HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY: I () q 1
DATE FILED: PERMIT NUMBER:
PLAN REVIEW FEE: RECEIPT NO.: bala -
CONCURRENCY FEE: RECEIFTNU.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
1 -3 ?- 0
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 19C
nm 772462-1553 �'�A,
40'-�
APPLICATION for BUILDING PERMIT
CERTIFICATE of CAPACITV/ZONING COMPLIANCE
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:
2. PROJECT NAME: ',L-1, SITE PLAN NAME:
A-\
3. PROPERTY TAX ID #: 0 0 6 -5
4. LEGAL DESCRIPTION (attach extra sheets if necessary): D
5. PLATBOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
9. PARCEL SIZE (ACRES/SQ FT.): LOT DIMENSIONS: zo(. y
10. CO?"LETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY:
C --�' c)
)
It. TBACKS(ACTU FRONT: BACK: RIGHT SIDE: LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
NEW CONSTRUCTION EXPANSION/ADDITION INTERIOR RENOVATION
RESIDENTIAL COMMERCIAL INDUSTRIAL
OTHER(SPECIFY)
13. DESCRIPTION OF PROPOSED USE:
14. SQ. FT OF CONSTRUCTION: 15. SF. FT Ist FLOOK-
16. VALUE OF CONSTRUCTION: 32! 02-oo
I
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the fight to question and/or modify the indicatcd
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: L,—+ 1- 10 k-\.
ADDRESS: C-14 'S �' ( <- -r_ i
CITY: F4- 0 L" -C d- C STATE: — 1'.' L. ZIP: -3 yot Y2
PHONE (DAYTIME): (� -2h .;?= 6, ',),> Q Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FELL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLE14OLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME): C__)
ARCHlT/ENGINEER--
ADDRESS:
CITY:
PHONE (DAYTM):
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
FAX N�
STATE:
STATE:
STATE:
ST. LUCIE COUNTY CERT #:
Email:
ZIP:
MR
ZIP:
ZIP:
IMPORTANT NOfrICE: When a permit is issued and it is not picked up within 60 days after notification
it wifl be voided and returned to you by maiL
J��_ ;�� ! Planning & Development Services Department
14rel 1,41 Building & Code Regulations
2300 Virginia Avenue
- V ME X&A V Fort Pierce, Florida 34982
(772) 462-1553
OWNER/BUELDER 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;aq ws,
ordinances, building codes, and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advicetonl�o �oeet
ia
Ini la
the minimum code.
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I maybe responsible and 01�,gf, the
Initial
cost of the license.
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -
be held liable for all doctor, lawyer and rela ical
they may be entitled to workmen's compensation. I could V "
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 ftirther
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
_�)�,-,day of of 20
Jy_
Owner/ uilder Signature
STATE OF F��D
COUNTY OF
The f, in�* istrument was owledged before me this q day of—TOA
by who wersqg�lly kno to me, or who has
produced — _0 as id ication.
Signature o tary Type or rint e o Notary
Commission Number A14GELA M. HUFF!
Title: t ublic My COMMASION # EE 0?;�,
E)(PIRES: Apfil 12,20!
ritem
SLCPDSD Revised 07/22/2010 BMW TJWu Notary Public Underw I
NTY
F L 0 R t D A
rF- 6? v7-, �, " Tr I
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
FILLED LANDS AFFIDAVIT
1, the undersigned, am the owner of the following described property,
(Parcel ld#/Legal des'eription/.
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 WELL 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.
— � A-) i I � �' 0, c-', 1-\
Property Owner Name (Please Print)
( ') 4 1 A A
Fro_pert� Owner SigAature Date
STATE OF FLORIDA, COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY 20
BY CIOMS kkA-k"o i-\
-WHO IS PERSONALLY
KNOWN TO N4
OR WHO HAS
PRODUCED S
3N
R*9— b
AS IDENTIFICATION.
nry\^A'n-ft)LL._1�
_Av\oe_�oJA4uT�
SIGNATTIKE OFe5TKRY PUBLIC '
' I TYPE OR P"OTARY
COMMISSION NUMBER
SLCPDSD Revised 08/24/2010
ANGSA M. HUFF
my COMM16SION # EE WM
2015
EXPIRES: April 12, 2
Bwded Thru Notary Public Undwwriters
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MADE By ME, THAI 15 A CORRECr REPRESENTATION or rme.
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,3 115' LAND PLATTED, AND THAr PeRmANENr REFERENCE AeowmFiVIS
HAVE BEEN PLACED AS CALLED FOR UNDER SeCrION 7. CHAPTER
10,?75 OF THE LAWS OF THE' STATE OF FLORIDA
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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 he 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 MLJST BE RECORDED AND POSTED ON THE JOBSITE BEFORE TBE
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.
OWNER OR COSTWTOR S16N'ATURE
STATE OF FLI
COUNTY OF
The foregoing instrument was acknowledged before
me this day of 20 121%
by LZt 10A_t1,
who is personally known or has produced
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTYOF
The foregoing instrument
me this day
by
who is ve0onaliv known
acknowledged before
,20_____,
—or has produced
as identification.
Signature of lotary ANGE M. VJUFF Signature of Notary
puw U witem
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)12,2015 ommission No. (Seal)
Commission N Set .,/C
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NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY B. 4:
SECTION
TOWNSHIP
RANGE
MAPNO.
