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Home My WebLink AboutAPPLICATION FOR PRIVATE PROVIDERST LI�CIIENQ -LINTY CAN-f�&p St Lucie CauTRY . 2300 Virginia Avenue Ft Pierce, FL 34982 ,; CODE COMPLIAN. DIVISION Office, (772) 462-1553 Fax ., (772) 462-6454 SCANNED Application for Private Provider for Plans Review / Ins ��tkos (A/E Agreement. Revised July 1, 2003) St Lucie County Code Compliance Division PERMIT #: O 5-/a - C6 37, DATE: 11,4?7ef/ 2,3/Gp, zw? g7 STREET ADDRESS: k100 ii/c wC67-, eMAAC9 OF 06 MW % Pacel`w:.5`y/C�- 60/- Ir TO: St Lune County Building Department I have elected to utilize fF"Y ly GU,E/l1l TiL " R O• Ala. 9 p033 (Name of State Registered Architect / Engineer) (State Registration Number) (As recognized in chapter 468, 471, Florida Statutes) I _ _ FIRM NAME: ADDRESS: a,44ELlJijy C9/&54 &0/ IODSf TELEPHONE #: (/) �%?S- J��o�I� FAX #: 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, Electrical, Mechanical, Plumbing. (Affidavit Required) 61-01 INSPECTION(s): Building, 1/ Electrical, V Mechanical, 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 certified personnel identified in the 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 local 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/orplans review. With respect to the building that is the subject 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. ♦ `"-FEE SIMPLE OWNER: � (FRINI`NAME OF_ -FEE SIMPLE OWNER) (SIGN TURE OF FEE SIMPLE OWNER) awl 0& 742. 978 - /03fo "i:(DATE , ``' (PHONE #:) (ADDRESS) ; • ,' 1_ � NOTARY, STATE OF PA COUNTY OF 1401A4 41523 �� ' The npgoing instrument was acknowledged before me this day of , 200 F, B J 0KN V ta4- My commission expires: MAFIY E. TATRO Personally Known Produced ID Type of identification: �° : '" `'° N N DD 353137 Signature of Notaryhlic - State of * * April 17 2008 �gleeFc�o�'�°` Bonded Tfuu Budget Noury S!tvkes AFFIDAVIT FOR PLAN REVIEW: I affirm that I am qualified under chapter 468 or 471, Florida Statutes to provide building code plan review 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. OVER REV. 12/6/05 DMG I have reviewed the construction plans / docu determined that the plans reviewed comply w with all provisions of the standard / technical signature as affidavit under oath, that the foll, (a) The plans % documents were revim code and hold the appropriate licei (b) I am qualified as a plan examiner i (c) The plans comply with the applies requirements. (d) The plans comply to the laws as tc and show the structural design. (e) The plans and design conform to t stability. (f) To the -best of my knowledge, the codes and the applicable fire -safe Florida Building,Code and chapte IgCb7f P. MC-40AM Inspections: I affirm that I am .qualified under s. 4 s. 553.791, Floiida'Statutes pursuant hereby accepts the responsibility for understand that.inspections are requi as prescribed by the local authority t inspections, and accept responsibilit; of the structure, I will provide the Bi plumbing systems have been erected 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 lie 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 mit hard card, red print indicates a required inspection which satisfies the 180-day inspection "colored red on the per requirement") within 180-days (�0-days for demolition permits) from the issue date of the permit. All subsequent inspections shall be made within 180-day time frame prior to permit expiration. NO INSPECTIONS WILL BE ., .......w.. . wrr wtn rwreDL'f^T7ANC Wii .i . RV, r nts to determine compliance with the applicable codes. I have the applicable codes. I