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HomeMy WebLinkAboutSUBMITTED PAPERSOFTICE"USE-OhII,` : I DATE FILED: PLAN REVIEW FEE: RECEIPT NO.: ��3 PERMIT NUMBER: _ ) l I Z. -6243 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 SCANNED 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 8Y 772-462-1553 „ St. LUc;e County A S APPLICATION for,BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE RmP PROJECT INFORMATION 1. LOCATION/SITE ADDRESS: 2. PROJECT NAME: C E755 ITE PLAN NAME: 3. PROPERTY TAX IDooa1- 2 4. LEGAL DESCRIPTION (attach extra sheets if necessary): SeC a+A-GCAAe- 5. PLAT BOOK 6. PAGE NO. 7, BLOCK NO. 8. LOT NO. 9. PARCEL SIZE (ACRES/SQ FT.): r cce5 LOT DIMENSIONS: I p 10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECTOR WORK ACTIVITY: WST41-4 - I O V e b DN 11. SETBACKS (ACTUAL) FRONT: 10 " BACK: / S" RIGHT SIDE LEFT SIDE: 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) [ ] NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION [� RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL [VOTHER(SPECIFY) M®C %4c�_ 2pD% 1pu17' 0 13. DESCRIPTION OF PROPOSED USE: 14. SQ. FT OF CONSTRUCTION: Q �� S 15, SF. FT 1 st FLOOR: 16. 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 must be submitted with this application. SLCCDV Form No.: 001-02 UPDATED 6/25/09 OWNER INFORMATION NAME: ADDRESS: � 1 - -V . CITY: TATE: EL ZIP: -5 / PHONE (DAYTIME): -6jo) &jQ � - 73PL 3 Email: & ,TM n@ 14-0 L . �Ql� 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): ( ) l CONTRACTOR INFORMATION -) ST. of FL REG.CERT #: -�-rr V • -S 1 y 9 ST. LUCIE COUNTY CERT #: BUSINESS NAME: -FO rl t' S m O b t% games- P s mN c, QUALIFIERS NAME: I ^40 M A- S, & (', R V ADDRESS: 3 q Enl gZ j �1 CITY: Sr. GLD (% Q STATE: �L ZIP: 3 4(7 PHONE (DAYTIME): Y( 07) �S%-�6 �5� FAX NO. 40�-S foL !, 39Email:(g, /jQ pL ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): L_) BONDING COMPANY: ADDRESS: CITY: MORTGAGE LENDER: ADDRESS: CITY: STATE: STATE: STATE: ZIP: M19 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. "i, i OFFICE USE ONLY 2e- ` ,Dr #: 11 12= QIL43 SECTION TOWNSHIP Lt RANGE Lio MAPNO. ZONING LAND USE LOT CVG % - - TAZ NO. - - - FLOOD ZONE. FIRM MAP # -- -- FI VELV MA7 HGT CONST TYPE OCCUP_TYPE_- - . _ _`_.__ _ MAX OCCUP - 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 IMPACT FEE CORRECTION PUBIC BID FEE GENERAL PARKS IMPACT FEE SCHOOL IMPACT FEE AD IMPACT FEE CREDIT Y N LAW ENF IMPACT FEE- FIRE/EMS IMPACT FEE DRIVEWAY REQUIRED Y N DRIVEWAY FEE ADMINISTRATIVE VARIANCE FEE SPECIFY SUBS -REQUIRED MECHANIC ROOF ELECTRIC (i GAS PLUMBING _ ,- NON -CONFORMING LOT OF RECORD FEES MISCELLANEOUS FEES DATE SENT TO ADDRESSING: / REVIEWS FRONT CO ZONING REVIEW SUPERVISOR REVIEW PLANS REVIEW VEGETATION . REVEW SEATURTLE REVIEW MANGROVE REVIEW _ DATE RECEIVED abdo. DATE .COMPLETED _ • 13 • �2. - -. INITIALS i 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. O R OR CONTRACTOR SIGNATURE STATE OF FLORIDA COUNTY OF .Sr. ut c_et The foregoing instrument was acknowledged before me this 10 day of T)L- (_ 20 (I , by who is personally known �or has produced RACTOR SIGNA STATE OF FLORIDA COUNTY OF O SCC- aC.C- The foregoing instrument was acknowledged before me this day ofn�L/,��� f , 20A'�, by who is personally known �or has produced as identification. as identification. / - of Notary t,ar ruB JAMES C. DEVUN n ture of Notary �n No. .•.•�`,c* * -A," MY COMMISSION #DD847699 EXPIRES; January i7, 2013 Budget NolsrySW= �0 �P:;B�% JAMESC.DEVUN Commission N * MISSIOf� 67699 �►t EXPIRES: January 17, 2013 .Or FOF BondedThru N ��rFOFFI�N�O Bonded Thru Budget Notary Services 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. r I LEV THESE PLANS AND L PROPOSED WORK. ARE SUBJECT TO A CORRECTIONS, AEQUTAED BY FIELD IN PECTORS THAT MAY BE NECESSARY IN RDER TO Manufactured Home Installation Specifications (Must be completed and submitted with your application) Applicant Tom's Mobile Homes, Inc. Permit # i I l Z - O ZL43 Address 6445 US 150 Ft. Pierce FILE COPY Manufacturers Name Roof Zone II Wind Zone II No. of Sections 1 Width 14 Length 60 Year 1986 Serial # 5,Sr4 f7LAc(. J ZZ?4p7 Installation Standard Used (check) Manufacturers Manual 15C-1 X Site Preparation Debris and Organic Removal X Water Drainage: Natural X Foundation Swale Pad Other Load bearing soil density Or assumed 1,000 psf X Footing type: Poured in place Portable Xiya) -f Mainrail frame block: Size 8x8xl6 Placement O.C. 4.5 Perimeter blocking: Size Number Location Ridge beam support: Number Size Location Center line blocking: Number N/A Size Location Special supports required (fireplace, bay window) Yes No Mating of Units: Mating gasket A ( 4 Type used Fasteners: Roof Type Spacing Endwall Type Spacing Floors Type Spacing Anchors: Type 6,000 3,150 Height of Unit (top of foundation to frame): Angle of straps `A 50 Number of frame ties Z& Spacing 5�q 0 o.c. rAw Number of over -roof ties (if required) Number of sidewall anchors Zone II ✓ Zone III Number of centerline anchors �11' Number of stabilizers Vents required for underpinning.(' f 50 soor area): No. Prepared by: R114 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page # 15C-1 Page #At LA Page # N/A Page # N/A Page # 40 Page # ri ol- Page # 167c- i Page # 5 C— Page # 15C'1 Page #. RJ C- 1 Page # N/A Page # Page # N/A Page # Date: (— 1 (6. ( Z CONCEALED FASTENERS OR ATTACHMENTS ARE THE RESPONSIBILITY OF THE CONTRACTOR OF RECORD PLANNING & DEVELOPMENT SERVICE DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 (772)462-1557 Mobile Home Inspection Report All requests for permits to place or replace used Mobile / Manufactured homes must be accompanied by this completed Inspection Report and copies of both sides of the Title to the home. All used Mobile homes must be Wind Zone ll'certified: Owner: Richard Metheny (Print or type) Address: _6445 US 1 Lot 50 FOrt Pierce, FL 34946. (Physical Location of Home) Date: 12/20/2011 Year / Manufacturer: 1985 BEAC Serial # SSMFLAC122267 HUD Plate #FLA277323 Width_14' Length_60' Single X Double Wind Zone —II C = In Compliance N = Not in Compliance Fire Safety / Electrical _N 1. Smoke Detector: Installed Missing X _C_ 2. Electrical System Checked: Exposed Wiring Other _C 3. Distribution Panel: Missing Loose Main Missing Breaker Missing Unplugged Opening Other _N 4. Electrical Fixtures: Missing _C Installed Improperly Improperly Wired Loose Wire GFCI receptacles not where required_X _C_ 5. Electrical Ground: Chassis Main Panel X ' Gas Pipe Revised 08/24/2010 Page 1 THESE PLANS AND ALL PROPOSED WORK ARE SUBJECT TO ANY CORRECTIONS REQUIRED BY FIELD INSPECTORS THAT MAY EH NECESSARY IN ORDER TO ONRY WITH M, APFW@A9 0000M3 ST'LUCIE COUNTY BUILDING Dl) N RE cc l: REVIEWED DATE PLANS ND PER IT MUST BEAKEPT ON JOB OR NO INSPECTION WILL BE MADE tw C PI&F Construction _C_ 1. Exit Doors Operable: Front X Back X Other _C_ 2. Exit Door Locks: Missing Inoperable _C_ 3. Egress windows: Missing Inoperable _C_ 4. Windows: Broken Glass Inoperable _N_ 5. Screens: Missing Damaged_X_ _C_ 6. Floor System: Joist X Decking___A_ Area Damaged _C_ 7. Interior Paneling: Missing Loose X_ Damaged _N_ 8. Rodent Proofing: Bottom Board Pipe openings Other _C_ 9. Leaks Apparent: Ceiling Doors Floor X_ Roof _C_ 10. Vertical tie -down straps: Missing Short Damaged C 11. Structural modifications since manufactured: YES NO —X— C— 12. Walls: Structurally Unsound Loose Weather tight _X Plumbing _N_ 1. Trap: Missing Not connected X Other _C_ 2. Plumbing fixtures: Missing Not installed Not Vented _C_ 3. Relief Valve: Missing Inoperable Other _N_4. Drain Waste and Venting Piping: Missing X Not supported Clean outs Use of fittings Not capped Heating and Air Conditioning _N_ 1. Heating Appliances: Missing X Not Connected Other, _C_ 2. Deleted Heating/AC system: Not installed X Other. _C_ 3. Thermostat: Missing Inoperable _C_ 4. Air registers: Missing Inoperable _C_ 5. Ducts: Not sealed Missing Collapsed N/A 6. Gas furnace Water heater vent: