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Home My WebLink AboutSUBMITTED PAPERSDate: L I cf I 1 Z 1 Fee Due 7 w I Receipt# U `' I Permit # 120:2- Planning & Development Services Building & Code Regulations Division S�gNNEC 2300 Virginia Ave. - Fort Pierce, FL 34982 (772)462-1553 COt%nty SPECIALTY PERMIT APPLICATION ❑ Electrical Plumbing ❑ HVAC ❑ Fence ❑ Shed ❑ Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address:'-1 01 �n D rH l : l ► )c, h bCy 2. Parcel ID Number: �AD2 _ W 10 — UnCQQS —t-) / Office Use Only Section Township Range Map Page Zoning Land Use Initials l y I 3. Complete Description of Project or W 4. Owners Informations Ar'�1�i I I J 5. Contractors Information Name: i6q Cum Address:5101 City: t State: FL Reg/Cert #: County Cert#: Business Name: Zip: -�4q Phone: U 1a 11C1 72(Ohone: � Qp C��t�33-9ottQ 6. Value of Construction: $ Fax: 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 reguI ting construction and zoning. twilm PRINT OWNER O CONTRACTOR NAME SrG&ATURff OF OJIEYR CONTRACTOR STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS DAY OF .J(JlJ 20——',By WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED 1 _ to `i 110� AS IDEN CATION. 11 (seal ) DAWN MIL *I MY CO SI OF NOTARY TYPE OR PRINT NAME OF NOTARY ':�� MMISSION MIL MY EXPIRES: March 22, 2013 , COMMISSION NUMBER Bonded Thru Not Publk Undwwdtan 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 'I iCORD A NOTICE OF COMMENCEMENT MF iSULT IN YOUR PAYING TWICE FOR WIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND i O 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. Lucie Co 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 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 V 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 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 a cal 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 b 'ding 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 temps of the owner/builder exemption shall be reported by the Building and Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this day ofF r of 20 f2,-. h OwnerBuil i ature STATE OF FLO COUNTY OF The for oing instrument wasAcknowledge ore me this day of by _>=ho is personally known to me, or who has produced L as identification. 1 l� S.� — i�U �� ►7' P I :•ia�'"'Y - : DAWN MILONE F , SSION N DD 852587 •.i M COMMI Signature of Notary Type or Print Name of Notary •, a1 Se, PIRES: March 22, 2013 Title: Notary Public Commission Numberf;t.� Bonded Thru Notary pu�� U�xl:nwiters FL St. Lucie County - PCIS 02-09-2012 11:25:30 12602/5196 COCKRELL, COURTNEY 5701 SPRUCE DR FORT PIERCE FL 34982 Amount Tendered: 493.00 Amount Paid: 493.00 Change Due: 0.00 Thank You User ID: WARDD LATERAL $ / �✓ • TOTAL NAME I ACCT. # L (/O� (!. c rdl SERVICE ADDRESS J 1 )0 i 1 J J SUBDIVISION_LOT %'f ,r'"4J BLOCK_ // lJ BILLING ADDRESS PHONE # / % ! _� ' i '' ' /�/' 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. CUSTOMER :� i .� - SOCIAL SEC/ SIGNATURE FED ID t NAME OF SPOUSE SPOUSE SOCIAL SEC. DATE RECEIVED CA v`- CASH �r r lc USECHK #Y I Y d ,/ RECEIVED BY rLCbt) Property Appraiser - St.Lt County, FL Page IofI PROPERTY RECORD CARD Benjamin T Ellis Record: 1 of 1 <<Prev Next Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification Site Address: 5701 SPRUCE DR ParcellD: 3402-610-0208-000 4 ��OCIE eo�� Sec/Town/Range: 11 :36S :40E Map ID: 34/11N Account #: 38355 Land Use: SF Res Zoning: RS-4 City/Cnty: St Lucie County Ownership and Mailing Legal Description Owner: Benjamin T Ellis Courtney J INDIAN RIVER ESTATES-UNIT-09- BLK 77 LOT 23 Cockrell (MAP 34/1IN) (OR 3359-2302) Address: 5701 Spruce Dr Fort Pierce FL 34982 Sales Information Assessment 2011 Total Land and Building Final Date Price Code Deed Book/Page 2011 Final: 37900 Land Value:6900 Acres: 0.23 1/17/2012 45000 0001 WD 3359 / 2302 Assessed: 37900 Building 31000 8/31 /2009 100 0111 QC 3124 / 2122 Value. 7/31/2007 100 01 QC 2861 / 0554 Ag.Credit: 0 Finished 2240 SgFt 12/1 /1975 2000 00 CV 0246 / 1456 Area: 1/1/1900 0 / Exempt: Taxable: Taxes: 771.11 Exterior Features View: - ExtType: HC- - HC- Grade: D+ - D+ StoryHght: 0020 - 2 Story Interior Features BedRooms: 2 FullBath: 1 1/2Bath: 0 %A/C: 100 Special Features and Yard Items Type Y/S Qty. Units Qua[. BUILDING INFORMATION RoofCover: SD -Dim Shingle RoofStruct: YearBlt: 1976 Frame: EffYrBlt: 1977 PrimeWall: No.Units: 1 SecWall: Electric: MX - MAXIMUM PrmintWall: HeatType: FHA - FrcdHotAir AvgHt/FI: HeatFuel: ELEC - Electric Prm.Flors: %Heated: 100 %Sprinkled: Land Information Cond. YrBlt. No. Land Use Type 215 -Front 1 0100-SF Res Ft GA - Gable HP - Hardi Plank DW - Drywall CU - Carpet 0 Measure Depth 80 125 THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED. httn.//www.naslc.org/r)rc.asi)?T)rclld=340261002080004 2/9/2012