Zoning: RS-4 CityfCntlr St Lucie County
Ownership and Mailing Legal Description
Owner. David P Krupa Valerie M Krupa INDIAN RIVER ESTATES -UNIT 07- BLK 48 LOT 17 (MAP 34/02S) (OR
Address: 275 Dickinson Hill Rd 3349-2087)
Russell MA 01071
Salo" Information Assessment 2011 Final Total Land and Building
Dale Prior code Deed Book#-dge 2011 Final: 6900 Land Value: 6900 Maas: 0.23
12/15/2011 38000 0112 SP 3349 / 2087 Assessed: 6900 Buldrg Value: 0
10/26/2011 20000 0112 CT 3338 / 0786 Ag-Credit 0 Finished Area: 1300 SgFt
7/21 /2006 177500 00 WD 2620 / 0775 Exempt 6900
3/14/2005 25300 00 WD 2187 / 1715 Taxable: 0
6/26/2004 32000 00 WD 2010 / 1510 Taxes: 0
4/8/2004 23000 00 `Alc 1 ^i^ ' 07cc
9/24/2002 4900 00 WD 1588 / 1041
11/2/1998 100 01 PR 1189 / 2196
4/1/1978 47400 02 CV 0285 / 1582
BUILDING INFORMATION
Exterior Features
View:
-
RooR.ovcr:
EAType:
HC+ - HC+
YearBlt
Grade:
C+ - C+
EfIYrBlt
SkwyHght:
0010 - 1 Story
No.UrMs:
-n{erivi Features
BedRooms:
3
Electric
FuQath:
2
HeatType:
1/213ath:
0
HeatFuet
%AIC:
100
%Healed-
Special Features and
Yard Items
Type
Y/S Qty. Unds
Qual. Cord_ YrBIL
DVX - Driv-Concret
Y 1 756
AV AV 2006
SD - Dim Shingle
2006
2006
1
MX - MAXIMUM
FHA - FrcdHotAir
ELEC - Electric
100
Land Information
No- Lard Use
1 0100-SF Res
ROGIStruct
Frame:
PrineWall:
SecWafl:
AvgHIFI:
Prm.Flors:
%Spikdded:
HP - Hip
BS - CB Stucco
DW - Drywall
CT - Tile -Ceramic
0
Type Measure Deplh
BI -Front Ft 80 125
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
http://wu><v.paslc.org/prc.asp?prclid=34026080273000") 2/7/2012