Missing Loose Page 2 i N 7. Return Air: To Furnace To A/C From rooms _C_ 8. Range: Vent X_ Hood_X - -FILt uury _N/A_ 9. Gas Valve: Accessible Installed improperly _N/A_ 10. Gas lines: Not capped Not supported Kinked Not bonded Summary 1. Is subject structure found to be fifty (50%) or more damaged or deteriorated? YES NO X 2. Will a remodeling permit be required? YES X NO The provisions of the repair and remodeling code shall ensure safe and livable housing and shall not be more stringent than those standards required to be met in the manufacture of mobile homes. Such provisions shall include, but not be limited to, standards for structural adequacy, plumbing, heating, electrical systems, and fire and life safety. FS 320.8232 IF ANY RENOVATIONS OR IMPROVEMENTS OVER AND ABOVE THE REQUIREMENTS OF FS 320.8232 ARE TO BE PERFORMED ON ANY MOBILE HOME WHICH WILL BE PERMITTED TO BE TIED -DOWN IN ST. LUCIE COUNTY, A SEPARATE PERMIT WITH ENGINEERING (IF APPLICABLE) WILL BE REQUIRED. ALL SEPARATE PERMITS MUST OBTAIN A FINAL INSPECTION BEFORE A FINAL INSPECTION IS OBTAINED FOR THE TIE -DOWN PERMIT. NO MOBILE HOME WILL BE ALLOWED TO BE MOVED TO ST. LUCIE COUNTY OR RE- LOCATED WITHIN ST. LUCIE COUNTY UNTIL THE REQUIRED DOCUMENTS HAVE BEEN SUBMITTED, REVIEWED, APPROVED AND THE TIE -DOWN PERMIT HAS BEEN ISSUED. A REGISTERED FLORIDA PROFESSIONAL ENGINEER MUST COMPLETE THIS DOCUMENT, SIGN AND AFFIX THEIR SEAL. Date inspected: _12/20/2011 Inspected By: License #: _FL PE 61000 Signature of Engineer 2 (seal) SLCPDSD Revised 08/24/2010 Page 3 SOIL TEST AFFIDA VITS TORQUE TEST AF.FIDA VIT A�,krjcw ,have personall Performed / / Y P d the torque test at the fc llovi;'IIW Property location: to ��S � S (7�-► Legal Description —'— - m 4e Property Owner I have made the following determination as follows: TORQUE: Z e LBS. ANCHOR SIZE "� � FT. Si re License No. Date -- PENTROAIETER TEST AFFIDA VIT Imo'' cznc"d ,have personally performed the entrome p ter test at the following property location: (p5gs U 6 �� 1 LP�c� Legal escription e perty Owner I have made -the following determination as follows: ASSUMED 1000 PSF OR TESTED LOAD. BEARING SOII., CA.P.A(:IT''r 2� PSF signiture License No. Date -- "ooq MZ��r -- S (2v,4- AV s 'r--- xs 'GI 0-1115 "LA Cyp#O" Bay Mobile Home Park US HWY 1 IY Recrestkn6l Haft Fs] ��� POND KINGS HM W-02 t;OL �--J MY r BOUNDARY SMVEY 369.730'Y 933.72' asaswr c!o Ob ^UITrM SL'9`236+Y 9_57 2.05'06 r[5, .n;o � 'a ` � a aco o.5sas xuTP � r;ti, 219a2' E 3Lxlm v� fN L.IA .�N-�,'(!• Yi ` .T\* Pam rO+o:fM1r4 r� ICDGT \\A - A'vEGEi7i'`iz'�'.. TaElsoN $ 9 '�--�.,�,_ _7,�,�T.r:.:a.-� •, r!'"; �t,. L• .t . +:t. qc .7`TY O.LL0 WGT _-_�_Y a,'p n sLU W �.._ `' i�i(• WFU.VJA bJv A / Dcto'� ) $ o a `------ - \ mMx« 'o Y� :y +. Y- .w ; f � �'ul'.-�;....:.. ,:.: � - - -��vu<S.,\• _ r/ee rml a. 4 � _ "+c vtxu - -..:�.{,L^.�'!rt�-<azti": {,t`::�a =:. :i;lr�•• .i f. ,. �' �n•--':s��?'-;'�"�{;:a�-�fi57y..�sc `,T, rxolnTr "40 locale rAR:K WtYOrT ( / -4GI - r_ heavy-a-w I192.I7- NL9'23`0M1W 1192.IT _ =S SOUTH UNE T rWr9 LV,QRre Nollwvv - � NOP,TNGlST . OF 5EC.FIOF1 i' GRAPHIC SCATS I I IN list l LEGAL DESCRIPTION: SURVEYOR'S NOTES: MAT rAAT Or _90UM 300 rECT Or ME SEIM In Or TMC NORMEI5T IM I I The *— wpt d Prep-Iy — —,-J aM d—rbtd OP 5ECTC G. Tl7Wl$,.MIP 3.1 50UM, RAAIG[ -10 EAST, IWIG'N6T Or Tt3: baled - the'I — legal 0--ftme Prwd<d br Qa - WE5TERLY RIGM-Or-WAYOF U.S MIGMWAY A I: LESS AND [XC[PTING 21 AR b—m' and J s lh— h—+re rccarded +�1 ThERtMOM R"r-0r WAY Or TtM FLORIDA 5TATC TURAMIK AUTUORTII• A5 rm —d t ke dtr -. sI- 5MD" IM DUD BOOR 213. PAGE 5G5. PUBUC RECORDS OrST. LUCIA eu.d 31 The LW. shwa. h— aa:ro rot abab.add Tor eneemerin n COUM. FLOR1DA:', dha r—&d arJ.mbnrlee rnt''h— a U.e Fl xd the same, d a.y -, roc b..h— rn the ..acre. BEING ME'LL55 AND D=KING FORTION NVMONCD Al; T MORE <) fwndabo.e arN/w toam9a tNt mryaov tr/rad The PART!CU{AFMY OESCWBEO AS FOVOW5, b'wndarY NeA d the FArctl berem !er>$ed aro roe ahr.+N. 1■e1�1 ,ti a a: 4 f� F3.B1YIiAI$ ■del ��rcaa�ar�eacs a oBm KQAW0 ■il we e•B■BW ........ FM FM aaltiw�G®,F■Il PL, e 5fi Mill Hff iA�P��tr����p: i! 1 Rw�f�Ifywy���Wi®qM�MqI i� Rf $■■■8 iYiD ( �� $ 6$■Md " ®�0 ■■III ... ■ a yidle� �Il��_ .. .■a alNmapp i T7f1■�q'IL■iffi6t ��1 t� Mild �p ! YIlYP■Ii OPG Y t� L'• isn®ea■■a_�ra ;k ,���L�y.,:w����Cgw�.� �, sn * —p ---r PERMIT NUMBER ! !I Z Installer-60K0`S �' tt'Dt'L License# -16 jp95 Ile Address of home 6, 445-1— being installed r-rt T"� t ManufacturerLength x width NOTE_ if home is a single wide fill out one half of the blocking plan if home is a triple or quad wide sketch in remainder of home I understand Lateral Arm Systems cannot be used on any home (new or us ) where the sidewall ties exceed 5 It 4 in. Installer's initials Wel Typical pier spacing -40b ti I lateral Show locations of Longitudinal and Lateral Systems (use dark ■ = ■ ■ ■_ �_�_ ■__ RNOt _■ NINE M=1 ...�.■.......... ..............■.. �M �C . ■■■■..■■......■ ................ �t .....■.■ ..................■....... .......■■■...■.■...■H.■.■■■■..._... ao r;&kMIT WORKSHEET Pagc 1 a. 2 New Home ❑ - Used Home (] Home installed to the Manufacturers Installation Manual ❑ Home is installed in accordance with Rule 15-C Single wide Wind Zone II `Eg Wind Zone III ❑ Double wide ❑ 9nstgflation Decal # . _ :T9' .3© Triple/Quad ❑ Serial # S S M*- 4.--- j Z 2:2-1 % PIER SPACING TABLE FOR USED HOMES Load bearing capacity Footer size (sq in) 16' x 16' (258) 18 1/2' x 18 1/2' (342) 20- x 20• (4()0) 22- x 22' (484)' 1 24' X 24' (576)' 26' x 26• (676) 1000 DS 3 4 5 g 1500 s 4 6 6 7 g 2000 psfs s s s 2500 psf 7 6 8 8 ----8T 8 8 3000 pst 8 81 8 8 8 3500 pst 8 8 8 811 Interpaatea from huge Ibu-1 pier spactnq tame. PIER PAD SIZES I-beam pier pad size 1'7, S tc X7,cg- Perimeter pier pad size Other pier pad sizes (required by the mfg.) t Draw the approximate locations of marriage wall openings 4 foot or greater. Use this LLU symbol to show the piers. List all marriage wall openings greater than 4 foot and their pier pad sizes below. Opening Pier pad size TIEDOWN COMPONENTS Longitudinal Stabilizing Device (LSD) Manufacturer dL/U�l�TEe11 _ Longitudinal Stabiliz,117g Device w/ Lateral Arms Manufacturer /A bly gougj L'Tt'c',('./ POPULAR PAD SIZES WWI �IF1� i k� IL• S'i�Zc�i IL•! tc�' i �Ii>�Ii� • � � irtc�i[ S�� i�flv�1.SIY��:� �I:1'i►1�1 �(� ANCHORS 4 It S it FRAME TIES within 2' of end of home spaced at 5' 4' oc OTHER TIES Number Sidewall 2 (v Longitudinal Marriage wall Shearwall ,J 1 PERMIT NUMBER POCKET PENETROMETER TEST The pocket penetrometer tests are rounded down to 110®© psf or check here to declare 1000 lb. soil without testing. X X X X POCKET PENETROMETER TESTING METHOD 1. Test the perimeter of the home at 6 locations. 2. Take the reading at the depth of the tooter. 3. Using 500 lb. increments, take the lowest reading and round down to that increment. X X TORQUE PROBE TEST The results of the torque probe test is ;Zkd inch pounds or check here it you are declaring 5' anchors without testing . A test showing 275 inch pounds or less will require 5 foot anchors. Note: A state approved lateral arm system is being used and 4 ft. anchors are allowed at the sidewatl locations. I understand 5 it anchors are required at all centerline tie points where the torque test reading is 275 or less and wh re mobile home manufacturer may requires anchors with 4 g capacity. Installer's initials ALL TESTS MUST BE PERFORMED BY A LICENSED INSTALLER Installer Name / +�� �5 4 ` a.lz-adja Date Tested 1 a '—' I^ I I Electrical Connect electrical conductors between multi -wide units, but not to the main power >ource. This includes the bonding wire between mull -wide units. Pg. Plumbina connect all sewer drains to an existing sewer tap or septic tank. Pg. :)nnect all potable water supply piping to an existing water meter, water tap, or other ndependent water supply systems. Pg. PE -HMI I WORKSt-iEET I page 2 of 2 Site Preparation Debris and organic materia r oved Water drainage: Natural Swale Pad Other