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HomeMy WebLinkAboutWALKER ACOE_ DEPARTMENT OF THE ARMY JACKSONVILLE DISTRICT CORPS OF ENGINEERS /_ :; '• 4400 PGA BOULEVARD, SUITE 500 PALM BEACH GARDENS, FLORIDA 33410 July 23, 2020 REPLY TO ATTENTION OF Regulatory Division Palm Beach Gardens Section SAJ-2020-02308(GP-RHF) Gerald Walker 138 Parliament Court Fort Pierce, FL 34949 Dear Mr. Walker: The U.S. Army Corps of Engineers (Corps) assigned your application for a Department of the Army permit, which the Corps received on June 14, 2020, the file number SAJ-2020-02308(GP-RHF). The proposed work consists of removal and replacement of an existing 50 foot by 7 foot dock. The activities subject to this permit are authorized pursuant to authorities under Section 10 of the Rivers and Harbors Act of 1899 (33 U.S.C. § 403). This project is located within waters of the US associated with a residential canal adjacent to 138 Parliament Court, Section 14, Township 34 South, Range 40 East, Fort Pierce, St. Lucie County, Florida. Your project, as depicted on the enclosed drawings, is authorized by Regional General Permit (GP) SAJ-20. This authorization is valid until March 27, 2023. Please access the Corps' Jacksonville District Regulatory Division Internet page to view the special and general conditions for SAJ-20, which apply specifically to this authorization. The Internet URL address is: http://www.saj.usace.army.mil/Missions/Regulatory.aspx Please be aware this Internet address is case sensitive; and, you will need to enter it exactly as it appears above. Once there you will need to click on "Source Book",- and, ook";and, then click on "General Permits". Then you will need to click on the specific SAJ permit noted above. You must comply with all of the special and general conditions of the permit; and, any project -specific conditions noted below, or you may be subject to enforcement action. The following project -specific conditions are included with this authorization: 1. Reporting Address: The Permittee shall submit all reports, notifications, documentation and correspondence required by the general and special conditions of this permit to either (not both) of the following addresses: a. For electronic mail (preferred): SAJ-RD- Enforcement@usace.army.mil (not to exceed 15 MB). -2- b. For standard mail: U.S. Army Corps of Engineers, Regulatory Division, Enforcement Section, P.O. Box 4970, Jacksonville, FL 32232-0019. The Permittee shall reference this permit number, SAJ-2020-02308 (GP-RHF), on all submittals. 2. Self -Certification: Within 60 days of completion of the work authorized by this permit, the Permittee shall complete the attached "Self -Certification Statement of Compliance" form (Attached) and submit it to the Corps. In the event that the completed work deviates in any manner from the authorized work, the Permittee shall describe the deviations between the work authorized by this permit and the work as constructed on the "Self - Certification Statement of Compliance" form. The description of any deviations on the "Self -Certification Statement of Compliance" form does not constitute approval of any deviations by the Corps. 3. Cultural Resources/Historic Properties: a. No structure or work shall adversely affect impact or disturb properties listed in the National Register of Historic Places (NRNP) or those eligible for inclusion in the NRHP. b. If during the ground disturbing activities and construction work within the permit area, there are archaeological/cultural materials encountered which were not the subject of a previous cultural resources assessment survey (and which shall include, but not be limited to: pottery, modified shell, flora, fauna, human remains, ceramics, stone tools or metal implements, dugout canoes, evidence of structures or any other physical remains that could be associated with Native American cultures or early colonial or American settlement), the Permittee shall immediately stop all work and ground -disturbing activities within a 100 -meter diameter of the discovery and notify the Corps within the same business day (8 hours). The Corps shall then notify the Florida State Historic Preservation Officer (SHPO) and the appropriate Tribal Historic Preservation Officer(s) (THPO(s)) to assess the significance of the discovery and devise appropriate actions. c. Additional cultural resources assessments may be required of the permit area in the case of unanticipated discoveries as referenced in accordance with the above Special Condition ; and if deemed necessary by the SHPO, THPO(s), or Corps, in accordance with 36 -3 - CFR 800 or 33 CFR 325, Appendix C (5). Based, on the circumstances of the discovery, equity to all parties, and considerations of the public interest, the