accept full responsibility for compliance ies and other pertinent laws or ordinances. I provide my seal and Ina is true and correct to the best of my knowledge and belief: by me. I am duly authorized to perform plan review pursuant to the or certificates. ;r Part XII of Chapter 468, Florida Statutes. codes, standards, statutes and local ordinances or regulatory agency Life Safety Codes, type of construction and general arrangement requirements of the technical codes as to strength, stresses, strain and M STA plans and specifications comply with the applicablg,-minimum building ty standards rmined by the local authority in accordance with the r 633 Flori a-Statut V gd Px 11," /18y ( GNATURE OF PLANS EXAMINER) STATE LICENSE # 58 Florida Statutes to provide building inspection services as authorized by z section 104.3.2 Florida Building Code. It is understood that the undersigned )`erformiiig all`df the re-quired-inspections'identified in this document. I ed as -detailed in Section 105 of the Florida.Building Code, the permit card, and ivmg jurisdiction. I further agree to hold St Lucie County harmless for such-----' for compliance with all other. requirements..contained:within. Upon completion ilding Official a certification that the structure, electrical, gas, mechanical and in accordance with requirements of the technical codes. OF INSPECTOR), (SIGNATURE OF INSPECTOR) STATE LICENSE # ♦ Principle Architect / Engineer Jerry M. Weintraub (PRINTED NAME OF Architect / Engineer) 150 Highway 41A, 004, Satellite' Beach-, FL 132•937 . �................. V NOTARY: t I STATE OF f LI U. COUNTY OF _J.9 o '3 $ The foregoing instrur g By Personally Kno o s Signature of Notary 1 Whenever the owner ,................i County Inspector, a r or'Building;Code Sul Tlie. S Lucie .Count and / or`for the 'purpf construction docume Architect / Engineer s., Seal: - - e 't was acknowledged before me this 2 day of KI[ AVraa ;•200_�6 My commission expires: v ?.O Produced IDType ' entification: iiblic - State of Ft (contractor desires an inspection to be perf ed by anyone other than a abo or a St Lucie .w application form must be submitted and pproved by the St Lucie Coun uilding Official -rvisor BEFORE the subject inspection (s) is (are) PERFORMED.. Building Department may at any / all times visit the construction site to ensure compliance e of'spot inspections to verifying construction activities are in compliance with the is / drawings. Failure to follow standard operating procedures for inspections for St Lucie County may negate any further approvals for youlor 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 Should you have any questions regarding this procedure, please contact the St Lucie County Building Department ClientiEk 474 ACDRD, CERTIFICATE OF LIABILITY -INS PRANCE DATE(MMIODrM 10/28104 ODD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOi TION Van Glider Insurance Corp. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 700 Broadway, Suite 1000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver, CO 80203 3W 837-8500 INSURERS AFFORDING COVERAGE INSURED I INSURER A: XL Specialty Insurance Company The Weintraub Organization, Ltd. I INSURER s 6436 South Racine Circle, Suite 100 INSURER C; Greenwood Village, CO 80111 j INSURER D: INSURER E: NYGiV1V G.7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTwrrHSTANDwG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE i PO C EFF_cCISVE POLICY NUMBER DATE /DO IPO CY EXPIRATION D { LI11eRS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR ' i ! EACH OCCURRENCE I RREDAMAGE (My .fce) : MED EXP (Any mm