HomeMy WebLinkAboutSUBMITTED PAPERSDate:
0 Electrical
El Shed
cc Due:
RccxiDt#
Permit #
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce, FL 34982-5652
Tel. 561-462-1553
- 00 XC6--
3161
SPECIALTY PERMIT APPLICATION
B/P1-1-U--mbing [I HVAC El Fence St 8'0'4�AZ��
.441 &�, D
El Demolition El Gas Siding C041,
Seepage 2jor instructions and additionalpaperwork required./orspecialty permits
1. Location/Site Address:
2. Parcel ID Number:
Office Use
Township
I Range
I Map
ning
Land Use
Initials
Only
�Section
�
3. Qescription of Project or Work Activity:
4. Owners Information 5. Contractors Information
Name: k /�" FL Reg/Cert #:
Address:5qloL.�VA)L��-7— &049 County Cert#:
City: A?7— State: )q. Business Name:
Zip: �2 Phone: 772-��-//921`hone ax
6. Value of Construction: $ .2'50' 6XI)
-3V9fC'-)-
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that alk work will be done
in compliance with all applicable laws regulatin
116, Z &� —
PRINT QUALIFIERS/OWNHRS NAME I SIGNATURE OF QUALTMER/OWNER
Ft ACKNOWLEDGED BEFOREME 01—
FLORIDA, COUNTY OF 3� THIS C7 DAY OF
201
QBY WI-10 IS PERSONALLY KNOWN TO MROR WI-10 I fAS PRODUCED
e�w (17) &.. AS IDENTIFICATION. '13 v->vl 7f/- 6-k.
]DIWffaml
TITLE-.': NOTARY PUBLIC
.St. Lucie County Specialty Permit Applicition rev. R/25/05 ding
NAM F OF
COMMISSION NUMI1I-R
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X3
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-St. Lucie County
Building & Zoning Department
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 462-1553
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor even
though you do not have a license. You must provide direct, on -site supervision of the construction yourself You
may build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a cost of
under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially
improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within
one year after the construction is complete, the law will presume that you built or substantially improved it for sale
or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or
to supervise people working on your building; it is your responsibility to make sure that people employed by you
have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done.
Any person working on your building who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers'
compensation for that employee, all as prescribed by law. Your construction must comply with all applicaWws,
Initial / I /M
ordinances, building codes, and zoning regulations. L__A�
I understand that the building official and inspectors are not there to design or give advice on ho t
the minimum code. Initial M_
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 Z9
-r-7
I understand that if I compensate any person or company for work performed they are required tg b
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and lia the
cost of the license. Initial - �0
I understand that if any person that is unlicensed and uninsured gets injured on my construction prolecl-I
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related
cost, which could include loss of wages during recovery from their injury. Initial
7'
To qualify for this exemption under this subsection, an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zoning Departm nt o the Florida State Department of Professional RegAulatiogned and acknowled d h this
rl� of20
2— day of
Owner//Bujilder S1 nature
STATE OF FLORIDA
COUNTY OF 3(
The f egoing ins nt was acknowledged before me this _C4__ day of 20L2_
' e oin 4in nt was aCKnow1edgedT,,yr,,J,
by g g who is personally known me, or who has
produced as identification.
Oid-AIA4, __J_A. A A-F��
ur f 0 r rint Nime of Notary (Seal)
Sig, narur:e- of Nota C ypep.
t
Title: Notary Publ comonssion Number
MY HUA#PHREy
COM"SSION # DD 63304
EXPIP 8:M8 6,2011 7
OPde4 Th'u Notft Nblf Urlderwrilers
a
6
SEWER
"S
METER SZ.
1VVF
IRR
0
SECURITY DEP
SERVICE FEE
SAME DAY FEE
OVERTIME FEE
METERINSTALL.
CFC/WATER
FPVA CFC
CFC/SEWER
GUAR. REV.
4 (J _LATERAL
s 7
TOTAL
CUSTOMER
SIGNATURE
NAME OF SPOUSE
4
NAME
ACCT. # 16
SERVICE ADDRESS
A;//
BILLING ADDRESS
ATIES - P.O. BOX 728. FT. PIERCE. FL 34982
I IY4 �
o,F
51/0 -�VIV 5,,r- 7- t19
r x , x � - � -- �' � /' �7:' yv,
C 'I LOT BLOCK t7
77'
PHONE# 416!�2—JI92— MOVE IN/CLOSING DATE
This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay
the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAL SEC/
FED ID— X,
SPOUSE SOCIAL SEC.
OFFICE USE ONLY j .
" / " '- ', RECEIVED BYI,�titl" Ah4 k
DATE RECEIVED CASH CHK #
Property Appraiser - St.LLICiC C-linty, FL
Pao,e I of I
t,
Steve A Bellas Record: I of I
Property Identification
Site Address:
5910 SUNSET BV
Sec/Town/Range:
11:36S :40E
Map ID:
34/11S
Zoning:
RS-4
Ownership and Mailing
Owner. Steve A Bellas
Address: 5910 Sunset Blvd
Fort Pierce FL 34982
PROPERTY eECORD CARD
<<Prev Next Spec.Assmnt Taxes Exemptions Permits Home Print
ParceliD: 3402-609-0682-000-6
Account#� 38165 IT)
Land Use: SF Res
City/Cnty: St Lucie County
Legal Description
INDIAN RIVER ESTATES-UNIT-08- BLK 71 LOT 4 (MAP 34/11 S) (OR
3187-172)
Sales Information
Assessment 2009 Final
Total Land and Building
Date
Price
Code
Deed
Book/Page
2009 Final:
70300
Land Value: 15200 Acres 0.23
4/112010
100000
0001
WD
3187/0172
Assessed:
70300
Building Valuei 55100
8/3/2007
30000
01
WD
2861/2375
Ag.Credit:
0
Finished Area 1225 SqFt
10/24/2003
110000
00
WD
1831/2199
Exempt:
11/26/1996
66000
00
WD
1048/1985
Taxable:
11/8/1995
21500
01
QC
0983/2293
Taxes
1374.79
1/4/1993
48000
01
DE
0824/0898
10/7/1992
100
01
WD
0811 /1883
9/9/1992
55300
01
CT
0806/1378
BUILDING INFORMATION
Exterior Features
View:
RoofCover:
FS - Fibrglss Shg
RoofStruct:
HP - Hip
Exffype�
HC - HC
YearBIti
1984
Framei
Grade:
C-C
EffYrBIt
1984
PrimeWall:
BM - Brk/Masonary
StoryHght:
0010-1 Story
No.Units:
1
SecWall:
Interior Features
BedRooms:
2
Electric:
MX - MAXIMUM
PrmlntWall:
DW - Drywall
FullBath:
2
HeatType:
FHA - FrcdHotAir
AvgHt/Fl:
1/213ath
0
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.
YrBIt. No Land Use
Type
Measure Depth
DWC - Driv-Concret
Y 1 600
AV AV
1984 1 0100-SF Res
215 -Front Ft
80 125
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
h ttp: Hwww. pas I c. org/prc. asp?pi-c I i d=3 )40260906820006 8/2/2010