Fastening multi wide units Floor. Type Fastener: Length: Spacing: Walls: Type Fastener: Length: Spacing: Roof: Type Fastener. Length: cing: For used homes a min- 30 a e, galvanized metal strip will be centered over the c of of and fastened with gals. roofing nails at 2' center on both sides o erline. j Gasket (weatherproofing requlrem l) -� I understand a properly installed gasket is a requirement of all new and used homes and that condensation, mold, meldew and buckled marriage walls are a result of a poorly installed or no gasket being installed. I understand a strip of tape will not serve as a gasket. Installer's initials c Type gasket Installed: Pg. Between Floors Yes Between Walls Yes Bottom of ridgebeam Yes Weatherproofing The bottomboard will be repaired and/or taped. Yes " Pg. �� Siding on units is installed to manufacturees specifications. Yes TR' Fireplace chimney installed so as not to allow intrusion of rain water. Yes _ Miscellaneous Skirting to be installed. Yes Dryer vent installed outside of skirting. Yes ✓ N/A _ Range downflow vent installed outside of skirting. Yes NIA Drain lines supported at 4 foot intervals. Yes _✓/ Electrical crossovers protected. Yes C Other: I M Installer verifies all information �e e�O with tkipermit worksheet is accurate a&Ltr0e lase the A Installer Signature /'/'�%�� l Date �" ✓�� a Al +, STATE OF FLORIDA DE{ JiENT OF HIGHWAY SAFETY AND MOTOR VEI? _S DIVISION OF MOTOR VEHICLES- 2900 Apalachee Parkway • Neil Kirkman Building - Tallahassee, FL 32399-0620 - Notice of Sale of Motor Vehicle, Mobile Home or Vessel Section 319.22(2), Florida Statutes, requires that the seller file a Notice of Sale with the department within 30 days afterthe sale or transfer of the motor vehicle, vessel or mobile home. Filing this form removes any civil liability for the operation of the sold motor vehicle, vessel or mobile home. In addition to filing this form, we suggest you keep a copy of your bill of sale (we suggest it be notarized), certificate of title or other type of transaction document showing the vehicle was sold. Complete the information below, tear the top portion of this document at the pe foration and mail to the address above or submit to your local tat collector's office or license plate agency. I have this day of transferred by assignment of and delivered Florida Certificate of Title to: Name: Purchaser(s) Purchaser's DL/ID First MI Last Address ! If Selling Price $ UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FAPTS STATED IN IT ARE TRUE. Seller's Signature Co -Seller's Signature NOTE: THE SUBMISSION OF THIS FORM, ACCURATELY COMPLETED, TO A TAk COLLECTOR'S OFFICE, LICENSE PLATE AGENCY OR TO THE ADDRESS ABOVE WILL ALLOW THE TITLE CLERK TO UPDATE THE DMV DATABASE TO REFLECT THE TITLE RECORD AS "SOLD". HOWEVER, THE OWNERSHIP STATUS WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE. VID et® r x ON A > :.a Se a as e • I. _ >.. .r. 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PAW ltl w N"XVra t � s 14 l,^ Pan ftpagTown 5t'i I A tQIt 'pus �A ont►-Iqvl aq L-'4TO.i-ov golo,160,51 mla.0 .: ,V uge -" zmz loz q*=R ..� ` IOWA low . .. • .. ..-�.��' �-. nkrr R�iT.tF?�l,at+ 4t� BSI �'/�.�'��!9 y groundpo A bi*1herbM9ffUdJF-I81 Orton , .- - and-hust,bdM:Wth a rnlmllonoWn,* or 18 lh0%.tj.M*jW mft*tft bak andithe ecbiof the cones- CT0ftr3mu8t have rninimum-suftes wtv-bf 441:14, IN ond'M49t.be a rykfnuM-6fff*dt*P. d) If aNI-alms 16-IJ80d, the depth rnu&t-Ise 4-.--0.(AkffiUm. offt.800rh br8oko.tJn8WWom Is not re4lhutl_ Notare must-aliew for alt. les�14- cot .10A-innertfoow. C*_Whot Im- to -the-'60norete using (2) 518"x3l 0"dri 2* ""'d dostrod locotIon, Mark b0thole 100911 r mason bit, drill a Mole to a minimum r epfh of 3". IVlake.sure ill dust aft -co"Onft-18-bim" but of ffis h01*931,01pos, holes, then pla>Ke 1101 dry act) GA beak onto wedge bolfs, and Stan %VW96 bolt -6u%, Takb a hornftr End Ili d down by hitting the nut (making surd natto hit the top olthreads on bolt).1b91*A0f GO ig conga LA•TERAL:: 14. For wet set '(partftn simply install the anchor bDft into runh Ifooter. For dry sot Installaitift -(p., 0,110 - low t.) TA mark bolt hole 10fts, t nq *.610A.farn, masonry bit, drill a hole to a minimum depth of,!'. Make sure blown out of the m - __1_ (Simpson Part PSI 62300H Olt" X.Tor Powers equivalent) into (0) Carlo. d, d. connerathr and Into drilled hole. if ne'ed6d, take a hammer and lightly drive the wedge bolts down by hitting the -nu k1% t Us" -mot:whit to top of threads on bog), then rarmove the nut, The nift"i -0-20nowl "d-50 h pit W be at or b�alow.tbia 19. When using part# 1101 CVW (watmat) or 1101 pit ( ryset), Install pgr 6tope 17 a la. Notes: 1, LENGTH OF HOUSE IS THE ACTUAL BOX SIZE 2.0 F;9LAW RATEAMFWKT1EL0GATICN (reecls-fb 4. ALL WIDTHS; AND LENGTHS UP TO 521 0 • ALL WIDTHS; AND LENGTHS OVER 527TO 80' 0 II Ll HOMES WITH 5112 ROOF PITCH REQUIRE: 'PER FLORIDA REGULATIONS Jbir home lengths UP to 52'and 8 sytteni s for homes over 52' and up 80% One stabilizer plate surd fame tie required at each lateral bracing system, F LE COPY TTO/900(n SHWOH HUNK SW01 990969LOV XVA 09:9T ZT09/10/ZO a!N,, G©Ife9, INO. P1.Q1lfEt�tit;,4J4T11 THE Mani 1, • 'Wow-, a sOr14 . ► 16.4 M f" t�.isS; If -the foAtlwtn�. e+turditiorls'occur 41VP!' contact 011y r 7evhrn�tvglbs:at 1-8 28 rr ` �) Prehti tgfat.�aC ty) Lsrtg:th. hate exude 78't:) Roct.eaues exceed 16" d) Std6waq:heldnt .. 4�.1Aotlltfbn Is iahttih 1t0 feet �f.o»st ,: �tefio :Va�e ;end; rts► It1. Est approtfbete two habt : oqu�rr�.to:a obe flt�l loll 'tor gash rb :'ffppa;pjgynd pgFT 16 i. r.tr�teiw;ohre�i$ I• 0 und•paln(C) 011M'.dr drivspjrr tirMly, into soil until 01,10i With.ar:belaweisil.. !' 11r4fr, t is ttie-lvRgitudiri�tlblase®•elm Seti�ae use pler urnier the -home and sri UM be Iv fled:es, y t)ther 5fai; It is rit3oaMlt"rended tttat after Wei litr9'plere. and ogre=third") before home is lowerpq vbittplstel'y bn #Q .plats, tioritPlete steps 4 through 8 below:thiQn rteFrvve jacks, :roiriib;;.tirrtr7 , -*• used s t etnttcorrect equere tube brace (E) length for set- Gp (pier) height at support location. (The 16, tubc:is'elways used as the 601tom part of the lolned. dinal arm)- Note; Either tube can be used by ltaelf, out and drillod to longth as'dvttg'.a'3 a 40 to 46 degree angle is maintained. PIER HEIGHT (APprU, 4B degro" Max.) 1,25" ADJUSTABLE Tube Length 1.50" ADJUSTiABLIE Tube Length 6. ati uatrtienkf the 1.30' square tube* (E (18" tuba) )Into the "U" bracket (J), Insert carriage bolt ono leave nut loose: for.ti I 6- Place I-beam 00111neotor (F) loosely on the Wtorn Range of the -I-beam, 7. aide the $elected 1.25" tube (E) into a 1.66' tubs,. E) end' attach to I-beam connectors (F) and famvn loosely w{tri'bnit arFd'nvf: ' $' deg Repe$t -and not stops thrvugll7 to crests the "V' patbem of the Square tubes loosely In place. The angle Is not =to exoved''6 9. Afar a�ll bolts are tiglhtpneow 0d, Secure '1.25" and 1,60" tubes using four(4)114"-14 x 314" serf to In pP g screws in praKirlll'ed hblos; • THI WOOL 1101 "V" NCTI: THE USE .. ��M'R.Errn4•NGe'1ulti•FSglIPAt6WEpT A�T trf'4el^G, LiR,:P t4TU<l F40Pdtift OT(4.7 GROUND VVFMC�NCXCpfF'r TI08.' VHIPMTHg 10. Install HOMENti►Nt1FACTt7R)=R BRlCf�'I�S�IPP#REN7 rome(ning vertical tre-down straps and 41 ground anchors per home manufacturer's Instructions. Nd r�; pgr{lne• •. anchors to eq sized stir rdingdhor to Florida.torqueC condition. Any manufacturer's speoifloatrons for sidewall anchor loads in exCeaga bf 4,000 Ibs, require a S' andhor per Flde' Code, 11, Nam{; r=ech se n9i is r+equireq to have a frame to and stabilizer attached at each lateral 8mt stabilizingI st8btlizsr plate needs to be located withln 18" from of center grOurid pan. ocation• .This flame .tie & . .. 