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Home My WebLink AboutSUBMITTED PAPERSDate: Fee Due: Permit # _ C}CINTY wit\ F L O R I D R 3-7 V. Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 SC YNED St �uCie CA 111W SPECIALTY PERMIT APPLICATION ❑ Electrical ❑ plumbing ❑ HVAC ❑ Fence ❑ Shed E'Demolition ❑ Gas ❑ Siding See page 2 for instructions and additional paperwork required for specialty permits 1. Location/Site Address: 2. Parcel ID Number: oZ tOg oa 73 6062 Office Use Only Section Township Range Map Page Zoning an Use Initials CH �01- M 3. Complete Description of Project or Work: ��/f'�l/�lrl�. �•��//�/1��d' 41!' r C .s 4. Owners Information 5. Contractors Information Name: Address: City: State: Zip: 9V a Phone: y/y7pZ" 6. Value of Construction: $ ` 0 FL Reg/Cert #: !0le� County Cert#: Business Name: Phone: Fax: OWNER'S AFFIDAVIT: I certlty that allot the mIOrmanon contameu in compliance with all applicable laws regulating PRINT OWNER OR STATE OF FLORIDA, COUNTY SIGNA ACKNOWLEDGED BEFORE ME THIS DAY OF , 20�BY ^ WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED A • IG N A Y TYPEORP�TN OEOFNO&� COMMISSION NUMBER ln `3: 8 N � L K Zu n'_ NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYIKU—FWICE 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 TI_ __CORD A NOTICE OF•COMMENCEMENT MA' SULT 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 he 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. Planning & Development Services Department 0111 ig, I Building & Code Regulations • • 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 applicabirjaws 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 the minimum code. Initial 02�1 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 liab fore 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 medic 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 Regul Signed and acknowledged on this day of�_ of 20 /�. 'Owner/Builder Si-gtlaturt STATE OF FLORIDA 16 COUNTY OF 4t, e�_ The f oing ins umen was acknowledged before me this day of �,fi� -' -_, 201d, by _Iwho is personally known to me, or who has prod as identification. Signature of otary T or Print Name o o (Seal) Title: Notary Public Commission Number _ XUDI�EY 5 HUMPHREY ?,Pyg •,, 1 EE 061159 F , MY COMMISSION SLCPDSD Revised 07/22/2010 _ ,. Metc t 2p15 EXPIRE` r'' dters d niru Underv+ '� QC: gonde _ -��YLGZfi (/�YLY Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 02/09/2012 DAVID P KRUPA 275 DICKINSON HILL RD RUSSELL, MA 01071 RE: Building Permit NumbE 1202-0106 ASBESTOS NOTICE TO OWNER/BUILDER Disclosure Statement: State law requires asbestos abatement 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 asbestos abatement contractor even though you do not have a license. You must supervise the construction youself. You may move, remove or dispose of asbestos -containing materials on a residential building where you occupy the building and the building is not for sale or lease, or the building is a farm outbuilding on your property. If you sell or lease such building within 1 year after the asbestos abatement is complete, the law will presume that you intended to sell or lease the property at the time the work was done, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. Your work must be done according to all local, state and federal laws and regulations which apply to asbestos abatement projects. It is your responsibility to notify the Department of Envronmental Protection of your intentions to remove asbestos. It is your responsibility to make sure that the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Owner Signature & Date Property Appraiser - St.Lucie C ity, FL Page I of I PROPERTY RECORD CARD David P Krupa Record: 1 of 1 <<Prev Next » Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification ,� �,UCIE BOG Site Address: 5300 SEAGRAPE DR ParcellD: 3402-608-0273-000-3 y� y.A Sec/Town/Range: Map ID'. 02 :36S :40E 34/02S Account Land Use, #: 37363 SF Res Zoning: RS-4 City/Cnty: St Lucie County AZA 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 Sales Information Assessment 2011 Final Total Land and Building Date Price Code Deed Book/Page 2011 Final: 6900 Land Value: 6900 Acres 0.23 12/15/2011 38000 0112 SP 3349 / 2087 Assessed: 6900 Building 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 WD 1942 / 0766 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 RoofCover: SD - Dim Shingle RootStruct: HP - Hip ExtType: HC+ - HC+ YearBlt: 2006 Frame: Grade, C+ - C+ EffYrBlt: 2006 PrimeWall: BS - CB Stucco StoryHght: 0010 - 1 Story No.Units: 1 SecWall: Interior Features BedRooms: 3 Electric: MX - MAXIMUM PrmintWall: DW - Drywall FullBath: 2 HeatType: FHA - FrcdHotAir AvgHUFI: 1/26ath: 0 HeatFuel: ELEC - Electric Prm.Flors: CT - Tile -Ceramic %A/C: 100 %Heated 100 %Sprinkled: 0 Special Features and Yard Items Land Information Type Y/S Qty Units Qual. Cond. YrBlt. No. Land Use Type Measure Depth DWC - Driv-Concret Y 1 756 AV AV 2006 1 0100-SF Res 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://www.paslc.org/prc.asp?prcIid=340260802730003 2/9/2012