HomeMy WebLinkAboutFinal TermiteNew Construction Subterranean Termite OMB Approval No. 2502-0525
Service Record (exp.09/30/2022)
This form is completed by the licensed Pest Control Company
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information
its required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB
control number.
Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the
builder to certify that an authorized Pest Control company performed all required treatment for termites, and that the builder guarantees the treated area
against infestation for one year. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will
use the information collected. The information is not considered confidential, therefore, no assurance of confidentiality is provided.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when treatment for prevention of subterranean termite
infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control company and builder, unless stated otherwise.
Section 1: General Information (Pest Control Company Information)
Company Name: HomeTeam Pest Defense, Inc.
Company Address 4341 Fortune Place City west Melbourne State FL Zip 32904-1532
Company Business License No. 3B165929 Company Phone No. 321-409-8489
FHA/VA Case No. (if any)
Section 2: Builder Information
Company Name SynergV Homes Phone No. 561-939-9885
Section 3: Property Information
105 Se Celestia Ct,
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip) Port Saint Lucie, FL, 34983-2119
Section 4: Service Information
Date(s) of Service(s) 06/05/2021
Type of Construction (More than one box may be checked) ❑x Slab ❑ Basement ❑ Crawl ❑ Other
Check all that apply:
❑ A. Soil Applied Liquid Termiticide
Brand Name of Termiticide: EPA Registration No.
Approx. Dilution (%): Approx. Total Gallons Mix Applied: Treatment completed on exterior: ❑x Yes ❑ No
❑ B. Wood Applied Liquid Termiticide
Brand Name of Termiticide: EPA Registration No.
Approx. Dilution (%): Approx. Total Gallons Mix Applied:
❑X C. Bait system Installed
Name of System SENTRICONAA EPA Registration No. 62719-608 Number of Stations installed 22
❑ D. Physical Barrier System Installed
Name of System Attach installation information (required)
Service Agreement Available? X❑ Yes ❑ No
Note: Some state laws require service agreements to be issued. This form does not preempt state law.
Attachments (List)
Comments
Name ofApplicator(s) Mike Brewton Certification No. (if required by State law) IF132379
The applicator has used a product in accordance with the product label and state requirements. All materials and methods used comply with state and federal
regulations.
Authorized Signature( Date 06/07/21
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010. 1012; 31 U.S.C. 3729, 3802)
form HUD-NPMA-99-B (08/2008)
�q d"T $I City of Port St. Lucie
Building Department
121 SW Port St. Lucie Blvd.
{{0 417 Port St. Lucie, FL 34984 * 772-871-5132
Pandapublicweb.cityofpsl.com
Certificate of Compliance
for Termite Protection
(as required by Florida Building Code R318.1)
PERMIT INFORMATION
Permit #:
105 Se Celestia Ct, Port Saint Lucie, FL 34983-2119
Address of Treatment
Legal Description (Sec/Block/Lot)
PEST CONTROL COMPANY
HomeTeam Pest Defense Kenneth Colabella
Company Name — Please Print License Holder Name
321-409-8489 JF132379
Phone Number License #
TREATMENT INFORMATION
Method of Termite Prevention Treatment:
❑ Soil Barrier ❑ Wood Treatment ❑x Bait System* ❑ Other (describe)
*Per FBC R318.1.7— a signed copy of the contract assuring the installation, maintenance and monitoring of the baiting
system that is in compliance with the requirements of Chapter 482, F.S. shall be provided to the Building Official prior
to the pouring of the slab and the system must be installed prior to final building approval.
The Building has received a complete treatment for the prevention of subterranean termites. Treatment is in
accordance with rules and laws established by the Florida Department of Agriculture and Consumer Services.
06/07/2021
Authorized Signature Date
Ken Colabella
Print Name
Form created 02/25/2019 revised 04/19/19 tv