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Home My WebLink AboutAPPLICATION FOR PRIVATE PROVIDERK • ST ILU CI E C'� '�iI` TYY (CODE (C®Mi I�1<,� �'��;`�"�� [�1(.�II[��N 2300 Virginia Avenue - Ft Pierce, FL 34992 offico (772) 462-1553 rtt < (772) 462SGANNED BY St. Lucie County Application for Ffavate Flrovider f®sr Plans, R. -J near f ans peeflons (AfF Agreement. Revised July 1. ?1101. St Lucie County Code Compliance PERMIT #: DATE: E� P—S 7QLP_ STREET ADDRESS: A Et�.e�3 Parcel 9: TO: St. Lucie County Building 1 have elected to utilize R •� IWl itaLC l:ct;iRtmLieaN mbcrj P1RA4 NAME: 1 1 IaLnCV 1 !�lS;,� ----•• ADDRESS: p �J 3_,() T 1�1[-?7 Vem &Lh—R �f Rte_ � �� TELEPHONE �%"I r! — FAX 1 � IO)(J_tYp Y� 1 as a private provider as authorized in s. 553.791, Florida Statutes. 1 h:ivr al: ri sd to use this "Private Provider" for: (check all that apply)- - �9,815 iRequi ed) building, Electrical, :c l lu g INSP, CTTuire� •,:I :c 1 lU bb iR35)P3GC iCI®id(s): _Building, Electrical, LY LPy PEE 5➢.ivfli'M OWNER! I line elected to use one or more private providers to provide building, Lodr, Ilan review and/or inspections services on the building that is The subject of the enclosed permit application, .Ls riurty r !zed by part)M, chapter 469, Florida Statutes & s. 553.791, Florida Statutes.I understand that the local buildinl.. 1: ieial miry not review the plans submitted or perform the required building inspections to determine mpi:d ; c with tite applicable codesi except to the extdht specified in said law. Instead, plans review and/or required Ptnld i ., inspections shall be performed by licensed or certified personnel identified in the application. The law: umib vs ninirn an insurance requirements for such personnel, but I understand that I may require more insurance to , i .xec' my interests. By executing this, form, I acknowledge that I have made inquiry regarding the competence of I be licrr:ed or certified personnel and the level of their insurance and am satisfied that my interests are adequately pro acci; c I agree to indemnify, defend mud hold harmless the local goveramen and 1 1-: d building official(s) from any and all claims arising from my use of these licensed or certified personnel to perrL r• builduvg code inspection services and/or plans review. With respect to the building that is the subject o!'I] ic :1- lited Puri)) it application, T understand that if t elect to wake any changes to the listed private providers or the cr • •: cs to be provided by those private providers, the fee sunple.owncr I shall, within twonty-four (24) hbur. ;rrt,:- -:ay change~, update the notice to reflect such changes. // FEE geoifi FL �29(Iri (2) ' NOTARY: � STATE Non COUNTY 6� The reg fop ins 1) T) f of Notary w ac1 wlcdged before me this e Res ley e Produced ID Type/ c—Stateof �: uL AFFIDAVIT FOR ol:,. ,r_G� a _, 20f IBn7n::r c'es: I-OLr I id I i• RE IFW: I affirm that am qualified under chapter 469 or 471, Florida Statu:t:a to :•i- -vide building code plan review services as authorized by s. 553.791, Florida Statutes pursuant to section 1 Q•1.1 2 t • i -rida Building Code with respect to the buildbng that is the subject of the enclosed permit application. I unilri::L:i•: hat the local building official may not review the plans submitted or perform the required building inspeci:rms , i etetmine compliance with the applicable codes, except to the extent specified in said law. W bo, °•; JULIE A BARRETT MY COMMISSION #FF732752 ti``... \aoiha^F EXPIRES September 28,2018 (407) 398-0153 Florltlallol.ry. a kp,tgIn I fbave reviewed the constructio ns / documents to determine compl:nnre ^r h , pplicable codes• i have determined that the plans revie%,, ;;omplywith the applicable codes. i ac. ep ' Il rusponsihility for eome)lAbOe with all provisions of the staudadd / technical codes and other'pertinent 11::�'., - I rdinancus. I prov{de my seal and signature as affidavit under oath, that rite following is true. Bud correct ti the ,-e . of tsy kricwledge and belief. - (a) The plans / documents 'vote reviewed Sy rnyself. I am duly autliru in : o pl:rfnrm plan ievlew pursuant to the code and hold the appropriate licenses or certificates. (b) I am qualified as a plan examiner under Part Xrl of Chaptet• 46.9, 1'1u• 1 a Statute. (c) The plans comply with the applicable codes, standards, statute:. and ! 