12. Salect'the o0rTW square tuba brace (H) length for.set-up lateral tranaverse at support location. The lengths come In either ed" or 72"'lengths, (WXh this 1.50" tUbe as the betb�rn tube, and the 1,26" tube as the Inserted tube,) 13•Slide Install the 1.50 f hxvvrse brace (H) to the around pan connector (D) with bolt and nut, M $1.26" transverse.brece Into the 1.50, brace end attach to adjacent I-beam connector ( I) with -bolt andt. " nu . - .. i m- e US OLNER TKNNOLOEIES, INC, 1-800. "7437 Te►eP111011.9s1-796.40tto . .pare s31-7Ati"8811 .. - Wlvwoilveriechneloples,or�Ti • ' rILE. COPY TTO/90018 SH40H H'IIgOX SN01 99096SLOb YV_q OZ:9T ZTOZ/TO/ZO two hundred (2,200) pound flexural strength as measured b Standard Test Y Method for Sampling and Testing Concrete Masonry Units, ASTM C 140-96. Solid 4" concrete blocks M1: are the minimum thickness of blocks that will meet this test. Poured concrete shall be a minimum of fcl = 2500 PSI. All plastic products shall be conditioned to ASTM 1) 618-6-I; reapproved 1990, Standard Practice for Conditioning Plastics -and Electrical Insulating Materials for Testing. Plastics shall be tested to the following standards: ASTM D 790-92, r Standard Test Methods for Flexural Properties of Unreinforced and Reinforced Plastics and Electrical Insulating Materials; ASTM D 732-85, Standard Test Method for She Strength of Plastics by Punch Tool and ASTM 6 53-88, Standard Practice for Operating Light and Water Exposure Apparatus for Exposure of Nonmetallic Materials. All of the above ASTM Standards in paragraph 6 are hereby incorporated by reference. Specific Authority 320.011, 320.8325(2), F.S. Law Implemented 320.77(l0); -�20.822(12), 3.20.8285, 320.8325, 320.835(2) F.S�History - New 1-10-94, Amended 10-02-95. 15C-1.0103 ations and Piers. These -guidelines. shall be .used when the installation of.foundations and piers is not specified in the manufacturer's instructions or when the manufacturer's. installation instructions are not available.: (1) •'Piers:.. (a) Piers shall be centered under the I-beam and installed in accordance with Table A. The maximum spacing of piers shall be eight feet (8'). First pier shall be within two feet (2') q of either.end•,ofthe home. The pier, foundation shall be a minimum of 4" x 16" x 16" solid :t concrete pad precast or poured eight inch (8") minimum in place or other material approved and listed by the department. . (b) Piers maybe constructed of regular 8" x 8" x 16" concrete blocks, open cells 4 (with open cells vertical), centered on the footing or foundation. A 2" x 8" x 16" pressure :treated or other material :approved and listed by the department, pursuant to rules 15C-1.0105 ?` and 15C-1.0106, shall completely cover the.top•of the pier with pressure treated shims (1/4" minimum; 11/2" maximum thickness x 31/2" minimum width x 6" minimum length) centered.and.driven tight from both sides of the :I-beam.between the -wood plate or.cap and the main frame.Single tiered block piers shall be installedperpendicular °? to the main I-beam. Exception: When a pier has been capped with at least a four inch (4") solid concrete block or other material approved and listed by the department, pursuant to rules 15C-1.0105 and 15C- 1.0106; one=fourth inch (1/4") of wood. stock or wood.shims or other material approved and 5 1LIM "•3k •t TTO/9001E SHNOH SM90K SN01 996VZ69LOV YVA TZ:9T ZTOZ/TO/ZO c FIGURE B . BLOCKING (Single Tiered) I -Beam (Frame) Wood Shims or other material approved and listed by the department pursuant to rules 15C� 1.0105 nd 15C-1.0106 (Ni" Maximum) .. ; . Cap - 2" x 8" x 16" Pressure Treated Wood or other material approved and listed by the •�% Celled Concrete Block �• ' Ground Level '• ; ' Footer or Pier Foundation • J. 4" x 16" x 16" Solid (One Piece) or other material approved and listed by the department Sod and Organic Material Removed BLACKING (Dduble Tiered and Blocks Interlocked) — I -Seam (Frame) Wood Shims or other material approved and listed by the department pursuant to rules •• 15C-1.0105 and 15C-1.0106 (1%" Maximum) �' . (Option) Pressure Treated Plate (V x 8" x 16' Minimum) Cap - 4" x 16" x 16, Solid Block 2-2" x. 8" x 16" Pressure Treated Wood or other material approved and listed by - • - the departmeni . (Option 2 -A" x.8" x 16") Must be perpendicular to I•Beam Celled Concrete Block ' Ground Level !: !\• Fodter or Pier Foundation 4." x•16" x 16'.Solid Block (One Piece) or other material approved and listed by the .. department Sod and Organic Material Removed n Specific 320.821 15C-1 "I • in Expt July 13 data ply standar, the mar .1985, p incorpo perform TTO/600[n SaNOH aIIIJON SN01 9M969LOV XVd T9:9T 9T09/T0/Z0 • 9 OT486A Galvanized Auger Anchor OT4869 Galvanized Auger Anchor OT807B GaivaniZOd:Avgei••Anchvr': OT1100CA OTMSP-1 OTMSPIG 1055-19 24.1:0. Galvariized.JI Hook Cbrrarete Anchor Galvanized Msta1 St$f�illet'Plate Galvanized Meta# i U-6r-Pldte Plastie-Stolfizer Plats Plastic Y.VedQe.(QTI� Adja#4#I�, Outrigger 'Swi�Ft�NtiFl�an�e•Gl - . ',. 4TSFT Swiwpl..Ffame Clamp :- 00002 .: Sid ev Il. Strap Connector.. T0C Sidey�all Quick Strap Coop or :tti55- lsL Longi%nal StaifBzing W!em All trel FoundA .n System 1101 . All Steel founekation Systen 1101 V All Steel Foundation System 5/6" x 4a":rod; •dbwble:`boit head with a 91441e 60—'diSC 3r{4'Ix413'"tad;-dbwbles dolt head with a sln'gi disc 314"-x W!-;tit-; dzUblWbOlt head with a disc i *—..040'm. dpdowble-loft head with a j-hooka 1�"`vWde'x`1"3 4/2":depth I8?''wide�x 131/2"dli x 7 1/2 side .12 .74-2 (thl s& att-top)•'c 9.95" (width) 3.5" x 6..0" x 0.940" Brackpt,:pipok.and scrgyy.-.adjwstment 3M6" X�f'-gslvgnized upper and'jower)alas for.- Wamping,@tte I-beaim A-36 Galvanized G-40 galvanized 7 gauge connector W. hoak sidewail brackets A-30/0610nized .1793 thick sq,:h'iile.in'i l(i NO 20" galvanized steel pad beam, - for,jonoiiudinal bracing -system w/square tubini.j .a .cross "x" pattem Longitudfnal Stabilizing7Systsm. ' ::. Longitudinal and Later.41--% ikziijg: $y teal Longitudinal Stabilizing & Laferal i3racing"System lnr: TTO/OTO12 MOH HIIgON SNOZ 8£66969LOV YVd TZ:9T ZTOZ/TO/ZO fci`tkl$. J T , .4—T40 'i CT1ARED HOMES a.:.c7 41462 MODEL # IDENTIFICATION WACRIPTION .1056-14 Plastic Foundation:. Pad 16" x 16" 1055-10 Plastic Foundation Pad 16" x 16" 105578.Plastic Foundation Pad 16, X 18" 1055-23 Plastic Foundation Pad 16" X 18 i/2" (rounded)(2 sq ft) 1055,9 Plastic Foundation Pad 181 /2" x 181 /2" x 15/16" SPA 264-1 Plastic Foundation Pad 181/2" x 18 1/2" x 3/4" 41484 Plastic Foundation: Pad 131/4" x 261/4" x 3/4" 1055A 6 Plastic Foundation Pad 17" x 22" x 1 1/8" 1055-7 Plastic Foundation -.Pad .20" x 20" x 7/8" 1055-21 Plastic Foundation Pad 17 1/2" x 221/2" 1065-17 Plastic Foundation Pad 1.71/2" x26 1/2" x 1 1/8" 1055-13 Plastic Foundation Pad 24" x 24" .1055-22 Plastic Foundation Pad 21,13" x 29.13" (rounded)., 1055-20 Plastic Foundation Pad 231/4" x 31 1/4" MAXIMUM PIER LOADS' IN POUNDS BASED ON SOIL VALUES Pad Area 1000 Ib 1500 lb 2000 Ib 2500 Ib 3000 Ib Remarks. Configuration ft. soil soil soil soil soil Max: 16" x 16" 1.77 1770 2650 3450 .. 4420 5310 5310 1IS" x16" 1.78 1780 2880 3560 4430 5340 5320 16" x 1`8" 2.0 2000 3000 4000 5000 6000 -6000 16" x 18 1/,2" (rounded) 2.0 2000 3000 4000 5000 .6000 6000 18 1/2" x 181/2" x 15/16" 2.360 2360 3550 4730 5910 7090 7090 IS 1/2" x 181&1 x 3/4" 2.375 2375 3563 4750 5598 5598 -5600 13 1/4" x 261/4" 2.4 2375 3563 4750 5938 6400 8400 17" x 22" 2.5 2500 3750 5000 6250 7500 750.0 20" x 20" 2.75 2750 4125 5500 6875. 8250 8250 17 1/2" x 22117 (rounded) 3.0 3000 4500 6000 7500 9000 9000 17 1/2" x 251/2" 3.0 3000 4500 6000 7500 9000 .9000 24" x 24" 4.0 4000 6000 8000 8000 8000 8000 21.13" x 29;13" (rounded) 4.0 4000 6000 8000 8000 8000 .8000 23 1/4" x 31 1/4" 4.698 4698 7047 8000 8000 8000 .-8000 PAD CONFIGURATIONS Pad Description Pad Area 1000 lb 1 2000 lb 1 3000 Ib (Pyramid Footer Configuration) (sq. ft.) soil soil soil (2) 1314" x 26 1/4" as a base and (1) 20" x 20" on top 4.8 4,800 9,600 NIA Three (3) 17" x 22" 5,0 5,000 10,000 N/A Three (3) 17 1/2" x 25 1/2" 6.0 6,000 12,000 N/A (Revised 01106) TTO/TTO 2 Note: Installer is responsible for determining soil bearing capacity. 