HomeMy WebLinkAboutTermite Treatment forms Planning &Development Services
Building &Code Regulation Division
® 2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #:_ aaU 'U5 r JO ADDRESS:
BUILDER/CONTRACTOR: OL 2�' -P
PEST CONTROL CONTRACTOR. EVICT-A-BUG JERMITE&PEST CONTROL INC.
PEST CONTROL LICENSE #: J13175775
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: -3 C`3' Chemicals used: DOMINION 2L
Percentage of solution: .05% Total gallons used: 1�0
Date of Treatment: &1 mac'}- -0 Time of Treatment: 1 f 3
-- - --- Footing - _.- - - - - - --- - -�-- -- --- -
_ 1st Treatment C_-I-�"�reatment
��Re-Treat Re-Treat
A�riv way Pools
Treatment 1st Treatment
RePe t Re-Treat
_(;2�0t ier er eter for Final Ins ion
e-18 Treatment
Re-Treat P J G�� etlbyPAU LUGARAJ
0 20.93.19
i nature of a Date
Note: There must be a completed form for each requir d treatment or r -tre ment and this form must be on the job
site to be picked up by the inspector at time of each inspection or the s h tiled inspection will fail and a re-inspection
fee charged.
FBC104.2.6 Certificate of Protective Treatment for prevention of termites. A weather resistant jobs/te 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 veriFable 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.
Revised 7/24/2014
• Termite Inspection e5u5 Christ is for 772-323-7921
Termite Pretreatment �® EVICf-A-Bug a T011 firec: l-d11-365-9990
Pest Control �Rodent
et Service Termite 8
ME 772-340-5990
IBB• Fire Ant Lawn Service rv, Pest
o trol, Email: Evictabug@gmail.com
• Whitefly Treatment Inc. 4293 SW High Meadow Ave.
• Licensed & Insured Lic.JB175775, Palm City, FL 34990.
Notice of Preventative Treatment for Termites
(as required by Florida Building Code(FBC) 104.2.6, 105.10&R318.1 and Broward County Chapter FBC 105.2.2)
PEST PREVENTION I FIRE ANT SERVICE I TERMITE SERVICE I RODENT EXCLUSION&REMOVAL I WHITEFLY TREATMENT
DATE OF SERVICE �t'f -' 6 l� TIME S +
DEVELOPMENT NAME(PROJECT) CONTRACTOR'S NAME CONTACJERSON
STRUCTURE ADDRESS(LOT/BLOCK) 1'r- CITY,STATE COUNTY I' L-.,
NOTES 7 ZIP CODE
-1
TREATMENT TYPEIAREA
❑FLOATING ❑MONOLITHIC .O-.P,ATIO ❑GARAGE ;O�DRIVEWAY ❑STEM WALLIFOOTERS ❑ADDITION
❑CUTOUTS ❑FOOTER ❑FRONT ENTRY ❑RETREAT ❑BORA CARE TREATMENT ❑PLUMBING CUT OUTS ❑SIDEWALKS
❑TAMP&TREAT, O TREAT ONLY ❑FINAL ❑POOL DECK ❑OTHER
PRODUCTS
S
❑BASELINE f❑DOMINION 2LACTIVE INGREDIENT ❑TERMIDOR SC ❑BORACARE ❑PREMISE ❑TALSTAR
❑OTHER r
ACTIVE INGREDIENT - —�;p-IMIDACLAPRID ❑BIFENTHRIN- ❑DISODIUM OCTABORATE TETRAHYDRATE -
CONCENTRATION
E
❑.06% ❑.1% ❑.12% ❑.25% ❑.05% ❑23% ❑9% ❑OTHER GALLONS APPLIED �1
SQUARE FOOTAGE Z` LINEAR FOOTAGE
SQUARE FOOTAGE VERIFIED
\ES ❑NO �L`MEASURED OR VERIFIED PER PLANS
JOB READY CONDITIONS MET
,W YES- ❑NO DETAILS
"Certificate of Compliance"
As per l04.2.6,105.10&R318.1 FBC-If.soil chemical barrier method for termite prevention is used.,
Final exterior treatment shall be completed prior to final building approval.
Certificate of Compliance: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.(Per the Florida Building Code.)
If this notice is for the final'exterior treatment,initial and date this line
FINAL STICKER `
❑ELECTRICAL PANEL ❑WATER HEATER '❑OTHER
Payment Terms: Payment due at time of service.
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L ✓r` ��a
Date (Applicator:(Evict
A ug"Termite and Pest Control,Inc.) b
tl
Date Customer(Property Owner or Agent)
www.evictabugpestcontrol.com