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HomeMy WebLinkAboutCERTIFICATE OF TERMITE TREATMENT"- Planning & Development Services SCANNED Building & Code Regulation Division 2300 Virginia Ave BY Fort Pierce, FL 34982 Sk L! cip Gglanty 772-462-2172 Fax 772-462-6443 I CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION PERMIT # : f m% - JOB ADI BUILDER/CONTRACTOR: AeTAS PEST CONTROL CONTRACTOR: ��n PEST CONTROL LICENSE #: -,I— 7- We, the undersigned, hereby certify that we have subterranean termites in accordance with the star SgR�re feet,if area treated: / w Percentage of solution: Date of Treatment: �/ Footing 1s` Treatment Re -Treat Driveway 1st Treatment Re -Treat Other I" Treatment L TREATMENT ated the above described construction for of the National Pest Control Association. ;hemicals used: AL-m i Ar-- 'otal gallons used: 11,,4 Time of Treatment: I,'d 0 ✓/Slab �1S` Treatment Re -Treat Pools 211,31) 1st Treatment Re -Treat Perimeter for Final Inspection Re -Treat �-F Z.o,36�a -�^ SigrAture of Exterminator bate Note. There must be a completed form for each req I 'red treatment or re -treatment and this firm must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re -inspection fee charged. FBC104.2.6 Certificate of Protective Treatment for prevention of termites A weather resistant jobsite pasting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment cs completed, providing a dopy 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' siteT Option, area treated, chemical used, percent concentration and number of gallons used, to establish a verifiable 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 dais of applications. 1%ZV1bUU I I I PA l.q()t 5 4D Customer J� zt�t^4, 6 Address City ;F %f" uC.✓? State 1 Z Zip .iVT�l Phone 1V41 I' r _05�� Contract # ------------------------------------------------------------ Terminix Addr/ess J7 0 41,V (/zNfitia ref t ' City -Veld i �ts �1 State FZ- Zip Telephone / 72 3i/� DO i TERM/N/X Application and Terminix® Insulation Service Record Date of Application Ti � In �� Time Out Applicat Ir(s)/Certif. # � � /� _11 ZD.jJ _� J Supervisor/Certif.# L ❑ Original Treatment ❑ Retreatment i© Pretreatment ❑ Compete Treatment ❑ Limited Treatment ❑ Perimeter Plus ❑ Attic Insulation ❑ *Wind Speed J `MPH from the (direction) Target Pest /I] Subterranean Termites ❑ Drywood Termites ❑ Old House lBorers ❑ Powderpost Beetles ❑ Wood Decay Fungi ❑ Product Applied Chemical Manufacturer EPA# % Applied Amount ElAlpineTermite Foam Dinotefuran BASF 499-526 ❑ 0.025% oz ❑ BoraThor Max PT Disodium OctaborateTetrahydrate -Ensystex II, Inc. 8�824-11 ❑ 9% El 13% ❑ 16% El 23% gal ❑ BoraThor SP Disodium OctaborateTetrahydrate Ensystex II, Inc 8 824-8 ❑ 10% ❑ 15% gal ❑ Bora-Care Disodium OctaborateTetrahydrate NISUS 64405-1 ❑ 9% ❑ 13% ❑ 16% ❑ 23% gal ❑ Fast Out CS Foam Cyfluthrin BASF 499-523 ❑ 0.1 % oz ❑ Phantom (SC) Chlorfenapyr BASF 241-392 ❑ 0.125% ❑ 0.25% gal ❑ Premise Pre -Construction Imidacloprid Bayer 492-1331 ❑ 0.05% gal ❑ Termidor SC (SC) Fipronil BASF 7969-210 ❑ 0.06% ❑ 0.125% gal ❑ Termidor 80 (WG) Fipronil j BASF 7969-209 ❑ 0.06% ❑ 0.125% gal ❑ Tim-Bor (SP) Disodium OctaborateTetrahydrate NISUS 64405-8 ❑ 10% ❑ 15 % gal ❑ AdvanceTermite Bait Diflubenzuron BASF 499-500 ❑ 0.25% (124gm) ea ❑ Recruit F D Noviflumuron DOW y62 719-608 ❑ 0.5% _ ea The following is by Corporate approval only: ❑ Prelude (EC) Permethrin Syngenta 00-997 ❑ 0.5% ❑ 1 % ❑ 2% gal ❑ T.A.P Insulation Orthoboric Acid Pest Control Insulation 72787-1183896 ❑ 11.1 % ❑ 12.5% ❑ *Gas Engine ❑ *Electric motor ,O *Diaphragm Pump El *Piston Pump ❑ *25 PSI or less at nozzle El*50 PSI or less at nozzle o _*PSI at pump ❑ _*PSI at pump ❑ *Hand Duster ❑ *Aerosol Injection ❑ *Compressed Air, Sprayer ❑ AreasTreated: ❑ See Below b'See Contract Graph ❑ Sep Attached Graph awr / 1 z✓vvt/ t,L:V Control'Services have been performed on my property to my satisfaction. f� Customer/iyy L/ 30# bags Formulation A=Aerosol B=Bait D=Dust EC=Emulsifiable Conc. F=Foam SC=Suspendible Conc. SL=Soluble Liquid SP=Soluble Powder WG=Water Dispersible Granules WP=Wettable Powder *Application Rate ❑ 4 gal/10 linear ft ❑ 2 gal/10 linear ft ❑ 1 gal/10 square ft ❑ 1.5 gal/10 square ft ❑ / ❑ Applied at less than label rate ❑ Monitoring Stations only (no bait) ❑ *Roller Pump ❑ *In -Line Injection System ❑ Insulation Blower Description of AreasTreated Activity r �� �/A /� }/ d 1 1 JOfi>1^ �lr7oY�ydl i�� Termite Technician Notice of Treatment was posted at or near Date Posted O � Manager ❑ Electric Breaker Box ❑ Water Heater Closet Bookkeeper ❑ Bath Trap Access ❑ Beneath the Kitchen Sink © 2013TheTerminix International Company Limited Partnership. All rights reserved. Key #31117 Rev. 3/13 *Complete where applicable. I