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Home My WebLink AboutTermite Cert =RECEIVEDPlanning & Development ServicesBuilding & Code Regulation Division2300 Virginia AveFort Pierce, FL 34982 772-462-2172 Fax 772-462-6443 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT PERMIT #: JOB ADDRESS: C i r^ lei BUILDER/CONTRACTOR: 3 PEST CONTROL CONTRACTOR: 'e ov Se c-v i c -es PEST CONTROL LICENSE #: We, the undersigned, hereby certify that we have pretreated the above described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet if area treated: Chemicals used: 1-e &1 �� d � Percentage of solution: y Total gallons used: Date of Treatment: � 3� �a� Time of Treatment: �^ 3 t Footing Slab 1st Treatment 1st Treatment Re-Treat Re-Treat Driveway Pools 1st Treatment 1st Treatment Re-Treat 1 Re-Treat Other 6 V 4 D v Perimeter for Final Inspection 1st Treatment l Re-Treat Signature of Exterm' ator Date Note: There must be a completed form for each required treatment or re-treatment and this form must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re-inspection fee charged. FBC 104.2.6 Certificate of Protective Treatment for prevention of termites. A weather resistant jobsite posting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed, providing a copy for the person the permit is issued to and another copy for the building permit files The Treatment Certificate shall provide the product used, identity of the applicator, time and date of the treatment, site location, area treated, chemical used, percent concentration and number of gallons used, to establish a verifiable record of protective treatment. If the soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on the electrical panel box cover, listing all the treatments and dates of applications. 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C m � /NWOl63; ■ ■ ■NiC ■ iCCH■i i!!■i .!i■ ■■WO■.. aM ■"��CC� i i ■a!i!■■'�■iil.■C. C■f.■ ■ ■.. .I C■WOaua� ■i■1■ u.uCa i■aa■■■ ■■a -.r .a..■. .a. ..i■■�r a.i.■ ..fe ' NCWOii.: i■ii�mN� : ■CC■HCNW Con. a■i■■: iii ■ ■■ ■aaMi� WO■� H■H ■ ■al/■ ;� son ■ ■■aaili■a ! ' MONO ■■■iill��i � ■ H �:;'L:■..Ci.... l/p ,■■fir ■ . .... Ci:CNiC� C■■aC' i 'd 7:C.� Mi:iCi■0�� ■ ■■C�R � :'� ■■�■i■NMM ■WONM �■u ■a■■ii1C"��.rf.■ar■e IMEM uWO■■iaOME ME ME N►� ■i■a■rll �. fi��i[ ■a a�r■faiuC■■�!!. ■ ■■+ u�al �.r :aa■■Ci+u■mIr`r M11= was ■.�.■..�.. .ice■.. .■.B.�.iN. ■■.. 100110110 MONO ]ROOM �!■■■i■■H■i�■ii ■llNi ■ate■u. H■■■■ate■H ■i iH■ 5M�MN��C■C�Ce�..i' mono CWCC� �iuC Ci�i■CCC�■ 1itq rir BEERI� Oman MONO on i■■■/:s i i�OEM "■ CC■�': CCCgCC�CCC�iC:••�■•• ■ iCC� .■Ni■■■ ■ ■■aNf WOMEN ■■. i■■® BNOM■�iCCC ` CHCC! C CC �I'CC ! ia■i �iNnl.i ■ H NN�ri■■.r■I�i �■i8ai ■ ■■WOit.■Npl�mmumm■■ii�■a■H ■i■ii■■a■ ■ia■■ ■M■.a■iH ■■■Mil _ ■■■■l.i� mom !i■ IUMN�..!<M� ��i� WO�CC■i.��■. 1� ■ACC■Ni.�.�?1� ■at ili �qY� iNf■;Cn CiHiCC�WOH � ii ■awCiiw� aa■.C�■Mwei ■N■N.�" ipC 1ICC■� SEE@PECIF�ICAT10e NS` F®R TREATMENT ARE KEYE�DD�TMO�RAVv G i ■� ■i P� R `ES OUnTF_D IiEREIN C COO D FOR �l Oman an v it WIPEOUTSERVICES,uc.. SERVICE AGREEMENT 4001 VIRGINIA AVENUE,SUITE A Effective date:(date of treatment): 09/30/2020 FORT PIERCE,FLORIDA 34981-5577 St.Lucie:772-429-7716 Martin:772-287-8486 Indian River:772-567-7392 North Palm Beach: 561-746-7364 All others:888-568-6888 Covered Premises: See graph for localized treatment Billing information: (if different from the Covered Premises) Name Lombardo,John Name Address 1544 NW Buttonbush Cir Address city Palm City FL City State 34990 Phone 305-795-5595 Zip code Zip code: Phone: This agreement only applies to the Covered Premises;it cannot be transferred to any other address. Treatment: This Agreement applies to Covered Premises specified above for the treatment of the following Organism(s): [] Drywood Termites [] Bedbugs [] Preventive(no visual evidence) [] Presumptive/Existing (affected wood/live activity) [X] Subterranean Termites [] Rodent