HomeMy WebLinkAboutApplication for Private Provider for Plan Review or InspectionsST LUCIE COUNTY CODE COMPLIANCE D
2300 Virginia Avenue
Ft. Pierce, FL 34982
Office: (772) 462-1553
Fax: (772) 462-1148
Application for Private Provider for Plans Review / Inspections
PERMIT #
(A/E Agreement, Revised July 1, 2001)
St. Lucie County Code Compliance Division
DATE: MARCH 12, 2021
OCEAN HARBOR N. CONDOMINIUMS - BLDG. A CONCRETE REPAIR
STREET ADDRESS: 5151 N. HWY A1A, Units 215/315, 315/415, 415/515, 515/615, and 811, FORT PIERCE, FL 34949
Parcel #
To: St. Lucie County Building Department
I have elected to utilize MICHAEL A. LUE f FL PE# 47520 / SI# 1061
(Name of State Registered Architect / Engineer) (State Registration Number)
(As recognized in chapter 468, 471, Florida Statutes)
FIRM NAME: M L ENGINEERING, INC
ADDRESS: 2030 37TH AVENUE, VERO BEACH, FL 32960
TELEPHONE #: ( 772 ) 569-1257
FAX #: ( 772 ) 569-4041
As a private provider as authorized in s. 553.791, Florida Statutes. I have elected to use this "Private Provider" for:
(check all that apply):
PLANS REVIEW: Building, 1:1Electrical, 1:1Mechanical, 1:1Plumbing.
(Affidavit Required)
INSPECTION(s): R1 Building, 0 Electrical, 0 Mechanical, 11 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 applicable codes, except to the
extent specified in said law. Instead, plans review and/or required building inspections shall be performed by
licensed or certified personnel identified in this application. The law requires minimum insurance requirements for
such personnel, but 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 agree to indemnify, defend and hold harmless the local government and paid building official(s) from any and all
claims arising from my use of these licensed or certified personnel to perform building code inspection services
and/or plans review. With respect to the building that is the subj ect of the enclosed permit application, I Understand
that if I elect to make 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 changes.
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FEE SIMPLE OWNER:
GENE ROSS - ELLIOTT MERRILL COMMUNITY MANAGEMENT
(PRINT NAME OF SIMPLE OWNER)
772-569-98GNA" OF SIMPLE OWNER)
�MbTT MERRILL COMMUNITY MANAGEMENT, 835 20TH PLACE, VP90WEACH, FL 32960
(ADDRESS)
NOTARY:
fri
STATE OF I LM k
COUNTY OF ' �� G.n �4�� 'I+— 1 /�
T ore oin instrument was acknowledged before me this � 5 day for /" `Cv-,o, , 20
B - S My commission expires:
Pers ally Known Produced IDT e of 'dentific ion:
Signature of Notary Public — State of 0-
AFFIDAVIT FOR PLAN REVIEW:
I affirm that I am qualified under chapter 468 or 471, Florida Statutes to provide building code plan services as
authorized by s. 553.791, Florida Statutes pursuant to section 104.3 2 Florida Building Code with respect to the
building that is the subject of the enclosed permit application. 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.
JULIEBARRETT
;otr�rc�eL.
Notary Public - state of Florida
' `trr `
Corrn•issior - ..
•`. ::� �.�:
MN Colrrr. -X:if pS se" ? . 222
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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 all responsibility for compliance with
all provisions of the standard / technical codes and other pertinent laws and 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 the 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 guides 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 sections 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 the 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 plans 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 "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 recent inspection which satisfies the 180-day requirement")
within 180-days (60-days for demolition permits) from the effective date of the permit. All subsequent inspections
shall be made within 180-day time frame prior to permit expiration. NO INSPECTIONS WILL BE
PERFORMED SUBSEOUENT TO PERMIT EXPIRATION: AND NO INSPECTIONS WILL BE
HANDLED "AFTER -THE -FACT".
df AM!tAELrer:
(QH�I 3W OF Architect. Engineer)
TJJffib //37TH AVENUE, VERO BEACH, FL
(ADDRESS)
``��t111IIIIIII�//��/
AN
Arcl± te;� EnginN. 47520
772-566SI-'FL6RE OF _
1960 (PH&E) ^~�
� STATE OF
Architect / Engineer 0� •.,F� L 0 R 1D I�;
Seal: 'i
NOTARY: STATE OF FLORIDA ,,/,��sS��NIAIi����\``•
COUNTY OF INDIAN RIVER
The foregoing instrument was acknowledged before me this 12th day for MARCH , 2021
By MICHAEL A. LUE My commission expires: 02/18/2024
Personally Known ✓ Produced ID Type of identification:
Signature of Notary Public — Statp of FL Christine L. Jackman - GG 953623
Notary Public State of Florida
+�
or
Christine L Jackman
My Commission GG 953823
Sxplres 02/16/2024
Whenever the owner / contractor desires an inspection to be performed by anyone other that the above or a St. Lucie
County Inspector, a new application form must be submitted and approved by the St. Lucie County Building Official
or Building Code Supervisor BEFORE the subject inspections(s) is (are) PERFORMED.
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 expirations. All violators
will be referred to the FL. D.B.P.R.
Should you have any questions regarding this proceXre, please coitact the St. Luci/Xounty Building Department.
:�-.S ..Buffdi—n�aQQfficial of Building Code
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