10 F r '' ° t SH40H TII OR S1101 SE°6 x ov � ,r 3 'k `'i T TOZ/ /ZO z IL u rJousloo A lon. STYLE -CREST PRODUCTS D►. Fmmont on 43420 Mail Lied Satisfaction to: Dept of Highway Safety and Mli' lcles, Neil Kirkman Building, Tallahassee, FL 32399-0500 T # 688936639 B# 427750 i Identilication Number Year —�Make Body T WT-L-BHP ��T Vessel Regis. No. Title Number t 't� tiSSMFLAC122267 �1985 I BEAC�HS 16Q' I 141642629 'III FFRIM-IM12 �+I'1 � t �f rt ''IIRegistered Owner: Date of Issue 12/12/2011 Lien ReleaseII Interest in thedescribed vehicle is hereby released RICHARD EDWARD METHENY i BY I 4033 N US HWY 1 LOT 22 Title FT PIERCE, FL 34946 Data IMPORTANT INFORMATION i 1. When ownership of the vehicle described herein is B transferred, the seller MUST complete in full the Transfer of Title by Seller section at the bottom of the certificate of title. Mail To: 2. Upon sale of this vehicle, the seller must complete RICHARD EDWARD METHENY the notice of sale on the reverse side of this form. I 4033 N VS HWY 1 LOT 22 3. Remove your license plate from the vehicle. 4. See the web address below for more information and FT PIERCE, FL 34946 the appropriate forms required for the purchaser to title and register the vehicle, mobile home or vessel: �,11 http://www.hsmv.state.fl.us/htmUtitlinf.himl Q'Y� !_'# ? I fi' r f- Odometer Sfatusur Vessef Marwfacturer oiOHusQ fi ; Hutt Ma ✓ 4 ReRtsteteii Owner RICHARD EDWARD METHEN7". 4033 N TiS'• i3WY 1. 'LOT FT PIERCE: .FL' .34945 1 St Eiidnholder OIVISIOINOFMOTOg1STfiEFVIC6S TALtAHASSEE eq 4 ir�i��t�i�l i0i.-;W i a;ra Lambert' _ all ��ate oi:i'ssve �• •. � "12 --'9y 021 p4ie STATE OF FLORIDA DE� irMENT OF HIGHWAY SAFETY AND MOTOR Vl `.ES j DIVISION OF MOTOR VEHICLES- 2900 Apalachee Parkway • Neil Kirkman Building - Tallahassee, FL 32399-0620 Notice of Sale of Motor Vehicle, Mobile Home or Vessel Section 319.22(2), Florida Statutes, requires that the seller file a Notice of Sale with the department within 30 days after Ili, sale or transfer of the motor vehicle, vessel or mobile home. Filing this form removes any civil liability for the operation of the sold motor vehicle, vessel or mobile home. In addition to filing this form, we suggest you keep a copy of your bill of sale (we suggest it be notarized), certificate of title or other type of transaction document showing the vehicle was sold. Complete the information below, tear the top portion of this document at the ge oration and mail to the address above or submit to your local tax collector's office or license plate agency. I leave this day of , transferred by assignment of and delivered Florida Certificate of Title to: Name: Purchaser(s) Purchaser's DUID First MI Last Address � Selling Price $ UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FAPTS STATED IN IT ARE TRUE. Seller's Signature Co-Selle``r''s.Signature NOTE: THE SUBMISSION OF THIS FORM, ACCURATELY COMPLETED, TO A TAx COLLECTOR'S OFFICE, LICENSE PLATE AGENCY OR TO THE ADDRESS ABOVE WILL ALLOW THE TITLE CLERK TO UPDATE THE DMV DATABASE TO REFLECT THE TITLE RECORD AS "SOLD". HOWEVER, THE OWNERSHIP STATUS WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE. Page 1 of 1 t Vehicle Information Check Vehicle Information: Ya Vehicle Identification Number: SSMFLAC122267 Year/Make: 'i 1985 BEACHC©MUER TRL: A Previous Title State: FLORIDA Registration Expiration Date: 12/31/2012 Title: 41642629 Title Issue Date: 12/12/2011 Title Status: ACTIVE Title Print Date: 12/15/2011 Odometer Reading/Status: Odmometer Date: Color: UNKNOWN COLOR Vehicle Type: MOBILE HOME Length: 60 Owner Information: 1 owner Paper Title with Lien Salvage: Brands: Lien Information Name Address Date Receipt Date PO BOX 511178 CYPRESS BAY 2010 LLC MELBOURNE BEACH, FL 32951-0000 12/12/2011 12/12/2011 If any of the information on this record needs to be corrected, please contact your tax collector and complete appropriate paperwork to update the record. If you have lost or misplaced your title and need to apply for a duplicate, click here for the form and instructions. https:Hservices.flhsmv.gov/MVCheckWeb/ResultView.aspx 1/18/2012 PLANNING & DEVELOPMENT SERVICES BUILDING & CODE COMPLIANCE DIVISION BUILDING PERMIT SUB -CONTRACTOR SUMMARY 10017 s pl o bi k 125J /ocs will be using the following sub -contractors for the (Company/Individual Namel.mp project located at7-7 (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 cl✓� V sreo c f ct�'zd ( 3o l I rM Plumbing __COWS Mbb t lOom -e-s I oe_. Ao& `r�©wt s .Gtvo� rN 10xsIq HVAC/ Mechanical Roofing Gas OFFICE..USE ONLY: PERMIT ka- � � ISSUE DATE: NUMBER: PLANNING & DEVELOPMENT SERVICES d 41 Y Building & Code Compliance Division zim_ BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lucie County Contractor Certification Number: State of Flo-ida Certification Number (If applicab e) R l 3 01 Z 9-1 g W+ t`e (\ut 1 Tn c b5v ic- Letouyy\ ty have agreed to be the (Company Nametindividual Name) 61 Q-C-• sub -contractor for R'V_s) 1',C (Type of Trade) (Primary Contractor) for the project located at lPS-q S LL. s . 1- %�n1�nJ� 1 , Lo {"3D , +"'t- e 2y-rA- (Project Street Address or Property D #) 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 ContraCt07's License) ORIGIN SIGNATURES ARE REQUIRED L—el f L007 / wc&ct I Z Z.O/1 SIGNATURE PRINT NAME DATE Business Name: W 1 fe—C\ti+ S T1RG. Address: ? •Q' z0y }335 K City/State/Zip: fDt �jGCGe, T"L _ 3 q� Phone: �22-�t��".0� email: W�Cenvt�tnC Qo�•CQryl OFFICE USE ONLY: A dmmn to 7L idw PLANNING & DEVELOPMENT SERVICES DEPARTMENT BUILDING & CODE REGULATIONS DIVISION BUILDING PERMIT SUB -CONTRACTOR AGREEMENT 3�0(Di St. Lucie County Contractor Certification Number: State of Florida Certification Number (If applicable): �` — I (') 2 57 f , r -8 I��FS Cr1�m511�o�i�e fknieS have agreed to be the (Company Name/Individual Name) ""?I L� i" sub -contractor for-7 'orn;5 dob; V 14 mvs. kc (Type of Trade) (Primary Contractor) for the project located at to++ lf.s 50 �\e_rCe , fL (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) ORIGIN SIGN URES ARE REQUIRED 1 4w—s A' 6Tvr\Ae_( to - i Z GNATURE PRINT NAME DATE Business Name: O�M�o r`(101(Jt\4. Address: City/State/Zip: Phone: 5 .34-77Z %-��1—"1rJ-�•C? email: �mS OFFICE USE ONLY: PERMIT # ISSUE DATE 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, S:5M 1 LAcI 2ZZ (Parcel Id#/Legal description/ S. )�w v�y Imo. t?Ieccce 1 r L 3gFVo for which I have applied to St. Lucie County for a Final Development Permit. In accepting this Final Development Permit, BP Number 111 Z -0 2 Nj , 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. ,CV\Ci1 11 I/G 1 PropertyAwner N se rent) r rty Owner Signature Date STATE OF FLORIDA, COUNTY OF " 1_ ( C10 ly�% ACKNOWLEDGED ORE METH S is DAY OF �'�n 20 BY i WHO IS PERSONAL I v xNnwN Tn nnE _,y OR WHO HAS A COMMISSION NUMBER SLCPDSD Revised 08/24/2010 AS IDENTIFICATION. P-" bsien # DD 917334, .,hires September 22, 2013 ANO An) Troy Fain insurenm SOMBS-7019 �sEAi:) Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PROPERTY INFORMATION Address: 6445 U S 1 50 City/State/Zip: FORT PIERCE Parcel # : 1406-133-0002-000/2 Zoning: RMH-5 APPLICATION INFORMATION Permit Number: 1112-0243 Activity Type: New Permit Type: Mobile Home Review Comments FL 34946 Jurisdiction: St. Lucie County Lot # : Block: CONTRACTOR INFORMATION Contractor Name: THOMAS A. GRUNDEL Business Name: TOM'S MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE City / State / ZiI ST CLOUD, FL 34772 REVIEWS AND COMMENTS Review Type Status Documents Missing Pending Front Counter Review Complete To Be Reviewed by Zoning. Complete To Be Review by Plans Exar Pending Zoning Review Incomplete Page 1 Owner(s): IKT ENTERPRISES Application Type: Master Permit w/subs Other Activity: Stories: 1 Automatic Sprinkler System? Reviewed B Dawn Milone Dawn Milone Fax Number 407-892-4935 ct �� CQ y Date Started Date Complete Date Released 12/21/2011 12/21/2011 12/21/2011 Lydia Galbraith 01/11/2012 01/11/2012 01/11/2012 1 Comment PLEASE PROVIDE TWO PERMIT WORKSHEET (SEE ATTACHED) 01/11/2012 2 Comment PLEASE PROVIDE A SECOND ORIGINAL SIGNED AND SEALED INSPECTION REPORT. WE ONLY RECEIVED ONE. a n 01/11/2012 3 Co t PLEASE PROVIDE A SUBAGREEMENT FOR PLUMBING AND MECHANICAL. 