HomeMy WebLinkAboutBuilding Permit Application (2) r
Planning&Development Services Department
COUNTY Building&Code Regulations
2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
OWNERBUILDER 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. Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet
the minimum code. Initial_-Q v�
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 411
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 liable for
the
cost of the license. Initial /.S /_
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 related medical
cost,which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the 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
lo day of e_-C_. of 20�.
OwnerBuilder Signature
STATE OF FLORIDA (�
COUNTY OF J `tTC j✓ �-
The foregoing instrument was acknowledgedbefore me this �i day of 1��'C: ,20,/ °>
by who is personally known to me,or who has
produced { as identification.
pkSignature otNft#y T or Print Name of Not (Seal)
Title:No u lic fission Number
SLCPDSD Revised 05/152014 -
'`I AUDREY B.HUMPHREY
MY COMMISSION#FF 174712
I EXPIRES:March 6.2019
p1 Fd Bonded Thru Notary Public Underwriters
x
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
• I Permit Number: �°�-� V o7
l V�
Date: L, � y
RE'S ,
" J.L
- - E
Permit Application DEC 16 201
- K Building Perm pp
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR:
:.PRO Q . QVEMN� LO.�
_ P
Address:
Legal Description:
( n.,-(or h�n e�1 Lot No.—
/� it+-1
Property Tax ID#: r.Lrl ' l t71� �� y — 0
Block No. ...L
Site Plan Name:
Project Name: ma
Setbacks Front Back: Right Side: Left Side:
hFTAII-FDELI—
E,SC IPTION OF UVOEt
` i I
G �l
CONSTRUCAddTI
itiona wor to e per orme under this permit—check all tat appy:
Gas Piping_Mechanical _Gas Tank — p g —Shutters Windows/Doors— I
_Electric Plumbing —Sprinklers —Generator _Roof Pitch
/c� Pitch
S Ft. of First Floor:
Total Sq. Ft of Construction: i i I q'
�.
Cost of Construction: $ ?E`C C , 00 Utilities: _Sewer —Septic Building Height:
� , t,�,•q,� �e�eav ,W2�r1Y
Namer
Address: Op
City: r'� 1�I P�� Q. 'Iqptlr: esus"
� � City: State:
Zip Code: - Fax: �� -
-���_ � Zip Code: Fax:
Phone No.`-n — 0$�
Phone No
E-Mail:1�� 1� -
Fill in fee simple Title Holder on next page if different E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.