HomeMy WebLinkAboutMisc Letters Planning&Development Services Department
Building&Code Regulations
f� RM
e _ 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 for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved 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. Your construction must comply with all applicable
laws,ordinances,building codes,and zoning regulations. Initia
I understand that the building official and inspectors are not there to design or give advice on h wt meet
the minimum code. Initial
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. P�
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible and ' bl or the
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and rel ed,�pedical
cost,which could include loss of wages during recovery from their injury. Initia `L---
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 Departrnent tote Florida State Department of Professional Regulation. Signed d acknowledged on this
day of n 12C V. of 20�.
wner/Builder Signature
STATE OF FLOIqDA
COUNTY OF
The foregoing instrument was acknowledged before me this'_L—day of DA8ff 20J_J4_,
by AM17& f, W ;S who is personally known to me,or who has
prodced as identification.
Signature of No 16y Type or Print Name of Not (Seal)
Title:Notary Public Commission Number
SLCPDSD Revised 05/1512014
KAREN S. NIELSEN
_N a
Commission N FF 115637
My Commission Expires
June 12 2018
�y'y ryq' PI:AINL�TGAND DEVELOPMENT SERVICES'DEPARTMENT .-.__.
• Building and Code Regulations Division
` 2300 Virginia Ave
Fort Pierce,FL 34982
772-462-1553
Owner Builder Affidavit—Electrical Contracting
DISCLOSURE STATEMENT
F.S. 489.503 (6) EXEMPTIONS
State law requires electrical contracting to be done by licensed electrical 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
electrical contractor even though you do not have a license.You may install electrical wiring for a farm outbuilding
or a single-family or duplex residence. You may install electrical wiring in a commercial building the aggregate
construction costs of which are under$75,000. The home or building must be for your own use and occupancy. It
may not be built for sale or lease. If you sell or lease more than one building you have wired yourself within 1 year
after the construction is complete,the law will presume that you built it for sale or lease,which is a violation of this
exemption. You may not hire an unlicensed person as your electrical contractor. Your construction shall be done
according to building codes and zoning regulations. 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. Failure to do so may result
in a liability for you!
To qualify for this exemption under this subsection, an owner must personally appear and sign the building
permit application.
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
Community Development Director to the Florida State Department of Professional Regulation. Signed and
acknowledged on this , day of A,?c
OWNER/BUILDER SIGNATURE
STATE OF FLORI A
COUNTY OF !St.
The foregoing instrument was acknowledged before me this�_day of Vniq�,� ,20 i-(Ql
by \f\( j\f- 'Z ,who is personally known(__)to me or
0
has produced FL, as identificati
KAREN S. NIELSEN
AA
(seMrmission#FF 115037
Signature of Notary Print name of Notary ;., Fo,,: My CommissionExpiras
s� June 12, 2018
Title: Notary Public Commission Number
SLCPDSD Revised 4/11/2011
St.Lucie County Owner Builder Affidavit-Electrical Contracting
T.
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1 Universal North Americo EVIDENCE OF PROPERTY INSURANCE
Page 1
Named'Insured, TAMES ENDRESS Agency: GETTY BROWNE INSURANCE GROUP LLC'
uxrCI_CHA,4BERLIN-ENDF;ESS:: 73 S.US;HWY.T:
Mailing Address: 5207 FEATHER CREEK DR VERO BEACH,FLORIDA 32962
FORT PIERCE, FLORIDA 34951-5016 Phone: (772)569-2600
Policy Number: UICD000005S359 Effective: 2/19/2016 Expiration:2/19/2017
;i�ed:;Location: 5500!TN,l)ION,DR
`FORT PIERCE,-FLO-kMA 34951-5016
:�3a#iri�:TiRtbrmai`'ron
Line Of Business Insurance Company
Dwelling Fire(Form: DP-3) Universal Insurance Company of North America
Deductible Information
All.Other,Perils.Deduictible $1 f1t70
Hurricane Deductible $2,860
Coverage Information
Coverage Limit Premium
Coverage A-Dwelling. $143,000 $1,703
aCoverapi ;AI.-.GO&-Stmctures $2;900 ��$X
Coverage'C-"Personal Property $1,000 $lei
Coverage D- Loss Of.Use $14430.0 Included
Corerage`,E.--,Persi'naJ it `abtl y $3 a 4ao0 444
Coverage F- Medical Paymehts $1,000 Included
Y
t
Universal North America' EVIDENCE OF PROPERTY INSURANCE
Named Insured: JAMES ENDRESS Policy Number: UICDO000058359 Page 2
Additional-Coverage Information
;Kumbr on :. Descripttion. Pr�mji4m
UI 208 09/04 Ordinance or Law Coverage Included
UIDPCOVB 02/07 Cov B- Other Structures Decreased Limits Included
UI 203 09/04 Existing Damage Exclusion Included
OIRB1802 01/12 Mitigation Affidavit Included
outmCREDIT 02/1? sIme6ucec
DL 24 11 07/88 Premises Liability Included
?�L 24 f b7/S8 'Hvrn�`D�,y Gan;'ExtYusion IT+iel�d�d:.
