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Home My WebLink AboutAPPLICATION FOR PRIVATE PROVIDERST ILU CI E (CQ';TM (CODE (C®MPLI ANIPF I[All-WRON 2300 V irgirtia Avenue Ft Pierce, VL 34992 6GANNED BY oftico (17*"Wcogguntyg�, 1?tm (772WE NVEI d' ��dd DEC 0 8 2015 Application for FTWOO 1�ir®dut��lr ft®� �ll�im� iS,r; n ay ! Quu9YeQ�fl®St. Lucie County, FL (A/E Agreement. Revised July 1. = ns)'... St Lucie County Code Compliance PERMIT it: DATE: _. , A STREBTADDRESS: 5C�59 J o� HOY Parcel A: YO: St. Lucie County Building Department FL PE tztJ752o sZ- �1o61 I have elected to utilize M ! h- Qi I R Lt1e P ;tee j,�!t;µ anou Number) (Name of Sint- Registered Arohltcct! Enginmr) (As rceognimd in chapter 46e, 471, Florida Sletutcs) r1niNAME: JZ FL ADDRESS: 1030 37" dye VP,1-O QeaG-t l---3Z960 TELEPHONE #-. 'L 72) s��-�Z57 FA5(# : 777 � $�q �IO�I as a private provider as authorized in S. 553.791, Florida Statutes. I h:,vc oIvrl _-d to use this "Private Providee , for: (check all that apply): 1P7.ANSREgrJ[B9y; Euilding, Electrical, I:chznical,• Plumbing (Amdavh Required) 'cl :chanical, --Plumbing, INSPEC'TION(s); —Building, Electrical, FEE SaP/AM E OWNER-* I have elected to use one or more private providers to provide building W d"r 11an review and/or inspections services on the building that is the subject of the enelosod permit application, -%S burly r ized by Par[ XII, chapter 468, Florida Statutes & s. 553.791, Florida Statutes. I understand that the local bu!!dintt 1: icial may not review the plans submitted or perform the required building inspections to determine ,: 1 .mpl:., cc wielt the applicable codes, except to the extent specified in said law. Instead, plans review and/or required t•udd i .; )nspeo!ions shall be performed by licensed or certified personnel identified in the application. The law : t:uui! tl ninhrruin insurance requirements for such personnel, but I understand that I may require more insurance to v t11.f C' my interests. By executing this form, l acknowledge that I have made inquiry regarding the competence of I I,C lice r:-ed or ceniried personnel and the level of their insurance and am satisfied that my interests are adequately profile:,, v I agree to indemnify, defend mild hold harmless the local governmen avd i r: tl building official(s) from any and all claims arising from my use of these licensed or certifiedeh ts thersubjectlteection services f,111c 1. 1. lose li gt i applicode cation, I understand and/or plans review. With respect to the building that iP I elect to make any changes to the listed private providers or the 4cr • •: as to an provided those private providers, the fee simple.owner I shall, within twenty-four (24) how^; aft: ay chgrv, updatee the notice to reflect t such changes. o FEE SIMPI,)E ®WN2 Rr Pig rG'o`� 6c Itmwc(,ora�vn,�y (SIGNATlWI!IV2EOwNER) 'PRINTNAMh U1'"ESIMPLEO R) fVuy l a 1s (7.Zzi 569-9553 r II -/,NEB:) (DATE) � g 3 5 Zo ? k)cz Vero 6e�,c (gDDRE55) tr'.uulcti5s) 121 1V®TARV: STATE U JULIE A BARRETT ®vl�ITS' �( •�"+`T^'` �+ uP�� ' f OMMISSION #FF132752 The for going inspument was acknowledged before me thi :y of ��_ OVA 0 BY fj OS A4y commis :u1 c::r es:$ E$ September 2a, 2n16 (�P,n2 S _ Personallyown Produced 1D Type o id iIir,::•1 , 1� taryService.com Signature of Notary Public --State of I affirm that am qualified under chapter 468 or 471, Florida Statu;t:a .o :•i. •vide 9uildIng code plan review services as authorized by s. 553.791, Florida Statutes pursuant to section 10•I. ; 2 ;' , -rida Building Code with respect to the building that is the subject of the enclosed permit application_ I undrl>:b:r: hat the beak building official may not review the plans submitted or perform the required building inspecl:ons ' 1 etelmine compliance with the applicable codes, except to the extent specified in said law. OPER I have reviewed the eonstructir , 'Lis / documents to determine complcincu • r determined that the plans reviewed comply with the applicable ' „ u,e applicable codes, i have codes.I accep with all provisions of the standard / technical codes and other'pertinent lows ; Il respoasibility for eompliahce i rdinances. I provide my seal and signature as affidavit under oath, that the folloWing is true. and correct t:r rue ..:. of ny 7nowledge and belief, (a) The plans / documents were reviewed liy myself. I am duly awdin; in :' o perform plan review pursuant to the code and hold the appropriate licenses or certificates. (b) I am qualified as a plan examiner under Part xrI of Chapter• 4E:t. 1'h t• i a Statut,.:s. (c) The plans comply with the applicable codes, standards, statute:, and 11: it ordhimicus or regulatory agency requirelnepts, (d) The plans comply to the laws as to egress, Life Safety Codes, Ivve nrt 'niuvoZion and general arrangement and show the structural design. (e) The plans and design conform to the requirements of the techn:rul c:•,:: s as to strength, stresses, strain and stability, (f) To the best of my knowledge, the plans and speciftcations corm:!.