ZONING
LAND USE
LOT CVG %
TAZNO.
FLOOD ZONE
FIRM MAP #
I ST FLR ELV
MAXHGT
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
01ADO
LIBRARY
IMPACT
FEE
PUBLIC BLD
BRACTFEE
CORRECTION
>tZFEE
BID
UB C E
IMPACT
PARKS
BRACT
FEE
GENERAL
jo� RAL
SCHOOL
IMPACT
FEE
ROAD
CFYD!T
Y
N
LAW ENF
BRACT
FEE
FUWAMS
IMPACT
DRIVEWAY
REQUIRED
Y
N
DRIVEWAY
FEE
ADMU41STRATIVE
VARIANCE FEE
FEE
—1�1
SPECIFY
SUBS
MECHANIC ROOF
ELECTRIC GAS
NON -CONFORMING
LOT OF RECORD
MISCELLANEOUS
FEES
REQUIRED
PLUMBING
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
INITIALS
NOTICE OF COMMENCEMENT
Permit No. IOU Tax Folio No.V31 o_3 - Yn �2,-o o G oo o -
State of Florida County of St. Lucie
the undersigned hereby gives notice that improvement will be made to cepin real property, and in accordance with Chapter 713, Florida Statutes,
�he following information is provided in this Notice of Commencement.
Legal Description of Property: (and street address if available)-
-1 11 (Z- 'A,-, L 'Q6 f A I I
General description of improvement: �) C, k, 'L I C �-J C, !-I
Owner information or Lessee information if the Lessee contracted for the improvement:
Name C�_t- �-� 1::�,
Address .e �-f' C7,- Pt'c,- 5LO r 110- 3�19R,4
Interest in property:
Name and address of fee simple titleholder (if different from Owner listed above):
Contractor's Name: —
Contractor Address: Phone Number:
Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $
Name and address: Phone number:
I
tender Name: Phone Number:
ender's address:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Sectio
713.13(l)(a)7., Florida Statutes:
Name: Phone Number:
Address:
In addition to himself or herself, Owner designates
Lienor's Notice as provided in Section 713.13(l)(b), Florida Statutes.
Phone number of person or entity designated by owner:
to receive a copy of t
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be I year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
iNSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Jinder penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowledge and belief.
(Signalure' of Owner or l5e`sse�, or Owner's or Lessee's Authorized Officer/Director/Partner/Ma
I H 'REY
UMP'J
AUDREYBiHUMPHREY
'A ON 0 �E 06115 9
MY COMMISSION f EE 06 1�1 -59
Me',.,
EXPIRES: March 6, 2015
(Signatory's Title/Office) a P,� rqrdrs
&r; urderwnters
Bonded Thru Notary P
The foregoing instrument was acknowledged before me this day 20
"as for L-Z-1 _9U 777 A-/
Name of Person Type of authority (e.g. office r,trustee) Party on behalf of whom instrument was executied
C.
(Signa ure of Notaoublic - State of Florida) V
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally known or oduced Identification
_ pr
Type of Identification produced
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Property Appraiser - St.Lucie — inty, FL
Page I of I
William Sutton Record: 1 of I
Property Identification
Site Address:
338 Ashley St
Sec/Town/Range:
03:36S:40E
Map ID:
34/03S
Zoning:
RS-4
Ownership and Mailing
Owner:
William Sutton Paula Hall
Address:
338 Ashley St
Fort Pierce FL 34982-7324
Sales Information
Date Price
Code Deed
11/22/2011 100
0116 QC
4/10/2006 100
01 QC
3/1/1978 9500
01 Cv
PROPERTY RECORD CARD
<<Prev Next >> Spec.Assmnt Taxes Exemptions Permits Home Print
\,PE 00
Parcel(D�
Account #: 39449
Land Use:
SF Res
City/Cnty:
St Lucie County
Legal Description
REPLAT OF PALM GARDENS BLK 5 E 72.6 FT OF LOT 8 AND W
21.8 FT OF LOT 9 (0.23 AC) (OR 283-631: 2531-2
More...
Assessment 2011 Final Total Land and Building
Book/Page
2011 Final: 56100 Land Value: 6900 Acres 0.23
3341/2645
Assessed: 56100 Building Value: 49200
2531 /0221
Ag.Credit� 0 Finished Area: 1611 SqFt
0283/0631
Exempt:
Taxable:
Taxes: 1141.4
BUILDING INFORMATION
701 F-MW
Exterior Features
View:
RoofCover:
TN - Metal
RoofStruct:
GA - Gable
ExtType:
HD -HD
YearBIt:
1963
Frame:
Grade-
D-D
EffYrBIt:
1977
PrimeWall:
BS - CB Stucco
StoryHght:
0010-1 Story
No.Units:
1
SecWall
Interior Features
BeclRooms:
3
Electric:
MX - MAXIMUM
PrmIntWaIl:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/Fl:
1/2Bath
0
HeatFuel
ELEC - Electric
Prm.Flors:
TZ - Terrazo
%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
�4
FEN4 - CHAINLINK4'
Y 1
115 AV AV
1999 1 0100-SF Res
210 -Front
94 1�0
THIS INFORMATION 13 BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SGUBjECT TO CHANGE AND IS NOT WARRANTED
http://www.paslc.org/prc.asp?prclid=340380200650001 1/9/2012