01/11/2012 4 Comment PLEASE PROVIDE FILLED LANDS AFFIDAVIT FORM. YOU CAN BRING THAT IN AT TIME OF PICK UP. Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Review Comments PROPERTY INFORMATION Address: 6445 U S 1 50 City / State / Zip: FORT PIERCE FL 34946 Parcel # : 1406-133-0002-000/2 Jurisdiction: St. Lucie County Zoning: RMH-5 Lot # : Block: APPLICATION INFORMATION Permit Number: 1112-0243 Activity Type: New Permit Type: Mobile Home CONTRACTOR INFORMATION Contractor Name: THOMAS A. GRUNDEL Business Name: TOM'S MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE City / State / Zir ST CLOUD, FL 34772 Page 1 Owner(s): IKT ENTERPRISES Application Type: Master Permit w/subs Other Activity: Stories: 1 Automatic Sprinkler System? Fax Number 407-892-4935 REVIEWS AND COMMENTS Review Tvpe Status Reviewed By Date Started Date Complete Date Released Documents Missing Pending Dawn Milone 12/21/2011 02/07/2012 2 Comment CONTRACTOR TO NOTE THE DECAL NUMBER ON THE PERMIT MOBILE HOME WORKSHEETS Front Counter Review Complete Dawn Milone 12/21/2011 12/21/2011 Plans Examiner Review Incomplete Joe Cicio 01/30/2012 01/30/2012 2 Comment THE INSPECTION REPORTS MUST STATE THE CORRECT HOME MANUFACTURER AND YEAR OF MANUFACTURE AND [ INCLUDE THE INSTALLATION DECAL NUMBER *** O.K. ] Plans Examiner Review Incomplete Joe Cicio a 02/07/2012 1 Comment 1 RE -REVIEW [ $50.00 ] * THE MANUj, D 0 E SPEC SHEET STATES THAT THIS UNIT IS A 1985 DEAC ?? * THE TITLE STATEI BEAC AND THE INSPECTION REPORT FROM VILLAMIZAR STATES A 1984 SUNSTATE * THIS COMMENT HAD BEEN PREVIOUSLY LISTED AND UN -ADDRESSED *ALL DOCUMENTS MUST MATCH AS TO THE PROPER MANUFACTURER, YEAR ETC. 02/07/2012 2 Comment COMMENTS MAILED AND FAXED AS OF THIS DATE To Be Reviewed by Zoning Complete 01/11/2012 Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Review Comments To Be Review by Plans Exan Complete Joe Cicio 01/30/2012 01/30/2012 Zoning Review Incomplete Lydia Galbraith 01/11/2012 Page 2 01/11/2012 2 Comment PLEASE PROVIDE A SECOND ORIGINAL SIGNED AND SEALED INSPECTION REPORT. WE ONLY RECEIVED ONE. ** O.K. JMC *** 1/30/12 NOT RECEIVED. 01/11/2012 5 Comment 1/11/12 BY E-MAIL AND MAIL TO CONTRACTOR. TRANSMISSION VERIFICATION REPORT TIME 02/05/2012 15:53 NAME SLC CODE COMP FAX 7724626448 TEL 7724622963 SER.# BROE5J278861 DATE,TIME 02/05 15:53 FAX NO./NAME 914070924935 DURATION 00:00:29 PAGE(S) 02 RESULT OK MODE STANDARD ECM Planning & Development Services Building & Code Regulation Division Permit;Wng Department 2300 VirginiaAvenue Fort Pierce, FL 34982 Phone: (772) 462.1553 Fax: (772) 492-1678 PROPERTY INF_ORM�lr1oN Address: 6445 U S 150 City ! State l zip: FORT PIERCE Parcel 0 : 1406.133-0002-00012 Zoning: RMH-5 APPLICATION IMPS 7RNATION Permit Number: 1112-024$ Activity Type: New Permit Type: Mobile Home CONTRACTOR INFORMATION Contractor Name: THOMASA.GRUNDEL Business Name: TOWS MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE City I State 1 Zip Review Comments FL 34946 Jurisdiction: St. Lucie County I..ot # : Block: 5T CLOUD. FL $4772 Page 1 owner(s): IKT ENTERPRISES Application Type: Master Permit w/subs lather Activity: Stories: 1 Automatic Sprinkler System? El Fax Number 407-892-4935 REVIEWS AND COMMEND Review Tune status Reviewed 8v D�f1� S td Data Complete Data Released Documents Missing Pending Dawn Milone 12121/2011 02107/2012 2 Commenl CONTRACTOR TO NOTE THE [DECAL NUMBER ON THE PERMIT MOBILE HOME WORKSHEETS Front Counter Review Complete Dawr1 Milano 1212112011 12/2112011 Planning & Development Services Building & Code Regulation Division Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Address: 6445 U S 1 50 City / State / Zip: FORT PIERCE Parcel # : 1406-133-0002-000/2 Zoning: RMH-5 Review Comments FL 34946 Jurisdiction: St. Lucie County Lot # : Block: APPLICATION INFORMATION Permit Number: 1112-0243 Activity Type: New Permit Type: Mobile Home CONTRACTOR INFORMATION Contractor Name: THOMASA.GRUNDEL Business Name: TOM'S MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE City / State / Zi f ST CLOUD, FL 34772 REVIEWS AND COMMENTS Review Type Status Voided Page 1 Owner(s): IKT ENTERPRISES Application Type: Master Permit w/subs Other Activity: Stories: 1 Automatic Sprinkler System? El Fax Number 407-892-4935 Reviewed By Date Started Date Complete Date Released Documents Missing Pending Dawn Milone 12121/2011 Front Counter Review ' Complete Dawn Milone 12/21/2011 12/21/2011 Plans Examiner Review Incomplete Joe Cicio 01/30/2012 Planning & Development Services Building & Code Regulation Division Review Comments Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Page 2 Phone: (772) 462-1553 Fax: (772) 462-1578 01/30/2012 1 Comment SUBMITA SECOND SIGNED, DATED AND SEALED"MUBILE HUMS MHLUIIUN KtrUKI .. 01/30/2012 2 Comment THE INSPECTION REPORTS MUST STATE THE CORRECT HOME MANUFACTURER AND YEAR OF MANUFACTURE AND INCLUDE THE INSTALLATION DECAL NUMBER 01/30/2012 3 Comment SUBMIT [ DUPLICATE ] PRODUCT APPROVALS FOR ALL PROPOSED SET-UP COMPONENTS INCLUDING THE SHIMS AND CAP BOARDS 01/31/2012 4 Comment SUBMITA SKETCH SHOWING THE TIE -DOWN FOR THE STYLECREST STEPS 01/31/2012 5 Comment WHAT IS THE #6 AND #66 ON THE 4TH LINE OF THE WORKSHEET 01/31/2012 6 Comment COMMENTS MAILED AND FAXED AS OF THIS DATE To Be Reviewed by Zoning Complete 01/11/2012 To Be Review by Plans Exan Complete Joe Cicio 01/30/2012 01/30/2012 Zoning Review Incomplete Lydia Galbraith 01/11/2012 01/11/2012 2 Comment PLEASE PROVIDE A SECOND ORIGINAL SIGNED AND SEALED INSPECTION REPORT. WE ONLY RECEIVED ONE. 1/30/12 NOT RECEIVED. 01/11/2012 5 Comment 1/11/12 BY E-MAILAND MAIL TO CONTRACTOR. TRANSMISSION VERIFICATION REPORT TIME 01/29/2012 12:49 NAME SLC CODE COMP FAX 7724626448 TEL 7724622963 SER.# BROE5J278861 DATE,TIME 01/29 12:48 FAX NO./NAME 914078924935 DURATION 00:00:28 PAGE(S) 02 RESULT OK MODE STANDARD ECM Planning & Development Services Ouilding & Code Regulation Division Permitting Department 2300 Virginia Avenue, Fart Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772) 402-1578 PROPERLY INFORMATION Address: 6445 U S 1 50 City I State J Zip:' FORT PIERCE Parcel # : 1406-13$-0002-00012 Zoning: RMH-5 APPLICATION INF. _ORMATION Permit Number. 1112-0243 Activity'fype: New Permit Type: Mobile Home CONTRACTOR 1N�ORNb4T/ON Contractor Name, THOMASA. GRUNDEL Business Name: TOWS MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE city I state I Zi; REVIEWS At cow,wEnrrs Review jygg _Status Voided Review Comments FL 34946 Jurisdiction: St, Lucie County Lot # : Block: ST CLOUD , FL 34772 Page 1 Owmr(s): IKT ENTERPRISES Application Type: Master Permitw/subs Other Activity: Stories: 1 Automatic Sprinkler Syr -tam? Fax Number 407.892-4935 EM wad By D Com fete 17ate Released ..,._ _ ... -.. nawn Milne► 12/2112011 Planning & Development Services Building & Code Regulation Division Review Comments Permitting Department 2300 Virginia Avenue Fort Pierce, FL 34982 Page 1 Phone: (772) 462.1553 Fax: (772) 462-1578 PROPERTY INFORMATION Address: 6445 U S 1 50 City/State/Zip: FORT PIERCE Parcel#: 1406-133-0002-000/2 Zoning: RMH-5 APPLICATION INFORMATION Permit Number: 1112-0243 Activity Type: New Permit Type: Mobile Home FL 34946 Jurisdiction: St. Lucie County Lot # : Block: CONTRACTOR INFORMATION Contractor Name: THOMASA.GRUNDEL Business Name: TOM'S MOBILE HOMES, INC Business Addr: 3344 HENRY J AVE City / State I Zil ST CLOUD, FL 34772 REVIEWS AND COMMENTS Review Type Status Documents Missing Pending Front Counter Review Complete To Be Reviewed by Zoning Complete To Be Review by Plans Exar Pending Owner(s): IKT ENTERPRISES Application Type:' Master Permit wlsubs Other Activity: Stories: 1 Automatic Sprinkler System? �i u Fax Number 407-892-4935 LA Reviewed By Date Started Date Complete Date Released Dawn Milone 1212112011 Dawn Milone 12/21/2011 12/21/2011 Zoning Review Incomplete Lydia Galbraith 01111/2012 01/11/2012 01/11/2012 1 Comment PLEASE PROVIDE TWO PERMIT WORKSHEET (SEE ATTACHED) 01/11/2012 2 Comment PLEASE PROVIDE A SECOND ORIGINAL SIGNEDAND SEALED INSPECTION REPORT. WE ONLY RECEIVED ONE. 01/11/2012 3 Comment PLEASE PROVIDE A SUB AGREEMENT FOR PLUMBING AND MECHANICAL. 