Corps may modify, suspend or revoke the permit in accordance with 33 CFR Part 325.7. Such activity shall not resume on non-federal lands without written authorization from the SHPO for finds under his or her jurisdiction, and from the Corps. d. In the unlikely event that unmarked human remains are identified on non-federal lands, they will be treated in accordance with Section 872.05 Florida Statutes. All work and ground disturbing activities within a 100 -meter diameter of the unmarked human remains shall immediately cease and the Permittee shall immediately notify the medical examiner, Corps, and State Archaeologist within the same business day (8 -hours). The Corps shall then notify the appropriate SHPO and THPO(s). Based, on the circumstances of the discovery, equity to all parties, and considerations of the public interest, the Corps may modify, suspend or revoke the permit in accordance with 33 CFR Part 325.7. Such activity shall not resume without written authorization from the State Archaeologist and from the Corps. 4. Project Design Criteria (PDCs) for In -Water Activities: The Permittee shall comply with National Marine Fisheries Service's "PDCs for In -Water Activities" dated November 20, 2017 (Attached). 5. PDCs for In -Water Noise from Pile and Sheet Pile Installation The maximum number of piles installed per day is limited to no more than 10 piles per day. 6. Daylight Hours: All activities must be completed during daylight hours. 7. Construction Location: Project construction shall take place from uplands or from floating equipment (e.g., barge); prop or wheel -washing is prohibited. 8. Manatee Conditions: The Permittee shall comply with the enclosed (Attached) "Standard Manatee Conditions for In -Water Work — 2011. 9. Assurance of Navigation and Maintenance: The Permittee understands and agrees that, if future operations by the United States require the removal, relocation, or other alteration, of the structures or -4 - work herein authorized, or if, in the opinion of the Secretary of the Army or his authorized representative, said structure or work shall cause unreasonable obstruction to the free navigation of the navigable waters, the Permittee will be required, upon due notice from the U.S. Army Corps of Engineers, to remove, relocate, or alter the structural work or obstructions caused thereby, without expense to the United States. No claim shall be made against the United States on account of any such removal or alteration. 10. North Atlantic Right Whale: The attachment describes the presence of North Atlantic right whales in the area and the Federal regulations governing the approach to North Atlantic right whales. 11. Commencement Notification: Within 10 days from the date of initiating the work authorized by this permit the Permittee shall submit a completed "Commencement Notification" Form (Attached). This authorization does not obviate the necessity to obtain any other Federal, State, or local permits, which may be required. Prior to the initiation of any construction, projects qualifying for this NWP/RGP permit must qualify for an exemption under section 403.813(1), F.S. or 373.406, F.S., or otherwise be authorized by the applicable permit required under Part IV of Chapter 373, F.S., by the Department of Environmental Protection, a water management district under section 373.069, F.S., or a local government with delegated authority under section 373.441, F.S., and receive Water Quality Certification (WQC) and applicable Coastal Zone Consistency Concurrence (CZCC) or waiver thereto, as well as any authorizations required for the use of state-owned submerged lands under Chapter 253, F.S., and, as applicable, Chapter 258, F.S. You should check State -permitting requirements with the Florida Department of Environmental Protection or the appropriate water management district. This authorization does not include conditions that would prevent the `take' of a state -listed fish or wildlife species. These species are protected under sec. 379.411, Florida Statutes, and listed under Rule 68A-27, Florida Administrative Code. With regard to fish and wildlife species designated as species of special concern or threatened by the State of Florida, you are responsible for coordinating directly with the Florida Fish and Wildlife Conservation Commission (FWC). You can visit the FWC license and permitting webpage (http://www.myfwc.com/license/wildlife/) for more information, including a list of those fish and wildlife species designated as species of special concern or threatened. The Florida Natural Areas Inventory (http://www.fnai.org/) also maintains updated lists, by county, of documented -5 - occurrences of those species. This letter of authorization does not give absolute Federal