• ", 1 the applicable minimum building codes and the applicable firc-safety standards as determined b; the t •;1 I authority in,accordance with the Florida Building Code and chapter 633 Florida Statutes. ilthlSp�v�dilO1W5: . I affirm that I am qualified under s. 468 Florida Statutes to provide buil,l:ng 1 r; acticn services as authorized by s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building'. Cudc Lis understood that the undersigned hereby accepts the responsibility for performing all of the required inspeimmn:• erltrtled in this document. I understand that inspections are required as detailed in Section 105 of the I• Int t I. Building Code, the permit card, and as prescribed by the local authority having jurisdiction. I further agree t,:• I:ishl -1 Lucie County harmless for such inspections, and accept responsibility for compliance with all other regt i-naw ,- contained within. Upon completion ofthe structure, I will provide the Building Official a certification tbatt•%t ;u i..:. Ire, electrical, gas, mechanical and plumbing systems have been erected in accordance with requirements of !1m 1, t: nicuI codes. The undersigned certifies that all work inspected (and approved) will coi-`'artr 1. all applicable codes and standards; as well as all related permit documents. In the event of any conflict between I is and documents, the more restrictive shall apply. A log shall be maintained of all inspections made ittcl,u 1: g the date of the inspection, the inspection performed using the permit "hard card" terminology and the hlr •1p, n• on of either approved or disapproved and an inspection report shall be forwarded to the Building I epuri- lent within 72-hours of making the inspection. Cach inspection report shall bear the seal of the Architect / I ,t:•:n_ 1 rerforming the inspection, along with his / her signature and the date. The permit will expire unless work •, rrr enced (and receives an approved inspection "colored red on the permit hard card, red print indicates a rota 1'-ut r. pecliou watch satisfies the I80-day requirement") within 180-days (60-days for demolition permits) from tt-,- :1n.: ate crtbe permit. All subsequent inspections shall be made within i 80-day time frame prior to permit exp1: atirn•. '40 INSPECTIONS WILL BE QiAIV1D;[,IEID ".reF"¢'I;1R-Ti QQ�-F'AC�'". o Architect / Fngineer: 0 I-oyae I a Ine i�C (PRINTED NAME OF Architect Engi ear) IIlZg116 (DATE) Z 0 30 3-7 NOTARYz sTltLTE ®� U ciI 11 rginccrl (p111,wl •. t('.. JULIE A BARREIT MY COMMISSION #FFr32752 Seal:oi'r,.d' EXPIRES September 28, 2018 C09JNTli )F a r n n ti\yc,t ' • —• --- oIn`a`ltlCyl�/te� ✓_lIet:s,nrr: �J?B�--1-a- ao e thiscg ay o+The mE rp/etub 20 � By My commission Pets V V Known _ProdueadID T eofr ntificanun:/� _ Signature of Notary public — State of �—: Whenever the owner / contractor desires an inspection to be performed'v.any 1 a other than the above or a St Lucie County Inspector, a now application form must be submitted and appro.•rrl tr.• n r St Lucie County Building Official or Building Code Supervisor BEFORE the subject inspection (a) is (are I'I ilz RME:i> • Cxl The St Lucie County Building Department may at any I all times visit tar con•: t -.ration sit• to ensure compliance The St Lucie County Building Department may at any / all times visit t.a. aons•r,< '` n sur to ensure compliance 121 and / or for the purpose ofspot, . ;ctiona to verifying construction act ,•d,r.:: i ,ompliance with the ' construction documenLg / draw; ' . -_ (Failure to follow standard operating procedures for inspections for Ni l a.n w County many negate any'further approvals for you or your form to perform this type of inspection. In ;addj, i•• n, 111cornplete or baccuiate inspection reports may result in tailed inspections, work stoppage a:, t n• :-ermil expiration. /Ill violators will he referred to the �l • lD 11 g& Should you have any questions regarding this procedure, please contact !:,,• S' ' cie ('onoty Building Department o IBuildingOfficialorBuilding Code supervisor Print Name Sigpaatoao-e