01/11/2012 4 Comment PLEASE PROVIDE FILLED LANDS AFFIDAVIT FORM. YOU CAN BRING THAT IN AT TIME OF PICK UP. i uuuuiir� m ucv. "upt. riunir, Atps://acaweb.brevardcounty.us/CitizenAccess/ I\ � Search Our Site: Advanced Search Home Building Development Search Applications Resister for an Account I ;Building Code Building 11BC09996: jLand_e_veloPmant'*' "_ .._....._.._...._._.__.._._.._..................... I Residentiat'Demotitiori Mo6tle`-Manufactured HalTie� — — -- — .......................... ....................... .....I._.......__._.......... I Planning & Development __.............._.._. _._. 7 .___. Location: Mission: To enhance Brevard citizen's b35FMERALD-LAKE-DR quality of life throughout the review 99COCOA of new development FL 32926 forcompliance with ............................. ........... ..., . .......... ...... ,.... ..._ ............. .. .......... ...... ........ ........... ... -,. . ..,.... ......,,, building and land Application Details development codes. Licensed Professional: Description: Thomas A Grundel remove mobile home from location/ sewer TOMS MOBILE HOMES INC. remove mobile home fiom location/ sewer OSCEOLA 3344 Henry I Ave ST CLOUD, FL, 34772 Home Phone: 407-908-5468 Fax:407-892-3598 Mobile Home IH10251481 More Details Completed (2) Pass - 1; Rescheduled - 1 Rescheduled Building Final (397201) view Details Rescheduled by: Victoria B Ward on 12l3012011 at 5:00 PM Pass Building.FiRaL(397349)? _ _ _ _ View Details Result by: Harry T Sullivan on 01/03/2012 at 3'_43-P_M_' > Processing Status Attachments > Related Buildings ..._._................... .......... .............. 1 of 2 i 1 / 14/2012 2:42 PM Form W'9 Request for Taxpayer Give Form to the (Rev. December20 Identification Number and Certification requester. Do not Department of the Treasury ury Internal Revenue Service send to the IRS. Name (as shown on your income tax return) N Business name/disregarded entity name, if different from above m m Tom's Mobile Homes, Inc. n. C Check appropriate box for federal tax classification: ° ❑ Individual/sole proprietor C Corporation ✓ S corporation Partnership P P ❑ P ❑ P ❑ p❑ Trust/estate m e a° -�F ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ON- El payee o------------------------------- c a ❑ Other (see instructions) ► U Address (number, street, and apt. or suite no.) Requester's name and address (optional) m3344 Henry J Avenue . ° City, state, and ZIP code W St. Cloud, FL 34772 List account number(s) here (optional) i axpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number to avoid backup withholding. For individuals, this is your social security number However, fora _ m _ resident alien, sole proprietor, or disregarded entity, see the Part I instructions onn page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see Now to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. F--r--7 ©®E©N®ME©S Under penalties of perjury, I certify that: The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured pr erty, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest 3pd dividends ou are not required to sign the certification, but you must provide your correct TIN. See the instructions on Daoe 4. Her Date ► Signature of CJ� Here d U,S_peison ►'- ' General Instructions Section references are to the Internal Revenue Code unl ss otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form W-9 (Rev. 12-2011) for da Mobb ke -came Insualler License y..... . ....Y4�o.r LIC'ENSEE::. TN,OMA;S A. GRI,INDEI �[7 ' LICENSE IER`: IH%1025148 -EFFE('TIVE DATE; 09/02/201 1 GXP1RATFON DATE: 00/30/20] 2 THE LICENSEE IxS HEREBY CERTIFIED UNDER TH4E,PROVISION&OF SECTION, 3^f). 2 , Fh, R -A STATU`IES TO:CONDUCT AND CARRY ON -BUSINESS AS AN INS1,4' OF 1\20$ILEHONEJ IN =;STATE O FL0kMA Dii ectoi Dig-" �iciil ��f M�>torist flll cep Sti to of F1'oiid :i : De ��utniei t �f Highway .Safe.ty'ancl Motor Vehicles - Division of Motorist Services 2012 PATSY HEFFNER, TAX COLLECTOR ACCOUNT NO. EXPIRES SEPTEMBER 30, 2012 OSCEOLA COUNTY STATE OF FLORIDA 17780 LOCAL BUSINESS TAX RECEIPT r RENEWAL •BUSINESS 4230 MH/RV SERVICE (BLDG DEPT) PATSY HEFFNER NEW LICENSE TYPE Tax Collector TRANSFER 0.00 4230-17780 ORIGINAL TAX 30.00 BUSINESS 16301145 AMOUNT NONEXEMPT 0.00 Tom's Mobile Home, Inc. 09/22/2011 334.4 Henry J. Ave. Oper YM PENALTY 0.00 St. Cloud, FL 34772 Till 163 COLLECTION COST 0.00 Paid 30.00 TOTAL 30.00 OSCEOLA COUNTY MAILING Tom's Mobile Home, Inc. ADDRESS 3344 Henry J. Ave. St. Cloud, FL 34772 IH/1025148 Exp.9/30/2011 i 9r PATSY HEFFNER, TAX COLLECTOR P.O. BOX 422105, KISSIMMEE FL 34742-2105 407-742-4000 0 . s ACORD CERTIFICA OF LIABILITY INSURANCE OF IDCK DATE (MWDD YYYY) TOMSM 1 OS/06 11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION J Meyers Insurance Group Metro 5003 Old Cheney Hwy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES -NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orlando FL 32807 Phone: 407-273-0230 Fax: 407-380-3211 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A' Owners —Insurance Company 32700 INSURER B'. wto-Norte IneNcanee Co 'y 18988 Tom's Mobile Homes Inc INSURERC: e.tn.n-o..r.:n.Nr.... . 10190 Thomas Grundel dba: 3344 Henry J Ave St Cloud FL 34772 INSURER D. INSURER E: THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCHES. AGGREGATE LIMITS SHOW! MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR LTR LTR NSRD TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDDrfY) DATE (MMMOIYY) LIMITS OENERALLIARIUTY EACH OCCURRENCE f 300000 A R COMMERCIAL GENERAL LIABILITY 064682-72682755-11 05/05/11 05/05/12 DAMAGE TO RENTED PREMISES(Eeoccurence) f 300000 MED EXP(AAy one pemon) $ 10000 CLAIMS MADE OCCUR PERSONAL S ADV INJURY f 300000 GENERAL AGGREGATE S 600000 GENL AGGREGATE UNIT APPLIES PER: PRODUCTS - COMP/OP ADD f 600000 PRO. LOC R I POLICY PRO AUTOMOBILE UASILITY B COMBINED SINGLE LIMB f 100000 ANY AUTO 4677768100 05/02/11 05/02/12 (Ere 1ddni) ALL OWNED AUTOS BODILY INJURY R SCHEDULEDAUTOS (Pei perwn) S HIREDAUTOS ' BODILY INJURY NON-0VMED AUTOS (Par —id-) S PROPERTY DAMAGE (Per ettNenU S OANAGE LIABILITY AUTO ONLY - EA ACCIDENTf ANY AUTO OTHER THAN EA ACC S i AUTO ONLY: AGO EXCESSNMRRELLA UASIUTY EACH OCCURRENCE j AGGREGATE S OCCUR ❑CLAIMS MADE S DEDUCTIBLE f f RETENTION f WORKERS COMPENSATION AND X TORYLMTB OER C EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE 72-781594 04/30/11 04/30/12 E.L. EACH ACCIDENT S 100000 OFFICEFMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE f 100000 By.., eeam. aMwdr E.L. DISEASE -POLICY LIMIT f 500000 SPECIAL PROVISIONS INIv OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS MOBILE HOME INSTALLATION / Dealer License # IH0000054 I f1FRT1P1f1ATc Ur%l neU VMI\VGLLM I IUf9 DHSMV-1 SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DHSMV DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Fax: 850-617-5191 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 2900 Apalachee Pkwy-Neil Kirkman Building -MS 6 6 IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER. ITS AGENTS OR Tallahassee FL 32399-0640E�@EY�ffiTSiSY� ACORD 25 (2001108) © ACORD CORPORATION 1988 FAX COVER SHEET TOM'S MOBILE HOMES, INC. 3344 HENRY J AVE. ST. CLOUD, FL 34772 407-957-9685 FAX 407-892-4935 SEND TO Company name From ST. LUCIE COUNTY BUILDING DEPT. TOM Attention Date JOE CICIO 1/31/2012 Office location Office location Fax number 6Z �� 57 Phone number 772 62-1678 772-462-1553 EJ urgent Reply ASAP Please comment 0 Please review For your Information Total pages, Including cover. -11 COMMENTS ------ ---- -- ... ...-------------..........