HomeMy WebLinkAboutTermite certAPPT. DATE TIME
INSPECTOR TECH
�� ■= DATE TAKEN: BY:
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Services, LLC
Martin 772-287-8486 • St. Lucie 772429-7716
Indian River 772-567-7392 • Palm Beach 561-746-7364
Corporate Office
4001 Virginia Avenue, Suite A • Fort Pierce, Florida 34981
FOR FAST, PROFESSIONAL SERVICE CALL
CUSTOMER INFORMATION
Amt. # SERVICE REQUESTED
NAME
ADDRESS
SOURCE
FL
CITY STATE
ZIP CODE/GRID
CONTRACTS:
HOME TEL# WORK TEL#
s
DIRECTIONS
PAYMENT / CREDIT CARD INFORMATION AUTHORIZATION
SVC AMT CARD TYPE
CHECK # /CARD # / EXP DATE AMT CODE DATE TIME
1.
2.
3. _
LAD I--
4.
TOTAL DUE
TOTAL AUTH. ERRED DATE
CARDHOLDER NAME (If different from above)
I AGREE TO PAY ABOVE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT (Visa/MasterCard Customer Inquiries Call 1-800-920-1079).
SIGNATURE:
DATE:
VALUED CUSTOMER COMMENTS:
SALES TECH COMMENTS:
PEST CONTROL / FLEAS / OTS
TERMITE / FUME
TREATMENT SITES TREATED
MATERIAL INSPECTED Evidence Treated MATERIAL
Name (%) & Amt SITES (Y/N) (Y/N) Name (%) & Amount
Mulch/Flowerbeds
Foundation
Woodpile/Garbage Area
Crawl Space
Doors/Windows/Eaves
Interior Walls
Attic/Crawl Space
Door Frames
Underneath Appliances
Window Frames
Wall Voids/False Bottoms
Bath Traps
Cracks/Crevices
Attic
Drawers/Cabinets/Closets
Other
Other
TARGET PESTS
Time/Beg: Camp: TOT: t��
Endorsement hereon acknowledges receipt of and satisfaction for services rendered. I certify the abov o be true and an accurate record of my operations.
CUSTOMERS SIGNATURE
DATE WIPEOUT TECHNICIAN
Planning & Development Services
-I Building & Code Regulation Division
2300 Virginia Ave
*• w Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: JOB ADDRESS: �3 G 1 r'�
BUILDER/CONTRACTOR: 3 Yy5
PEST CONTROL CONTRACTOR: VV i
PEST CONTROL LICENSE #: 1_3 'J O 6-?.$
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: / 6, e-jAj. r=%-
Percentage of solution: 5
Date of Treatment:
Footing
1st Treatment
Re -Treat
Driveway
X 1st Treatment
Re -Treat
Other
1st Treatment
Re -Treat
Chemicals used: D C -I ' r1 ' 0yi
Total gallons used: '7
Time of Treatment:! q ct ''n
Slab
1st Treatment
Re -Treat
Pools
1st Treatment
Re -Treat
Perimeter for Final Inspection
Sign ture of Exterminator 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.
FBC104.2.6 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.