Trapping [] Fumigation [ ] Powder Post Beetles [X] Other Spot treat only [X] "NO-TENT"Treatment-See Graph Coverage: [XI One Year or[] Other: beginning on the effective date above. WIPEOUT SERVICES, LLC agrees to provide necessary service and treatment for control of the organism identified in the treatment section for the Covered Premises. WIPEOUT SERVICES ,LLC. assumes no responsibility,financial or otherwise for the correction,repair or replacement of any part or portion of the structures showing signs of damage caused by such insects/organisms before or after treatment. WIPEOUT SERVICES,LLC. Liability is for retreatment only. Cost: The cost of the treatment is$ 125.00 payable in cash, check or credit card accepted by WIPEOUT SERVICES, LLC. WIPEOUT SERVICES,I.I.C. responsibility is while this agreement is in effect it will perform any additional treatments it finds necessary at no additional cost. Term: The term of this agreement is for the period of time noted above under Coverage. This Agreement may be extended by the Customer on an annual basis. Renewal for any additional one year period is contingent upon; (1) satisfactory re-inspection of the Covered Premises by WIPEOUT SERVICES,I.I.C.and(II)payment of the annual renewal fee. Renewal:[] Applicable [X] Not Applicable Month/Year: Amount $ Month/Year: Amount $ Month/Year: Amount S WIPEOUT SERVICES,LLC. reserves the right and sole discretion,to adjust the renewal fee after the third year renewal, upon notice to the Customer. The Customer is not obligated to renew the agreement. Either of the parties may terminate this Agreement at any time. This one year agreement automatically terminates at the end of the year if the Customer elects not to renew,or upon the conclusion of the Renewal Period if the customer has not renewed. Agreements not renewed by the month and day of the effective date on any renewal year become null and void. By signing this Agreement,the Customer agrees that WIPEOUT SERVICES,LLC.may contact(by mail or phone)to notify him/her of the renewal. Transferable: In the event of a transfer of ownership of the Covered Premises,this Agreement is not enforceable or transferable unless and until (a) WIPEOUT SERVICES,I.I.C.re-inspects the Covered Premises,(b)the transferee executes an Agreement in the form at use at that time by WIPEOUT SERVICES,LLC.: and(c)the transferee pays any applicable(1)transfer fee and any applicable(2)renewal fee. In no event shall any such transfer extend the original Renewal Period. Chemical Sensitivity: At the Customer's request,WIPEOUT SERVICES,LLC.will provide copies of the Product Labels and Material Safety Data Sheets for the products used in treating the Covered Premises. If any member of the Covered Premises household is or may be sensitive to chemicals or chemical odors,they should consult with their physician before products are applied in,on,around or under the Covered Premises. Notice to Customer: 1. You are entitled to a copy of this Agreement at the time you sign it. 2. Do not sign this Service Agreement before you thoroughly read it or if it contains any blank spaces. 3. An Inspection/Treatment Notice is located on the breaker box or other Notice to Buyer: On a home solicitation sale the Buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction,without any penalty or obligation. To cancel this transaction,mail or deliver written notice to WIPEOUT SERVICES,I.I.C. 4001 Virginia Ave.suite A,Fort Pierce,FL 34981 no later than midnight of:n/a (date). Customers Signature Date: 09 /30 /2020 Summary of Charges WIPEOUT Representative Date: 09 /30 /2020 Price........................ $ 125.00 WIPEOUT PESTS&TERMITES,Inc.has provided the Customer with copies of the manufactures Structure $ Occupant Fact Sheet and Customer Fumigation Preparation Sheet. Florida sales tax....... $ [] Not Applicable Customers Initials Total Due.................. $ 125.00