---------- ---------•------------------ ---- PLEASE FIND ATTACHED RESPONSE - • W - - - ----------------- ---- -4 - -- QNSE TO PLANS REVIEW-COMMENTS__AND OUR --___--•_-•------------- PHONE COVERSATION TODAY. : THANK YOU IN ADVANCE. TOM GRUNDEL -- -- TTO/T00 12 SHWOH H'IIHON SW01 5£6VZ68L0V YVA 6T s 9T ZTOZ/TO/ZO 01/2912012 12:48 7724626L- SLC CODE COMP PAGE 01/02 Planning a Development Services Review Comments &lildirM S Code Regulation Division Pemnit6na Department 2300 Virginia Avenue Fort Pierce, FL 34982 Page 1 Phone; (772) 462-1653 Fax (772) 462-1578 E /NFORMA770 Owner(s): /�Qdj�gg; 6445 U S 1 50 f IKT ENTE PROSES City ! State f Zip: FORT PIERCE FL $4946 F+aicel # : 1408.133-0002.000/2 Jurlsdit ion: St. Lucle County Zoning: RMH-5 Lot # : Block: APPUOT/ON INFORMAVON perntit Number: • 1112-'0243 Applicadon type: Master Permit w/subs Activity Type: New OBter Acti+►ity: permit Type: Moblla Home Stories. 1 Automatic 8prinkfer System? �] cm'TRACTOR /NFORMATION Contaaor. Name: THOMASA. GRUNDEL Fax Number 407-892-4935 Business Name:' TOWS MOBILE HOMES, INC 0oulness Add1n ; 3344 HENRY J AVE aty 13fatv'I Zi; ST CLOUD , FL 34772 Raing US.ANb COA+ANIENTS Ft vlevv Ty�se Status geviswsd ev 2M Started RIP CornPfete Date Released Voided 'Nora on t Missing Pending Dawn Milone 12/21/2011 Front Counter Review Complete Dawn Milano 1212112011 1212112011 Plans Examiner Re+rievu Incomplete Joe t:icio 01/3012012 TTO/Z00 1 SHKOH HU90H SX01 996VZ69LOV XVd 6T:9T ZTOZ/TO/ZO .01'/29/2612 12:48 772462644`EI SLC CODE COMP PAGE @2/62 Planning da Development Services Building &Cade Regulation Division Review Comments Permit ing Department 2300 VirginlaAvenae Forte 2 Page 2 Phone: (7 21 x: ( - 01/30/201Z 1 Comment SUBMITA SECOND SIGNED, DATED AND SEALED " MOBILE HOME INSPECTION REPORT" 0113WO12 2 Comment THE INSPECTION REPORTS MUST STATE THE CORRECT HOME MANUFACTURER AND YEAR OF MA NUFACTUREAND INCLUDE THE INSTALLATION DECAL NUMBER 01/30/2012 9 �' Co SUBMIT [ DUPLICATE ] RODUCT APPROVALS LL PROP ET CO LsDIN G THE S ` 0//312012 4 Commenl SUBMITASKETCH SHOWING THE TIE -DOWN FOR THE STYLECRESTSTEPS 01/312012 6 Commenl WHAT IS THE 96 AND 066 ON THE 4TH LINE OF THE WORKSHEET 01/3912012 6 Comment COMMENTS MAILED AND FAXED AS OF THIS DATE To Be RE.wlwod by Toning Complete 01/11/2012 To Be Roviavv by Plans Exan 'Complete Joe Clclo 0113012012 01/3012012 Zonling FtaVlew Incomplete Lydia Galbraith 01/11/2012 011112012 2 Commenl PLEASE PROVIDE A SECOND ORIGINAL SIGNED AND SEALED INSPECTION REPORT, WE ONLY RECEIVED ONE. 1130112 NOT RECEIVED. 01/112012 5 Comment 1111/12 BY E-MAILAND MAILTO CONTRACTOR. TTO/£001J SaWOH HIIgOIR SIROZ 996VZ69LOV XVA 6T:9T ZTOZ/TO/ZO Manufactured Home Installation Specifications (Must be completed and submitted with your application) , _l 4 Applicant /p,s0 �:._�Z _. /_)'1LS /��. Permit # —a Address %$ ci•s. 4y,1vl ,5Manufacturers Name BE AG Roof Zone ,r- Wind Zone Tr_ No. of Sections_]_ Width Length_ oD _GYear• 9r 95- Serial=# SSMFL-AG1ZZ2-6/ Installation Standard Used (check) Manufacturers Manual 6 ? I SC-1 66 �? Site Preparation Debris and Organic Removal y Page # Water Drainage: Natural �_ Swale Pad Other ' Page # Foundation Load bearing soil density 201D6 Or assumed 1,000 psf Page # Footing type: Poured in place Portable Page # rr Mainrail frame block: Size $ Placement o.c. % f Page # Perimeter blocking: Size D r Number � Location po2S Page # Ridge beam support: Number 0-2—Size 0,51Y.12 location (a Page # Center line blocking: Number — Size/ tion Page # Special supports required (fireplace, bay window) Yesy No Page # Mating of Units: Mating gasket Type used Page # Fasteners: Roof Type Spacing C. Page # Endwall Type Spacing o.c. Page # Floors Type Spac%i g o.c. Page # Anchors: Type 6,000 3,150 V Page # Height of Unit (top of foundation to frame): / 8 0",,W A7 Page # Angle of straps -10 o'f 4�_& Page # Number of frame ties _ (0 Spacing 9 o.c. Page # Number of over -roof ties (if required) .9 / Page # Number of sidewall anchors 24 Zone 11 Zone III Page # Number of centerline anchors N ber of stabilizer '; o Vents required for under ' tngs'150 s oor ea): No. /N S/��%�� �d Grp Page # Page # Prepared by,/ -�G� ���j��� Date: PLANNING & DEVELOPMENT SERVICE DEPARTMENT BUILDING & CODE REGULATIONS DIVISION 2300 Virginia Ave Fort Pierce, FL 34982 (772) 462-1557 Mobile Home Inspection Report All requests for permits to place or replace used Mobile / Manufactured homes must be accompanied by this completed Inspection Report and copies of both sides of the Title to the home. All used Mobile homes must be Wind Zone II certified. Owner: Richard Metheny Date: _12/20/2011 (Print or type) Address: _6545 US 1 Lot 50 FOrt Pierce, FL 34946 (Physical Location of Home) Year / Manufacturer.1 84 Sunstate'Manufactured-Homes-tnc' Serial # SSMFLAC122267 HUD Plate #FLA277323 eta Width_14' Length_60' Single X Double Wind Zone _II C = In Compliance N = Not in Compliance Fire Safety / Electrical _N 1. Smoke Detector: Installed Missing X _C_ 2. Electrical System Checked: Exposed Wiring Other _C 3. Distribution Panel: Missing Loose Main Missing Breaker Missing Unplugged Opening Other _N 4. Electrical Fixtures: Missing _C Installed Improperly Improperly Wired Loose Wire GFCI receptacles not where required_X_ _C_ 5. Electrical Ground;: Chassis Main Panel _X Gas Pipe Revised 08/24/2010 Construction _C_ 1. Exit Doors Operable: Front X Back_X Other _C_ 2. Exit Door Locks: Missing Inoperable _C_ 3. Egress windows: Missing Inoperable _C_4. Windows: Broken Glass Inoperable _N_ 5. Screens: Missing Damaged- X--C- 6. Floor System: Joist X Decking X Area Damaged _C_ 7. Interior Paneling: Missing Loose X_ Damaged _N_ 8. Rodent Proofing: Bottom Board Pipe openings Other _C_ 9. Leaks Apparent: Ceiling Doors Floor _X_ Roof _C_ 10. Vertical tie -down straps: Missing Short Damaged C_ 11. Structural modifications since manufactured: YES_ NO- X-C- 12. Walls: Structurally Unsound Loose Weather tight _X Plumbing _N_ 1. Trap: Missing Not connected X Other _C_ 2. Plumbing fixtures: Missing Not installed Not Vented _C_ 3. Relief Valve: Missing Inoperable Other _N_4. Drain Waste and Venting Piping: Missing X_ Not supported Clean outs Use of fittings Not capped Heating and Air Conditioning _N_ 1. Heating Appliances: Missing X Not Connected Other _C_ 2. Deleted Heating/AC system: Not installed X Other. _C_ 3. Thermostat: Missing Inoperable _C_ 4. Air registers: Missing Inoperable _C_ 5. Ducts: Not sealed Missing Collapsed. N/A 6. Gas furnace Water heater vent: Missing Loose Page 2 N 7. Return Air: To Furnace To A/C From rooms _C_ 8. Range: Vent _X Hood_X_ _N/A_ 9. Gas Valve: Accessible Installed improperly _N/A_ 10. Gas lines: Not capped Not supported Kinked Not bonded Summary 1. Is subject structure found to be fifty (50%) or more damaged or deteriorated? YES NO_X 2. Will a remodeling permit be required? YES X NO The provisions of the repair and remodeling code shall ensure safe and livable housing and shall not be more stringent than those standards required to be met in the manufacture of mobile homes. Such provisions shall include, but not be limited to, standards for structural adequacy, plumbing, heating, electrical systems, and fire and life safety. FS 320.8232 IF ANY RENOVATIONS OR IMPROVEMENTS OVER AND ABOVE THE REQUIREMENTS OF FS 320.8232 ARE TO BE PERFORMED ON ANY MOBILE HOME WHICH WILL BE PERMITTED TO BE TIED -DOWN IN ST. LUCIE COUNTY, A SEPARATE PERMIT WITH ENGINEERING (IF APPLICABLE) WILL BE REQUIRED. ALL SEPARATE PERMITS MUST OBTAIN A FINAL INSPECTION BEFORE A FINAL INSPECTION IS OBTAINED FOR THE TIE -DOWN PERMIT. NO MOBILE HOME WILL BE ALLOWED TO BE MOVED TO ST. LUCIE COUNTY OR RE- LOCATED WITHIN ST. LUCIE COUNTY UNTIL THE REQUIRED DOCUMENTS HAVE BEEN SUBMITTED, REVIEWED, APPROVED AND THE TIE -DOWN PERMIT HAS BEEN ISSUED. A REGISTERED FLORIDA PROFESSIONAL ENGINEER MUST COMPLETE THIS DOCUMENT, SIGN AND AFFIX THEIR SEAL. M, Date inspected: _1 `F-* Inspected By: Sign&ureof Enginee / ' -o STATE OF ���,�'••'��OR10P ••'0; a 81 E��'���`��• �B/°®4°ooseH�Aattoo�N��o SLCPDSD Revised 08/24/2010 Page 3 License #: _FL PE 61000 (seal)