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HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: DATE FILED: o(• PLAN REVIEW FEE: RECEIPT NO.: PERMIT NUMBER: 1 I 0? - U� 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 772462-1553 St. Lucie oourlty APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE PROJECT INFORMATION 1. LOCATION/SITE ADDRESS:0 ` Z AW-- rV,/ 2. PROJECT NAME:�� ph6e— SITE PLAN NAME: 3. PROPERTY TAX ID #: U /30/`L0 e'J -0 —CX "0 4. LEGAL DESCRIPTION (attach extra sheets if necessary): 0,ej4k-UEW j),j&-(,1UC%l Lll&j � j rbe 2a ag-zo , 5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): ©o LOT DIMENSIONS: 4 C , Q131 1 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: Ley' /r %T�i42� T SE AC ACTUAL) FRONT: io BACK: SIDE: LEFT SIDE: 1'y) T ' , ,RIIGHT N^V Uzo a 3 ifs% E O C STRUCT N (C ec prop rate xes) NEW CONSTRUCTION [ ] EXPANSION/ADDITION [) RESIDENTIAL [ ] COMMERCIAL [) OTHER (SPECIFY) DESCRIPTION OF PROPOSED USE: 7j-dAtae,P�/1lCALC [ ] INTERIOR RENOVATION [ ] INDUSTRIAL SQ. FT OF CONSTRUCTION: 6�2 15. SF. FT Ist FLOOR: VALUE OF CONSTRUCTION: $ 1/100, 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 6125/09 OWNER INFORMATION NAME: ADDRESS: 2/yAtL-14.2/) CITY: STATE: _ ZIP: 3w-�Y PHONE (DAYTIIAE): p�- 5`�l9� 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 (DAYTR E): CONTRACTOR INFORMATION ST. of FL REG.CERT #: BUSINESS NAME: QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): L__) ARCHIT/ENGINEER• ADDRESS: CITY: PHONE (DAYTIME): (_j BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: FAX NO. STATE: STATE: STATE: ST. LUCIE COUNTY CERT #: Email: ZIP: "All ZIP: 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 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 IMTROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE )OBSITE 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. ,9 OWNE R CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE STATE OF FLORIDA ^ COUNTY OF a The foregoing instrument was acknowledged befo 4 ( 'a ` me this day of 20_i ]__, by KIZW I ere 1Z X 'n who is personally known or has produced a Z", Q m as identification. s A m 2 tbiy cn V, Signature of a Commission No. (Seal) STATE OF FLORIDA COUNTY OF The foregoing instrument was me this day of by before 20 , who is personAy known or has produced as identification. of Notary Commission No. (Seal) 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 OWNERBUILDER APPLICANTS. For specific instructions see appropriate permit checklist. OFFICE USE ONLY BP #: SECTION TOWNSHIP RANGE MAP NO. ZONING LAND USE LOT CVG % TAZ NO. FLOOD ZONE FIRM MAP # I ST FLR ELV MAX HGT CONST TYPE OCCUP TYPE MAX OCCUP # 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 HABITABLE AREA RADON FEE PERMIT FEE LIBRARY IMPACT FEE PUBLIC BID BRACT FEE CORRECTION PUBIC BLD BRACT FEE GENERAL PARKS FACT FEE SCHOOL IMPACT FEE ROAD BRACT FEE CREDIT Y N LAW ENF IMPACT FEE FIRE/EMS BRACT 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 DATE COMPLETED INrrIALS S' Planning & Development Services Department ® Building & Code Regulations 2300 Virginia Avenue ?s. o Fort Pierce, Florida 34982 _<F ` (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 appli� e Al Initial ordinances, building codes, and zoning regulations. II I understand that the building official and inspectors are not there to design or give advI e n the minimum code. I understand that as an owner -builder that any contract disputes with sub -contractors and I must be hand] 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 require b licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsibleandliab e f cost of the license. 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 rela 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 owneribuilder exemption shall be reported by the Building and onmg Departrq to the Florida S to Department of Professional Regulation. Signed and owledged on this day of of 20 Owner/Builder Signature STATE OF FLORIDA COUNTY OF days A of CC ' , 20L , The egoZinstrument was acknowledged before who me tis personally known tome, or who has by as identification. produced414 Signature Typ r Print Name of Notar (Seal) Title: Notary Public Commission Number SLCPDSD Revised 07/22/2010 COUNTY F L O R I D A 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, (Parcel Id#/Legal descriptiont 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. Property Owner Na (Please Print) q roperty wrier Signature Date STATE OF FLORIDA, COUNTY OF ACKNOWLEDGED BEFORE ME THIS ! D;Y„QF 6 20 7 BY D QN OL —6 IS PER NALLY KNOWN TO ME OR WHO HAS PRODUCED SIGNATURE OF NOTARY COMMISSION NUMBER SLCPDSD Revised 09/24/2010 AS IDENTIFICATION. C .19 o• i7 a OR P T NOTARY M14 (SEAL) ���qV P�•., AUDREY B. HUMPHREY +q' � _ MY COMMISSION N EE 061159 EXPIRES: March 6, 2015 ? o? Bonded fhm Ndary Public Underwriters ZZCC-MGX 54131813 Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Customer Code: Customer Name: Customer Job Number: Order Code / Date: Project Code: Project Name: Project P.O. Number: Order P.O. Number: Ticket Date: Delivery Address: Map Page: Map/Row/Column: Delivery Instructions: Dispatcher: Ticket Number: Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use: LOAD CUMULATIVE ORDERED QUANTITY QUANTITY QUANTITY I MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT Cash Check # I Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge Comments WATER ADDED: GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE L] LOAD WAS TESTED BY: Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERMS: Any water added is at customers own risk. If water is added on job, concrete strength Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION Material terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety handling information, and to the material safety data sheets for additional information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE: within one business day after the receipt of materials. X 68UNIVERSAL CUSTOMER This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quotatii F any, and Seller's Order Confirmation (it ling limitations of warranties), as if fully set forth on this Delivery Ticket ('Agretjmrt" ). Seller will provide the Standard Tern d Conditions upon request. Buyer agrees that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees to pay in accordance with the Agreement. AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete products include Portland cement and aggregate products including limestone, dolomite, granite, volcanic rock, sand, gravel, and other siliceous materials. These products, including fly ash. may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions. Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust from handling, crushin;.�, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo - ilia. Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure. Safety: Avoid contact with eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective clothing>. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. If exposed to (lust abi)ve recommended limits (see NISDS), wear suitable NIOSH-approved respiratory protection. First Aid: In case of eye contact. immediately flush eyes with flowing water for 15 minutes. If dust is inhaled, move to fresh air. If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists. C:EMEX 920 Memorial City Way, Ste. 100 V5 combined Houston, Texas 77024 06/10 For further information, please visit www.ceme.xusa.com. Este ticket de entrega inacluye Como referencia al comprador (ya previamente ejecutada en su aplcaci6n de credito); cualquier t6i-mind estdrtdar, condiciones del vendedor, propuestas del vendedor y orden de confir►naci6n del vendedor (con limitaciones y garantias), Como acuerdo total del ticket de entrega rContrato"). El vendedor proveera los temrinos estaudares y condiciones det'al- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes rnencionados y que las cantidades y materiales fueron entre0. adds como se expresa en el mismo. Acepta pagan el monto de acuerdo a]. contrcto; al. menos que se identi- fique con una nota al frente de este docunrento. AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES Los productos (fie agrcgados son materiales naturales como piedra caliza, dolomita, granito. roca volcatnica, arena. Brava y otros materiales silicios. Los productos de cernento incluyen Cemento de tipo Portland, de albanileria, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de conereto incluyen cernento Portland y productos de agregados como piedra caliza, dolomita. granito, rota volcanica arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mas de. 0.025%. de silicio cristalino. Peligros: Mezcla de cernento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y Qjos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci(5n en los Ojos, pie] y!o en la zona respiratoria. Polvo del nranejo en el trituramiento, pulido, torte y/o perforaci6n puede contener rnateriales silicon, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, m.antenerse en temperatura calida. reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco. La humeda.d puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritaci6n o Seguridad: quemaduras era la nariz, garganta y pulmones. Acudir inmediatarnente al medico. El ries(Yo en ]a salad depende en la duraci6n y el nivel de la exposici6n. ~ Seguridad: lvite el contacto con Ojos y contacto prolongado con la piel. Use guantes, protecci6n en Jos ojos y ropa Primeros adecuada para protecci6n. Ldvese las manor con jab6n suave y agua despues del nranejo de materiales. Evite inhalar auxilios. polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 1.5 minutos. Si. se inhala polvo, exp6ngase a afire fresco. Si el cernento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atenci6n rnedica inmediatarnente si ]a irritaci6n continua. CEMEX 920 Memorial City Way, Ste. 100 V5 c(.anbinado Houston, Texas 77024 06/10 Para mas informaci6n visita www.cernexusa.corn. Property Appraiser - St.Lucie C ty, FL Page 1 of 1 PROPERTY RECORD CARD Donald J Krajicek Record: 1 of 1 <<Prev Next» Spec.Assmnt Taxes Exemptions Permits Home Print Property Identification Site Address: 7807 PENSACOLA RD Sec/Town/Range: 02 :34S :39E Map ID: 13/02S Zoning: RS-4 Ownership and Mailing Owner. Donald J Krajicek Carol Krajicek Address: 7807 Pensacola Rd Fort Pierce FL 34951-1430 Sales Information Date Price Code 9/3/2010 75000 0001 3/31/1989 73000 00 3/1/1986 6000 00 6/1/1978 7000 00 Exterior Features View ExtType HD+ - HD+ Grade: D+ - D+ StoryHght 0010 - 1 Story Interior Features ParcellD: 1301-606-0128-000-0 Account #: 1528 �� < Land Use SF Res Q� City/Cnty: St Lucie County Legal Description LAKEWOOD PARK -UNIT 6- BLK 63 LOT20 (MAP 13/02S) (OR 3228- 1059) Assessment 2011 Final Total Land and Building Deed Book/Page 2011 Final: 58600 Land Value: 5800 Acres 0.27 WD 3228 / 1059 Assessed: 58600 Building Value: 52800 WD 0630 / 0092 Ag.Credit: 0 Finished Area: 1536 SgFt CV 0493 / 1662 Exempt: 33600 CV 0295 / 1468 Taxable: 25000 Taxes: 576.39 BUILDING INFORMATION RoofCover TN - Metal YearBlt 1989 EffYrBlt: 1989 No.Units: 1 RoofStruct: HP - Hip Frame: PrimeWall: WS - Wood/Sheath SecWall: BedRooms: 3 Electric: MX - MAXIMUM PrmintWall: DW - Drywall FullBath: 1 HeatType: FHA - FrcdHotAir AvgHUFI: STD 1/2Bath: 1 HeatFuel: ELEC - Electric Prm.Flors: CU - Carpet %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 1 0100-SF Res BI -Front Ft 90 131 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?prclid=130160601280000 12/21 /2011