UI 205 09/04 CPIC Policy Perils Exclusion Included
UI DO 01/06 Deductible Options Notice Included
OIR167D3 10/06 Checklist of Coverage Included
DL 25 09 09/99 Special Provisions- Florida Included
WINDINIT2 10/t37 Windstorms Prcoteecve Device Ex'r"stirrg<Corrst- ($562).
UI 201 09/15 Coverage Limitation. Included
LFI.DPa Q7/1k Rental Dwelling Policy.Jacket %►eFuded
UIDPCGCC 01/12 Catastrophic Ground Cover Collapse Included
DL 24 01 07/88 Personal Liability Included
UIC0451 05/05 Calendar Year Hurricane Deductible Included
UI GLB 03/15 Notice of Privacy Policy Included
Q1RB1+6'SD xlj2tS30 tPi rrierneloss 14itig4tiGh,Disc6,4.i is Zracludeo
DP.0.0.03 .07/,88 DwElling Property,3 Spiecial Form Included
UI 220 06/10 Additional Policy Conditions-Florida Included
UI 206 09/04 Non-Structural Hail Loss Limitation Included•
UI 204 09/04 Limited Fungi,Wet/Dry Rot or Bacteria Cov Included
HOMEAGE 01/00 Age of Dwelling Discount/Surcharge $292
UI 0109 07/15 Special Provisions Florida Included
1!11 ergeiacy I�f4Mi �C Preporedffims Assist:`TrdstFund,- $z:
2012 Florida Insurance Guaranty Fund Assessment $2
Policy Fees $25
Premium Summary
Totals Premium
Basic Coverage Premium $1,676
Attached.:Br dorsenledts_Premi�rm r($270)
Fees.And-Assessments $29
.,.Sckaeilwle�i 3�r!opetty:�,"rer�9ttm �'
Total Policy Cost $1,435
Additional Interests —71
THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD
THE POLICY.BE TERMINATED,THE COMPANY.WILL GIVE THE;ADDMO.NAL JNT)=REST,.IpENT>FIED ABOVE.WRITTEN.
NOTICE, RNDF WILL SEND 1467667E31V:OF AiNY:CHANGES TOrT-NE-PaLICXrTH�Tf�ifFE�l":7HiAtl"IfVTERESI`,
IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW.
Summary Page I of I'
T INSURANCE
Quum FOIL PROPEM
TM
AGENCY INFORMATION QUOTE stjmmmRY-QQ Total Premium:$1,435
GROUPGETTY Prepared for:
BROWNE INSURANCE Deductibles
LLC
734 3 US HWY 1 JAMES ENDRESS Deductible:$1,000
Hurricane Deductible:$2,860
VERO:BEACH FL 32962 Quote Number:QUDF4142269
(772)569-2600 � Quote Date:2118/2016 3:17 PM Policy Term
Agency Code:80549 Form Code:DP-3 Effective Date:2/19/2016
Expiration Date:2/1912017
APPUCANT INFORMKFION COVERAGE INFORMA'1'10N
JAMES ENDRESS Coverage and Limits Limit Premium
5500 Shannon DR Dwelling Limit $143.000 $1,703
Fort Pierce,FL 34951-5016 Other Structures $2,900 $_81
LOCATION INFORPINFION Personal Property $1,000 $14
Fair Rental Value $14;300 INCL
5500 Shannon,DR
Fort Pierce,FL 34951-5016 Surcharges/Credits
POLICY INFORMATION Age of dwelling credittsurcharge $2.92.
Customer Matrix Adjustment
County
562:Saint Lucie Wind mitigation credit(WINDMIT2) $-562
Territor
Construction Type:Frame
Public Protection Class Code:03 Additional Coverages
Year Built,1987 Limited Fungi.Wet or Dry Rot.or Bacteria Coverage(UI 204) $10;000 Each INCL
PLEASE-READ $20,000
Aggregate
The quoted premium estimate is based L-Pren-dises Liability Limit $300.000 $40
on limited information provided by you M-Medical Payments to Others $1,000 -
concerning yourproperty and desired
coverage.The. _final_premium quotation Assess merits/Fees
amount will'be higher or lower 2612 FIGA Fee $2
depending upon results of a complete Policy Fee . $25
underwriting'revlaw. Emergency-Management Preparedness and Assistance Trust $2
THIS IS NOT A POLICY Fund
This quote does not guarantee
coverage and is subject to all conditions Total Premium $1,435
of the policy it represents.This quote is
valid for 21 days after issuance.
PAYMENT PLANS
Payment Option Down Payment #of Installments Installment Amount
TM Full Pay $1,435.00
Universal Insurance Company 2'Pay $717.50 1 $722.50
of North America 4 Pay $674.00 3 $292.00
P.O.Box 50907 8 Pay $358.75 7 $158.55
Sarasota,FL 34232 'A service fee of$5.00 will be added to all installments after deposit.
www.universalhortharnerig:�.com
https://w%vw.ulhna.coi-n/QuickQuote/1-itmIToPDF?ViewToLoad=Summary-PDr,&PDTActi... 2/18/2016