authority to perform the work as specified on your application. The proposed work may be subject to local building restrictions mandated by the National Flood Insurance Program. You should contact your local office that issues building permits to determine if your site is located in a flood -prone area, and if you must comply with the local building requirements mandated by the National Flood Insurance Program. If you are unable to access the internet or require a hardcopy of any of the conditions, limitations, or expiration date for the above referenced RGP, please contact Trey Fraley by telephone at 561-472-3526. Thank you for your cooperation with our permit program. The Corps Jacksonville District Regulatory Division is committed to improving service to our customers. We strive to perform our duty in a friendly and timely manner while working to preserve our environment. We invite you to complete our automated Customer Service Survey at http://corpsmapu.usace.army.mil/cm_apex/f?p=regulatory_survey. Please be aware this Internet address is case sensitive; and, you will need to enter it exactly as it appears above. Your input is appreciated — favorable or otherwise. 44.oa� Sincerely, Trey Fraley Project Manager Enclosures Attachment A: Drawings Attachment B: Self -Certification Attachment C: JaxBO PDC's for In -water Activities Attachment D: Standard Manatee Conditions for In -Water Work — 2011 Attachment E: North Atlantic Right Whale Pamphlet -2 - Attachment F: Commencement Notification Form Copies Furnished: Agent: Shane Ostrander, Benchmark Engineering of Treasure Coast LLC GENERAL CONDITIONS 33 CFR PART 320-330 1. The time limit for completing the work authorized ends on March 27 2023. 2. You must maintain the activity authorized by this permit in good condition and in conformance with the terms and conditions of this permit. You are not relieved of this requirement if you abandon the permitted activity, although you may make a good faith transfer to a third party in compliance with General Condition 4 below. Should you wish to cease to maintain the authorized activity or should you desire to abandon it without a good faith transfer, you must obtain a modification of this permit from this office, which may require restoration of the area. 3. If you discover any previously unknown historic or archeological remains while accomplishing the activity authorized by this permit, you must immediately notify this office of what you have found. We will initiate the Federal and state coordination required to determine if the remains warrant a recovery effort of if the site is eligible for listing in the National Register of Historic Places. 4. If you sell the property associated with this permit you must obtain the signature of the new owner in the space provided and forward a copy of the permit to this office to validate the transfer of this authorization. 5. If a conditioned water quality certification has been issued for your project, you must comply with the conditions specified in the certification as special conditions to this permit. For your convenience, a copy of the certification is attached if it contains such conditions. 6. You must allow a representative from this office to inspect the authorized activity at any time deemed necessary to ensure that it is being or has been accomplished in accordance with the terms and conditions of your permit. -3 - DEPARTMENT OF THE ARMY PERMIT TRANSFER REQUEST PERMIT NUMBER: SAJ-2020-02308 GP-RHF When the structures or work authorized by this permit are still in existence at the time the property is transferred, the terms and conditions of this permit will continue to be binding on the new owner(s) of the property. Although the construction period for works authorized by Department of the Army permits is finite, the permit itself, with its limitations. does not expire. To validate the transfer of this permit and the associated responsibilities associated with compliance with its terms and conditions, have the transferee sign and date below and mail to the U.S. Army Corps of Engineers, Enforcement Section, Post Office Box 4970, Jacksonville, FL 32232-0019. (TRANSFEREE -SIGNATURE) (DATE) (NAME -PRINTED) (MAILING ADDRESS) (CITY, STA, ZIP CODE) (SUBDIVISION) (LOT) (BLOCK) (STREET ADDRESS) M Ml Ukewwd Park exa N.1 frewsuroCoaw m bteallwel a Airpon.oiid K Cis 138 Par] Owdoill Hutchinson F Benchmark Engineering Walker of the Treasure Coast LLC Nwdoin 6, Hutchinson F.F. Aquatic Structures Division 138 Parliament Court 8o6 Delaware Ave. Fort Pierce, FL 34A Hutchinson Island, FL 950 L PRap,-wr L/NE O 24'j- 1 =20' EXISTING I — 350 S.F. DOCK 138 PARLIAMENT CT QUEENS COVE — UNIT ONE a BLOCK 17 — LOT L-- 1414-701-0167-000-4 W! fI _— a PRMERTY LINE I I Q Ii h� Benchmark Engineering of the Treasure Coast LLC Aquatic Structures Division 8o6 Delaware Ave. Fort Pierce, FL 3495o i 100' WIDE MANMADE BOAT CHANNEL Walker 138 Parliament Court Hutchinson Island, FL Powdoin G. Hutchinson F.