pevmn) I PERSONAL 8 ADV INJURY GENsRALAGGREGATE I i PRODUCTS-COMPlOPAGG S IS is I S i is IGEN'LAGGREGATE LIMITAPFLIESPER: i POLICY° LGC S AUTOMOBILE UABILMY ANY AUTO OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS I i COMBINED SINGLE LIwr I� I LYINJURY ( P—) I BODILY INJURY I (Per aeddent) i PROPERTYDAMAGE ;(Peracddenq SALL I S I I S S QARAGE UAB( ANY AUTO EXCESS LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S I AUTO ONLY - EA ACCIDENT Is I OTHER THAN EA ACC AUTO ONLY: AGG IS I EACH OCCURRENCE AGGREGATE is I IS I Is S s 4 WORKERS COMPENSATION AND EMPLOYERS• LIASILrTY I i IT STAMIiS I I FAR EJ_ EACH ACCIDENT EL DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT I S S S A I OTHER Professional jDPR9404092 IPabiliiy I 08110104 108//0105 ( I $1,000,000 per claim i $2,000,000 annl aggr. DESCFUP710H OF OPERATIDNSILOCATIONSNEHICLESID(CLUSIONS ADDED BY ENDORSEMEUWSPECIAL PROVISIONS Professional Liability Policy Includes 5 year tail option "For Proposal Purposes Oniy" ACORD 25S (7I9711 of atcascnwcran��e rn� SHOULD ANYOFTHEABOVE DESCREIED POLICIESSECANCELLED BEFORETHEM(TVATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TOMAIL31_DAYSWRITTEN NOTICETOTHE CERTIFICATE HOLDER HANIED TOTHE LEFT. BUTFAILURE TODOSOSHALL IMPOSE N O OSLIGATION OR LIAB ILITY OF ANY W N D UPON THE INSU RER.RS AGENTS OR REPRESENTATIVE � .. � � wrnon nnnonnwsrner areoe THE WEINTRAUB ORGANIZATION, LTD. PRIVATE PROVIDER QUALIFICATION STATEMENT Private Provider: Jerry M. Weintraub, P.E. Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: JWeintraub@weintrauborg.com Florida License #: P.E. Number: 30033 FLORIDA REGIONAL MANAGER Douglas W. Harvey Address: 3300 43`d Ave., Suite 4, Vero Beach, FL 32960 Telephone: 772-564-2681 Fax: 772-564-7498 Email: DHarvey,@weintrauborg.com Florida License #: BU763, BN1860, PX927 TREASURE COAST REGION Treasure Coast North Treasure Coast North Area Manager/Inspector: David L. Vines Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: DVines@weintrauborg.com Florida License#'s: BU1409, BN4842, PX2504 Plans Examiner: Everett Yankie Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: EYankiegweintrauborg com Florida License#'s: BU 165, BN464, PX215 Inspector: Russ Morris Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: R1VMorrisnweintrauborg com Florida License #: BN4661 Inspector: David R. Benoit Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: DBenoit@weintrauborg.com Florida License #: BN4870 ( a Inspector: Joe Burkott Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: JBurkott ,weintraubor com Florida License #: BN2716 Inspector: Jon Wolfersberger Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: JWolfersberger c@weintrauborg com Florida License #: BN4874 Inspector: Mark Knowlton Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections:386-756-5120 Email: MKnowlton(a,weintrauborg com Florida License #: BN932, PX411, BU1317 Inspector: Ronald Walton Address: 1333 Gateway Drive, Suite 1004, Melbourne, FL 32901 Telephone:321-725-5680 Fax:321-725-5689 Inspections: 321-725-2188 Email: RWalton(a,weintrauborg com Florida License #: BN2649, PX1413, SE15 Trea:s—ure Coast 'ouch Treasure Coast South Area Manager/Inspector: Scott McAdam Address: 3300 43`d Ave., Unit 4, Vero Beach, FL 32960 Telephone:772-564-2681 Fax:772-564-7498 Email: SMcAdamna,weintraubor .com Florida License#'s: BU904, BN381, PX1180 Plans Examiner/Inspector: Allen R. Bowman Address: 3300 43`d Ave., Unit 4, Vero Beach, FL 32960 Telephone:772-564-2681 Fax:772-564-7498 Email: ABowmanQweintraubor .com Florida License #'s: BU468, BN1356, PX587 Inspector: Wayne H. Russ Address: 3300 43`d Ave., Unit 4, Vero Beach, FL 32960 Telephone:772-564-2681 Fax:772-564-7498 Email: WRuss@weintrauborg.com Florida License #'s: BU452, BN1303, PX571 Inspector: Dwain Redden Address: 3300 43`d Ave., Unit 4, Vero Beach, FL 32960 Telephone:772-564-2681 Fax:772-564-7498 Email: DReddenaweintrauborg com - - - -Florida License #: BN3102 Plans Examiner: Jose E. Guanch Address: 3300 43`d Ave., Unit 4, Vero Beach, FL 32960 Telephone:772-564-2681 Fax:772-564-7498 Email: JGuanchpweintraubor .com Florida License #: BN2192, PX1189, SFP9 Plans Examiner/In 7ector: Tom McCants Address: 3300 43' Ave., Unit 4, Vero Beach, FL 32960 Telephone: 772-564-2681 Fax: 772-564-7498 Email: TMecants@weintrauborg.com Florida License #: BN2733, PX1434, PFP144 Plans Examiner/In? Jim Parker Address: 3300 43` Ave., Unit 4, Vero Beach, FL 32960 Telephone: 772-564-2681 Fax: 772-564-7498 Email: JParker@weintrauborg.com Florida License #: BN4597, PX2296, SFP 162 •' EDLUND •"DRITENBAB - BINK LEY ARCHITECTS AND ASSOCIATES; P.A. ; Members of the American Iristitute,of,Architects , -AR# AAC00.08 6 ` March 21'st, 2006 INDIW RIVER NATIONAL BANK - A BRANCH BANK Permit .No.-0512=0637-. , St. Lucie County- Plan Review. Comments To: -, Jolin' Peterson ; Plans examiner,. , Plans Exarriiner.'Re'vilew Comment.No': 1. Need request for. private provider forms with'proof of'ins urance and list of employees doing inspections. Provide ,paper,work before , permit can be.issued.;'; Response: „ ` ::Will comply; submitting second copy,of Private: Provider Compliance Application and Certificate of Insurance. t See -attached.. ,The inspectors for.Treasure Coast South..are: ; . 'Bi11.Abbott; Florida' -License #:. BN 4540-- " ' Email: Babbotl'cr�veintaubor:com Anthony'Giardino, Florida License'#'s:.BN 4125,'-PX2016 . Email: T iardin"Ca�weintraub6i e.eoin_ ' _Address: 562 S.E: ;Prot St.. Lucie Blvd.; Ft. -Pierce: • Telephone: 772-807=9335 ;Fax: ' . - 772-343=0585` . Submitted by: ; Wendy A stin Architect EDB Architects y _ IRNB,BUSINESS PARK BRANCH : Page f of 1_ Building, Department Comments,' 160 S.W '19th'Avenue, •Su_ite:101-C, Deerfield Beach, FL 33442 . Deerfield Beach 954/429.0995 Vero Beach-772/569-4320 Fax 954/421-9269 'Fax 772/569.92OS , ' EDLUND:- ORI,TENBAB • BINKLEY-' ARCHITECTS AND ASSOCIATES, P.A. . Members of the American Institute of Architects AR# AAC0008e6 - ... EDL.UND • DRITENBAS • BINKLEY ARCHITECTS AND ASSOCIATES, W.A. Members of the Americen Institute of Architects AR# AAC000B86 March 21 st, 2006 INDIAN RIVER NATIONAL BANK A BRANCH BANK Permit No. 0512-0637 St. Lucie County Plan Review Comments To: John Peterson Plans examiner Plans Examiner Review Comment No. 1. Need request for private provider forms with proof of insurance and list of employees doing inspections. Provide paper work before permit can be issued. Response: Will comply, submitting second copy of Private Provider Compliance Application and Certificate of Insurance. See attached. The Inspectors for Treasure Coast South are; Bill Abbott, Florida License #: BN 4540 Email: .8abboiahveintrauboM.com Anthony Glardino, Florida License #'a: BN 4125, PX2016 Email: T iardinao &1veintrayborzcoin Address: 562 S.E. Prot St. Lucie Blvd., Ft. Pierce Telephone: 772-807-9335 Fax: 772-343-0585 $ubmitted by: Wendy A tin Architect EDB Architects IRNB BUSINESS PARK BRANCH Page 7 of 1 Building Department Comments 1 So S.W. 12th Avenue, Suite 101-C. [Deerfield Seech, FL 33442 Deerfield Beach 0154/499•08915 Vero Beach 7712/569.4320 Fax 994/4121-6999 Fax 772/968-9909 60 39dd S1S31IHOiJV SQ3 80Z6699ZLLT 90:9T 900Z/ZZ/E0