HomeMy WebLinkAboutTERMITE TREATMENT CERTIFICATE�' i. r K i ,•
,... Planning &Development Services MAR 2 a 2%
Building & Code Regulation Division -St.
2300 Virginia Ave -
Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443 SCANNED
CERTIFICATE OF TERMITE TREATMENT St.LwieCounty
CONSTRUCTION SOIL TREATMENT
PERMIT JOB ADDRESS:
BUILDER/CONTRACTOR:
PEST CONTROL CONTRA(
PEST CONTROL LICENSE
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: W,6 Chemicals used: A� f " "*'r-i n
Percentage of solution: - Total gallons used: 3 % 6
Date of Treatment:
Footing
1s` Treatment
Re -Treat
Driveway
Vt Treatment
Re -Treat
Other
1' Treatment
Re -Treat
Time of Treatment:
Slab/
l� 1�` Treatment
Re -Treat
Pools
Treatment
Re -Treat
Perimeter for Final Inspection
Signature of Exterminator Date
Note. There must be a completed form for each required treatment or re -treatment and this form must be on the job
site to be picked up by the inspector at time of each inspection or the scheduled inspection will fall and a re -inspection
fee charged.
FBC104.2.6CerVficateofFiotecdveTreatment forprevendonoftennites Aweather resistantjobsitepostingboard
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 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 dates of applications.
Revised 7/24/2014
Subdivision:
Address
City & Zip
Owner
Name of Builder.
Shell Contractor.
Evfd" p6a H"49-00%�, Pie.
°Considering Your Environment"
State License Number 114708
11192 47th Road North Royal Palm Beach, FL 33411
561333-8777 / FAX 561333-8999 / Toll Free 866-414-PEST
T�
Property Information
Lot: Block: Section:
Plex,4cO ;
Builder / Contractor Information
Construction Type
Monolithic: Floating/Stemwall: Patio: Entry:
Driveway:_
Addition: Other:
Product / Treatment Information
Treatment Date:3`Z )4 Time: I; (� Technician:
Treatment Type (must check one) initial Under Slab: Supplem tal.
Product Applied: Cypermethdn: Premise 75 Other `n
Concentration:. c76 % Mixed Product Applied: �_ Gallons
Square Footage Treated: 32A5 Linear Feet Treated:
If this is checked, then final perimeter treatment has been completed and the
following statement is applicable.,
Cerdf/cate at Compliance. THIS BUILDING HAS RECEIVEDA COMPLETE TREATMENT FOR THE
PREVENTION OF SUBTERRANEAN TERMITES. TREATMENT IS INACCORDANCE WITH THE RULES AND
LAWS ESTABLISHED BYTHE FLORWA DEPARTMENT OFAGPJCULTUREAND CONSUMER SERVICES.
(Florida Building Code (FBC)1816.1.n
Applicators Name (Please Print)