�. FI # 70878 (__D 30 ,y V PROPOSED 350 SF. DOCK ~ REPLACEMENT 138 PARLIAMENT CT QUEENS COIF - UNIT ONE P Q BLOCK 17 -LOT L 1414-701-0167-000-4 jS I 100' µ10E MANMADE Canal Calculations BOAT CHANNEL Boat channel width= 100 LF 25% of canal = 25 LF Dock width extends=7 LF Total =7 LF into Boat channel Benchmark Engineering Walker of the Treasure Coast LLC 13owcloin G, Hutchinson FE. i38 Parliament Court Aquatic Structures Division ��# 7Q878 8o6 Delaware Ave. Fort Pierce, FL 34950 Hutchinson Island, FL DOCK SECTION VIEW DOCK PLAN VIEW VARIES ALL BOLTS 5/e" HD. GAL VAN/ZED OR STA/NLESS S7EEL I' X 6" SYP DECK/NG W/ J" PLANK, FASTENED — _ 2.5 SS SCREWS 2 PER SMINGERW/470 Ci -- o 1--- T 2" X 8" P. T. SYP, 0.40 ACO y -j Ln 72EA750 57RINGER.S BUTT JOINED & STAGGERED 2" X 8" P. T. SYP, — — ! 0.40 ACO 7REATED BENTS M/N. B" D/A 2.5 STRINGERS 24' '�TY CCA TREATED PILES O.C. MAX CENTER STRINGERS TOE NAILED W17H S.S. RING SHANK NAILS, OUTSIDE SMINGERS FACED NAILED DECK DETAILS r~ Benchmark Engineering Walker of the Treasure Coast LLC 13owdoin G, Hutchinson p,�, i38 Parliament Court Aquatic Structures Division ��# 7Q�`j%8 806 Delaware Ave. Fort Pierce, FL 34950 Hutchinson Island, FL SELF -CERTIFICATION STATEMENT OF COMPLIANCE Within sixty (60) days of completion of the authorized work, submit this form via electronic mail to sai-rd-enforcement(c�usace.army.mil (preferred, not to exceed 15MB) or by standard mail to U.S. Army Corps of Engineers, Enforcement Section, P.O. Box 4970, Jacksonville, FL 32232-0019. 1. Department of the Army Permit Number: SAJ- 2. Permittee Information: Name: Email: Address: Phone: 3. Date Authorized Work Started: Completed: 4. Contact to Schedule Inspection: Name: Email: Phone: 5. Description of Authorized Work (e.g. bank stabilization, fill placed within wetlands, docks, dredging, etc.): 6. Acreage or Square Feet of Impacts to Waters of the United States: 7. Describe Mitigation completed (if applicable): 8. Describe any Deviations from Permit (attach drawing(s) depicting the deviations): I certify that all work and mitigation (if applicable) was done in accordance with the limitations and conditions as described in the permit. Any deviations as described above are depicted on the attached drawing(s). Signature of Permittee Printed Name of Permittee Date Dated 9/18/2019 U.S. Army Corps of Engineers Jacksonville District's Programmatic Biological Opinion (JaxBO) Project Design Criteria (PDCs) for In -Water Activities November 20, 2017 1) (AP.7.) Education and Observation: The permittee must ensure that all personnel associated with the project are instructed about the potential presence of species protected under the ESA and the Marine Mammal Protection Act (MMPA). All on-site project personnel are responsible for observing water -related activities for the presence of protected species. All personnel shall be advised that there are civil and criminal penalties for harming, harassing, or killing ESA -listed species or marine mammals. To determine which species may be found in the project area, please review the relevant Protected Species List at: http://sero.nmfs.noaa.gov/protected resources/section 7/threatened endanaerediin dex.html 2) (AP.8.) Reporting of interactions with protected species: a) Any collision(s) with and/or injury to any sea turtle, sawfish, whale, or sturgeon occurring during the construction of a project, shall be reported immediately to NMFS's Protected Resources Division (PRD) at (1-727-824-5312) or by email to takereport.nmfsser@noaa.gov and SAJ-RD-Enforcement@usace.army.mil. b) Smalltooth sawfish: Report sightings to 1 -844 -SAWFISH or email Sawfish@MyFWC.com c) Sturgeon: Report dead sturgeon to 1-844-STURG 911 (1-844-788-7491) or email nmfs.ser.sturgeonnetwork@noaa.gov d) Sea turtles and marine mammals: Report stranded, injured, or dead animals to 1- 877 -WHALE HELP (1-877-942-5343). e) North Atlantic right whale: Report injured, dead, or entangled right whales to the USCG via VHF Channel 16. 