1: d ordinaurcus or regulatory agency requirements, (d) The plans comply to the laws as to egress, Life Safety Codes, l;, ry ,I! t m5nuction and general arrangement and show the structural design. ' (e) The plans and design conform to the requirements of the technu•ul cc'{ : i as to strength, stresses, strain and stability, W To the best of my knowledge, the plans and specifications cord;;.• ve I the'applicable minimum building codes and the applicable fir safety standards as determined by Iln: t •: ; I authority in accordance with the Florida Building Code and chapter 633 Florida Statutes. ][m1sp�Qdnouast I affirm'that 1 am qualified under s. 468 Florida Statutes to provide builrLol.. it,; teticn services as authorized by s, 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building•. I, „tie I. is undorstood that the undersigned hereby accepts the responsibility for performing all of the required inspctn ion.,- - crui(led in this document. I understand that inspections are required as detailed in Section 105 of the I. Iol I I. Building Code, the permit card, and as prescribed by the local authority having jurisdiction. I further agree t: h, dt 1 ^I Lude County harmless for such inspections, and accept responsibility for compliance with all other regt l-Innt:• „ contained within, Upon completion of the structure, ) will provide the Building Official a certification tbatt•,c No i,c • ire, electrical, gas, mechanical and plumbing systems have been erected in accordance with requirements o' ![w it t: nical codcs- The undersigned certifies that all work inspected (and approved) will covForin I . all applicable codes and staudards; as well as all related permit documents. In the event of any conflict bete ccn :-,,I is and documents, the more restrictive shall apply. A log shall be maintained of all inspections madt• incin I ! g the date of the inspection, the inspection performed using the permit "hard card" terminology and the ;It ;pt ;i• on of either approved or disapproved and an inspection report shall be forwarded to the Building I uptart- tent within 72-hours of making the inspection. Cach inspection report shall bear the seal of the Architect / F tl;•:It_ •I )erforming, the inspection, along with his / her signature and the date. The permit will expire unless work r ' t^,•I• encetl (:md receives an approved inspection "colored red on the permit hard card, red print indicates a reel r-u r. pectiou which satisfies the I80-day requirement") within 1110-days (60-days for demolition permits) from tt,' SII•..: ate of-ihe permit. All subsequent inspections shall be made within 180-day rime frame prior to permit expiniliw% d0 INSPLCTIONS WILL HE �-�- (P i DNA E QVArGhiteotiEngineer) (SIGNAT REt-- Ai.r:-ci/1'nginecr) Q-9-IL42 72 sGq- 7 (DATE) ,.41 •. APCllite['r 1 l{Yt1: lee,may ull- SNOTA TATEOF iO: Seal: FILE ttii/\.i�'9M* COi3NTY OF � 'fhe foregoing Instromegt ac wind d before me this ay of ;� t"t ��1ISS L JACKMA�V By ��il P I w t—J✓( My commission E.1nrr>: v Ca'M�aI5SI0N p FF�2316 Personal y Known,,'! Produced lD Type of identifi I ion: RE8 February 18. 2020 Signature of Notary Public— State of Whenever the owner / contractor desires an inspection to be performed'[: amp•/ a other than the above or a St Lucie County Inspector, a new application form must be submitted and approv:'d ;);• : ! a St Lucie County Building Official or Building Code Supervisor 13IE1FORE the subject inspection (a) is (are - PI (]a 4: WED ' tx] The St Lucie County Building Department may at any / all times visit t•u• t•.on,•I •,etion sits- to ensure compliance _ — ....,„,,.., —,,,y �,,,,,,,g uepar[tltent may at any / all tithes visit t.li• coin 1 aotlon S,tl• to ertsUre compliance C21 and! or for the purpose of spot I ^^ctions to verifying construction act ad,cx i ;.impliance with the construction documents / drawer Failure to follow standard operating procedures for Inspections for `t q &t. la Coulity may negate any further Approvals for yma or your term to perforca this typo of inspection. In addi%i•• n, Itteoraplete or inaccuinte inspection reports MAY result in failed inspections, work stoppage at,o + o. I•ermil expiration_ All violators will he referred to tfte F . lD $ Pl3 Should you have any questions regarding this procedure, please contact;!, s• • Cie Conoty Building Department C Illuilding Official or Building Code Supervisor Print Name Signature