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HomeMy WebLinkAboutApplication for Private Provider for Plans Review & InspectionsST LUCIE C-_ J . _ Y CODE COMPLIA E _ IVISION 2300 Virginia Avenue Ft Pierce, FL 34982 Office (772) 462-1553 Fax (772) 462-1148 Application for 4ivate Provider for Plans Review / Inspections (A/E Agreement. Revised July 1, 2003) St Lucie County Code Compliance Division PERMIT 4: 07 /0- - 0/0.Z STREET ADDRESS: Parcel #: DATE: '% - 2.©- .2, ©O,j TO: St. Lucie County Buildini; Department I have elected to utilize M la -met- J, © 'Coly.,yog , r1eL xG& 0 4-fO82 (Name of State Registered Architect / Engineer) (State Registration Number) (As recognized in chapter 468, 471, Florida Statutes) , FIRM NAME: `l oyxzLeer- 6c-•�. �n�GiN���2/i✓C�- � %sTin/G; /CPC �y�J ADDRESS: i4Ai2 2000 , Gc1E-7sr A*uri /�enc�, l�L- 33 Q5" TELEPHONE #: L56/) 6,87-¢29q FAX #: L66/ ) 836' -f/eZ as a private provider as authorized iri s. 553.791, Florida Statutes. I have elected to use this "Private Provider" for: (check all that apply): _PLANS REVIEW: Building, Electrical, �J _Mechanical, K Plumbing. (Affidavit Required) INSPECTION(s): Building, _Electrical, Mechanical, X Plumbing. FEE SIMPLE OWNER: I have elected to use one or more private providers to provide building codes plan review and/or inspections services on the building that is the subject of the enclosed permit application, as authorized by Part XII, chapter 468, Florida Statutes & s. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required building inspections shall be performed by licensed or. certi&d•personnel identified in the application. The law requires minimum insurance requirements for such -personnel,, bat, I•understand that I may require more insurance to protect my interests. By executing this form, I �, acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their, insurance and am satisfied that my interests are adequately protected. i I agree V --m iemnitj, defend and hold harmless the local government and local building official(s) from any and all claims :_a:isink-from my,Tuse of these licensed or certified personnel to perform building code inspection services -'and/or cans review. With respect to, the building that is the subject of the enclosed permit application, I understand (". p• P g j P PP tha't'if I elect to mak.-,;any changes to' the listed private providers or the services to be provided by those private providers, the,fee simple owner I shall, within twenty-four (24) hours after any changes, update the notice to reflect such cliaiiges. *-,;ytE•EE,.Si<MPLE, OWNER: 4(PRINTNXM$ OF FEE�SIMPLE OWNER). (SIGNATURE OFF IMPLE OWNER) �/--7/8 -- 875-3 (PHONE #:) 335 ���T� �I �P..✓ts�. e0Y/,J17�A1 h9c,9-K_* X--L 3_3�126 NOTARY: STATE OF 15;4�40A COUNTY OF P,tc17,1 The foregoing instrument was acknowledged before me this ;M Ifay of JU6 t/ , 200 5 By IZI;Oa , Jr My commission expires: / •-6 - 20og Personally Kno i/ Produced'XD Type of identification: Signature of of P,c - ate of F DAVIT F GOB 9tot. of Fkxldo Jon6.20M I affirm that I am qualified under chapter 468 or 471, ° - y S7gee Ian review services as authorized by s. 553.791, Florida' Statutes pursuant �s' `'1 ith respect to the building that is the subject of the enclosed permit appl imrsEdim trr4LT11r,"r0Ca1t official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified, in said law. OVER I have reviewed the construction plans / documents to determine compliance with the applicable codes. I have determined that the plans reviewed comply with the applicable codes. I accept full responsibility for compliance with all provisions of the standard / technical codes and other pertinent laws or ordinances. I provide my seal and signature as affidavit under oath, that the following is true and correct to the best of my, knowledge and belief: (a) The plans / documents were reviewed by myself. I am duly authorized to perform plan review pursuant to the code and hold the appropriate licenses or certificates. (b) I am qualified as a plan examiner under Part XII of Chapter 468, Florida Statutes. (c) The plans comply with the applicable codes, standards, statutes and local ordinances or regulatory agency requirements. (d) The plans comply to the laws as to egress, Life Safety Codes, type of construction and general arrangement and show the structural design. (e) The plans and design conform to the requirements of the technical codes as to strength, stresses, strain and stability. (f) To the best of my knowledge, the plans and specifications comply with the applicable minimum building codes and the applicable fire -safety standards as determined by the local authority in accordance with the Florida Building Code and chapter 633 Florida Statutes. Inspections: I affirm that I am qualified under s. 468 Florida Statutes to provide building inspection services as authorized by s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building Code. It is understood that the undersigned hereby accepts the responsibility for performing all of the required inspections identified in this document. I understand that inspections are required as detailed in Section 105 of the Florida Building Code, the permit card, and as prescribed by the local authority having jurisdiction. I further agree to hold St -Lucie County harmless for such inspections, and accept responsibility for compliance with all other requirements contained within. Upon completion of the structure, I will provide the Building Official a certification that the structure, electrical, gas, mechanical and plumbing systems have been erected in accordance with requirements of the technical codes. The undersigned certifies that all work inspected (and approved) will conform to all applicable codes and standards; as well as all related permit documents. In the event of any conflict between codes and documents, the more restrictive shall apply. A log shall be maintained of all inspections made including the date of the inspection, the inspection performed using the permit "hard card" terminology and the designation of either approved or disapproved and an inspection report shall be forwarded to the Building Department within 72-hours of making the inspection. Each inspection report shall bear the seal of the Architect / Engineer performing the inspection, along with his / her signature and the date. The permit will expire unless work is commenced (and receives an approved inspection "colored red on the.permit hard card, red print indicates a required inspection which satisfies the 180-day requirement") within 180-days (60-days for demolition permits) from the issue date of the permit. All subsequent inspections shall be made.. within 180-day time frame prior Jo permit expiration. NO INSPECTIONS WILL BE HANDLED "AFTER -THE -FACT". ♦k ►i ect/Engine CL (PRR,NED NAME OF Architect / Engineer) (DATE) (ADDRESS) Of-Afthitect / Engineer) ,. ' HONE #:) Architect / Engineer NOTARY: . Seal: STATE OF I oe., kim COUNTY OF The foregoing instrument was acknowledged before me this :3L day of My commission expires: Personally Known roduced ID Type of identification: Signature of Notary Public —State of C Qom_ - , I Whenever the owner / contractor desires an inspection to be performed by anyonj crffw,,T County Inspector, a new application form must be submitted and approved by th or Building Code Supervisor BEFORE the subject inspection (s) is (are) PERFORMED. 200 (P boo BRED B. BAKER dim State of Florida Commission # D02936377 WW" if o The St Lucie County Building Department may at any / all times visit the construction site to ensure compliance and / or for the purpose of spot inspections to verifying construction activities are in compliance with the construction documents / drawings. Failure to follow standard operating procedures for inspections for St Lucie County may negate any further approvals for you or your firm to perform this. type of inspection. In addition, incomplete or inaccurate inspection reports may result in failed inspections, work stoppage and / or permit expiration. All violators will be referred to the FL. D.B.P.R. Should you have al �juestF(&9 � gVdih gathis procedure r�l se contact the St Lucie County Building Department ::4klurl V'1r3ttl 3,u='6>.}t`'..'r�%i ���v��., ♦ Building Offi at, k . uiJdjgg,Cude��n�e�rvi'sor�; Print Name Signature Date