3) (AP.9.) Vessel Traffic and Construction Equipment: All vessel operators must watch for and avoid collision with species protected under the ESA and MMPA. Vessel operators must avoid potential interactions with protected species and operate in accordance with the following protective measures: a) Construction Equipment: i) All vessels associated with the construction project shall operate at "Idle Speed/No Wake" at all times while operating in water depths where the draft of the vessel provides less than a 4 -foot (ft) clearance from the bottom, and in all depths after a protected species has been observed in and has departed the area. ii) All vessels will follow marked channels and/or routes using the maximum water depth whenever possible. iii) Operation of any mechanical construction equipment, including vessels, shall cease immediately if a listed species is observed within a 50 -ft radius of construction equipment and shall not resume until the species has departed the area of its own volition. iv) If the detection of species is not possible during certain weather conditions (e.g., fog, rain, wind), then in -water operations will cease until weather conditions improve and detection is again feasible. b) All Vessels: i) Sea turtles: Maintain a minimum distance of 150 ft. ii) North Atlantic right whale: Maintain a minimum 1,500 -ft distance (500 yards). iii) Vessels 65 ft in length or longer must comply with the Right Whale Ship Strike Reduction Rule (50 CFR 224.105) which includes reducing speeds to 10 knots or less in Seasonal Management Areas (htto://www.fisheries.noaa.gov/pr/shipstrike/). iv) Mariners shall check various communication media for general information regarding avoiding ship strikes and specific information regarding right whale sightings in the area. These include NOAA weather radio, USCG NAVTEX broadcasts. and Notices to Mariners. v) Marine mammals (i.e., dolphins, whales [other than North Atlantic right whales], and porpoises): Maintain a minimum distance of 300 ft. vi) When these animals are sighted while the vessel is underway (e.g., bow - riding), attempt to remain parallel to the animal's course. Avoid excessive speed or abrupt changes in direction until they have left the area. vii) Reduce speed to 10 knots or less when mother/calf pairs or groups of marine mammals are observed, when safety permits. 4) (AP.10.) Turbidity Control Measures during Construction: Turbidity must be monitored and controlled. Prior to initiating any of the work covered under this Opinion, the Permittee shall install turbidity curtains as described below. In some instances, the use of turbidity curtains may be waived by the USACE project manager if the project is deemed too minimal to generate turbidity (e.g., certain ATON installation, scientific survey device placement, marine debris removal) or if the current is too strong for the curtains to stay in place. Turbidity curtains specifications: a) Install floating turbidity barriers with weighted skirts that extend to within 1 ft of the bottom around all work areas that are in, or adjacent to, surface waters. b) Use these turbidity barriers throughout construction to control erosion and siltation and ensure that turbidity levels within the project area do not exceed background conditions. c) Position turbidity barriers in a way that does not block species' entry to or exit from designated critical habitat. d) Monitor and maintain turbidity barriers in place until the authorized work has been completed and the water quality in the project area has returned to background conditions. e) In the range of ESA -listed corals (St. Lucie Inlet, Martin County south to the Dry Tortugas and the U.S. Caribbean) and Johnson's seagrass (Turkey Creek/Palm Bay south to central Biscayne Bay in the lagoon systems on the east coast of Florida): i) Projects that include upland earth moving (e.g., grading to install a building or parking lot associated with a dock and seawall project), must install sediment control barriers to prevent any upland sediments from reaching estuarine or marine waters. ii) The turbidity curtain requirement cannot be waived for any project that moves or removes sediment (e.g., dredging, auger to create a pile, trenching to install a cableline). If turbidity curtains are not feasible in an area based on site conditions such as water current, high wave action, or stormy conditions, the project must undergo individual Section 7 consultation and is not covered under this Programmatic Opinion. 5) (APA 1.) Entanglement: All turbidity curtains and other in -water equipment must be properly secured with materials that reduce the risk of entanglement of marine species (described below). Turbidity curtains likewise must be made of materials that reduce the risk of entanglement of marine species. a) In -water lines (rope, chain, and cable, including the lines to secure turbidity curtains) must be stiff, taut, and non -looping. Examples of such lines are heavy metal chains or heavy cables that do not readily loop and tangle. Flexible in - water lines, such as nylon rope or any lines that could loop or tangle, must be enclosed in a plastic or rubber sleeve/tube to add rigidity and prevent the line from looping and tangling. In all instances, no excess line is allowed in the water. b) Turbidity curtains and other in -water equipment must be placed in a manner that does not entrap species within the construction area or block access for them to navigate around the construction area. STANDARD MANATEE CONDITIONS FOR IN -WATER WORK 2011 The permittee shall comply with the following conditions intended to protect manatees from direct project effects: a. All personnel associated with the project shall be instructed about the presence of manatees and manatee speed zones, and the need to avoid collisions with and injury to manatees. The permittee shall advise all construction personnel that there are civil and criminal penalties for harming, harassing, or killing manatees which are protected under the Marine Mammal Protection Act, the Endangered Species Act, and the Florida Manatee Sanctuary Act. b. All vessels associated with the construction project shall operate at "Idle Speed/No Wake" at all times while in the immediate area and while in water where the draft of the vessel provides less than a four -foot clearance from the bottom. All vessels will follow routes of deep water whenever possible. C. Siltation or turbidity barriers shall be made of material in which manatees cannot become entangled, shall be properly secured, and shall be regularly monitored to avoid manatee entanglement or entrapment. Barriers must not impede manatee movement. d. All on-site project personnel are responsible for observing water -related activities for the presence of manatee(s). All in -water operations, including vessels, must be shutdown if a manatee(s) comes within 50 feet of the operation. Activities will not resume until the manatee(s) has moved beyond the 50 -foot radius of the project operation, or until 30 minutes elapses if the manatee(s) has not reappeared within 50 feet of the operation. Animals must not be herded away or harassed into leaving. e. Any collision with or injury to a manatee shall be reported immediately to the Florida Fish and Wildlife Conservation Commission (FWC) Hotline at 1-888-404-3922. Collision and/or injury should also be reported to the U.S. Fish and Wildlife Service in Jacksonville (1-904-731-3336) for north Florida or Vero Beach (1-772-562-3909) for south Florida, and to FWC at ImperiledSpecies@myFWC.com Temporary signs concerning manatees shall be posted prior to and during all in -water project activities. All signs are to be removed by the permittee upon completion of the project. Temporary signs that have already been approved for this use by the FWC must be used. One sign which reads Caution: Boaters must be posted. A second sign measuring at least 8'/2" by 11" explaining the requirements for "Idle Speed/No Wake" and the shut down of in -water operations must be posted in a location prominently visible to all personnel engaged in water -related activities. These signs can be viewed at MyFWC.com/manatee. Questions concerning these signs can be sent to the email address listed above. CAUTION: MANATEE HABITAT All project vessels IDLE SPEED/ NO WAKE When a manatee is within 50 feet of work all in -water activities must SHUT DOWN Report any collision with or injury to a manatee: Wildlife Alert: 1-888-404-FWCC(3922) North Atlantic Right Whale Information Form Federal Regulations Governing the Approach to North Atlantic Right Whales 1. Federal regulations governing the approach to North Atlantic right whales can be found at 50 CFR 224.103(c). It is illegal to approach and remain within 500 yards of right whales; 500 yards is equal to the distance of 5 football fields. Prohibitions on approaching right whales are as follows (Excerpts from 50 CFR 224.103(c), available at Unless otherwise lawfully allowed or unless doing so would create an imminent and serious threat to a person or vessel, it is unlawful to: (i) Approach (including by interception) within 500 yards (460 m) of a right whale by vessel (ii) Fail to undertake required right whale avoidance ° , ' t '`•, $00 yards a .4. measures. If underway, a vessel must steer a course away from the right whale and immediately leave the area at a slow safe speed. 2. Updates can be downloaded from: a. httn://www.nmfs.noaa.-,ov/pr/species/mammals/cetaceans/ri�)htwhale northatlantic.htm, or b. www.ecfhgov COMMENCEMENT NOTIFICATION Within ten (10) days of initiating the authorized work, submit this form via electronic mail to saj-rd-enforcement@usace.army. mil (preferred, not to exceed 15 MB) or by standard mail to U.S. Army Corps of Engineers, Enforcement Section, P. O. Box 4970, Jacksonville, FL 32232-0019. 1. Department of the Army Permit Number: SAJ- 2. Permittee Information: Name: Email: Address: Phone: 3. Construction Start Date: 4. Contact to Schedule Inspection: Name: Email: Phone: Signature of Permittee Printed Name of Permittee Date Dated 9/18/2019