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INSULATION CERTIFICATION
II
I, ~~/'I. Su\~f\e~ ' HEREBY CERTIFY THAT ATTIC INSULATION (Loose Fill
(Individu~l Qua ¡tier)
or Blown-in) OF R-~ IS COMPLETELY INSTALLED OVER THE ENTIRE SURFACE AREA AS
SPECIFIED ON THE ENERGY CODE CALCULATIONS AND/OR INSULATION 'PERMIT
APPLICATION FOR THE RESIDENCE/STRUCTURE LOCATED AT:
A \ h"1 $.,)"../ ~M~5
Legal Description
/07 £a~ St.
Street Aldress
RECEIVED
JUN 0 7 2007
PUblic \tV
St. LOCie Orks
County, 1=,-
S L c... ð 1CJ 1- 0 S-J6
Permit Number
Check Permit Number Type Liste .
Building Permit
f\(
Insulation PerlDit
, - 7-ð 7
Date
STATE OF FLORID·A, COUNTY OF INDIAN RIVER 1"-
was acknowledged before me this ~ day of (J un ¿
who is personally known to me ·or who
and who did/did not take an oath.
, 20 O?by
has produced
(Type of Identification)
F: \Community Deve lopment\Users\BLDADM IN\APPU
St. Lucie County
Building & Zoning Department
2300 Virginia A venue
Fort Pierce, FL 34982
772-462-2165
Fax 772-462-6443
'.~ f=' J \lI~" D
JUN 0 7 2007
Public Works
St. Lucie County, FL
Request for 30-Day Temporary Power Release I "
Permit Number: 010 -() S'Zh
Date:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE -it:!
ABOVE DESCRIBED PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FO£.n
THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENT IN PREPARATION FOR FINAL ;:=-_.:t
INSPECTION. IN CONSIDERATION OF APPROVAL OF THE REQUEST WE HEREBY f"-Ü;'''~
ACKNOWLEDGE AND AGREE AS FOLLOWS: ~
1. This temporary power release is requested for the above stated purpose only,
and there will be no occupancy of any type, other than that permitted by construction
during this time period.
2. As witness by our signatures, we hereby agree to abide by all terms and conditions
of this agreement, including Building Division Policy, which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled
"Requirements for 30 Day Power for Testing" have been fulfilled and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be made in writing to the Building Official stating the reason
for the request. Power may be removed from the site and/or a Stop Work Order issued if the Final Inspection
has not been approved within 30 days. A fee of $100.00 will be required to lift the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND
THEIR EMPLOYEES FROM ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE
WHICH MAY ARISE NOW OR IN THE FUTURE OUT OF THIS TRANSACTION, INCLUDING
ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE DISCONNECTION OF
ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
"PnW0
ONTRACTOR SIGNATURE
Jcs
DATE