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Home My WebLink AboutAPPLICATION FOR PRIVATE PROVIDER PLANST LU(�I�+ (�((T�i(TfifT�j(CODE (CO�ULA1l �r'��i(C�� iI�II.D!ll9llV111� 2300 Virginia Avenue Ft Fierce, FL 34952 offico (172) 462-1553 1--inc (772) 462-1148 Application for FRIV00 P rOVIdew for FRa ns 1t,c;'ew (A/B Agreement, Revised July 1. 3111)1. StLueie,County Code Compliance !Irvi:< v , SCANNED BY a nspectlo%§t Lucie Counh, DATE: co? PERMIT 0: �! Lc STREET ADDRESS: ��D& ALOr H--/ t� "� OltI� Parcel If: YO: St. Lucie County Building Department � 1 have elected to utilize 1' "' E111 e, IiLS� (Name o£ .. Registered Archacet/ EngInecr) +tote Itcl i,trntion umber) rye me gnwd in chapter d 8�ll 411 Florida Statutes) ORM NAME: ADDRESS_ - TELEPHONE 1tl�alV� ��.LI FAX V as a private provider as authorized in s, 553.791, Florida Statutes, I have u1vr1 sd to a,r, this "Private Provider" for: (check all that apply): ? LANS REVIEW: Building, Electrical, „ ' :chznical, , Plumbing. �tAmdavitRequired) l :chanical, 1NSP%CTIGN(s): Building, Electrical, _ Plumbing. FIEiE 51.IvdM E ®`6v7N Eli3: i have elected to use one or more private providers to provide buildinh WEIC ilan review and/or inspections services on the building that is the subject of the enclosed permit application, n€ aurN r ized by Part XI1, chapter 468, Florida Statutes & s, 553.791, Florida Statutes. I understand that the local bui Idml!, t: icial mny not review the plans submitted or perform the required building inspections to determine ,: wnp l:a �c with the applicable codes, except to the extent specified in said law, Instead, plans review and/or required I add I ., inspeceions shall be performed by licensed or certified personnel identified in the application. The law: voilliv s ninitnum insurance requirements for such personnel, but I understand that I may require more insurance ti 1 ill .Itrc my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of 1 be tisx r:ed, or certified personnel and the level of their insurance and am satisfied that my interests are adequately prui mil. r I agree to indemnify, defend and hold harmless the local governmen and i v: it building official(s) from any and all claims arising from my use of these licensed or certified personnel to i:ari't F. buiidu:g code inspection services and/or plans review. With respect to the building that is the subject o ii,c : i - loscd pemtft application, i understand that if 1 elect to make any, changes to the listed private providers or the cr s to be provided by those private providers, the fee simple.owna• I shall, within twenty-four (24) hour,; ati : ay changes, update the notice to reflect _ such changes. o FEE SIMPLY, ® w rA v,w,r n,enev nxIIs-cI L OWt ER) (SI AT '.I. flu I. F. Ih9PLG gVRdER) n--)5 Z (hVIe� Very t��z C}32U 121 NOTARV: STATE DF COUNTY Q The oregoit By of Notary as acknowledged before me this 0h, uT _l' 2�� y commission C:::' 'e My ,']X II Y roduced ID Type etritica I 111 — State Of XVm'n AVIT >F(QR IPL R vj 11 rev: I affirm than am qualified under chapter 468 or 471, Florida Statu:t:% m :•i as authorized by s. 553.791, Florida Statutes pursuant to section ttl i. 2 building that is the subject of the enclosed permit application. I under xL: r: review the plans submitted orperform the required bui [ding insped:ons • t codes, except to the extent specified in said law. OVER ^"'i"'��"4t, Jl1L1gEg •�� MY COF•i��' � � �°+ EXPIREay �pp,etga Flor -vide building code plan review services -rida Building Code with respect to the hat the local building official may not retetminc oumpliance with the applicable I have reviewed the constructic, ns/documents to determine compbam:c •r determined that the plaids ravie;,__`iomplywith the applicable codes.I accep C applicable codes, i have ' Il responsibility for compliance with all provisions of the standard / technical codes and other'periinent L:: , ; signature as affidavit under oath, that the following is true• and correct t-.i :. , rdinancus. I provide my seal and of my Jatowledge and belief: (a) The plans / documents were reviewed by myself. ➢ am duly ammo; irc•- the code and hold the appropriate licenses o perf>rm plan review pursuant to or certificates. (b) I am qualified as a plan examiner under Part XII of Chaptet 46x. 1'Inr i (c) The plans comply with the applicable codes, standards, statutes anti 1 t a Statutcc : it ordhla aces or regulatory agency requirements, (d) The plans comply to the laws as to egress, Life Safety Codes, t , ,: • n!-c and show the structural design. mst uction and general arrangement (e) The plans and design conform to the requirements of the technim I c: ,:: s as to srxcngth, stresses, strain, and stability. (f) To the best of my knowledge, the plans end specifications comph• v, : die applicable minimum building codes and tho applicable firo-safety standards as determined li ilit: i•t; I authority in accordance with the Florida Building Code and chapter 633 Florida Statutes. RnspecaiO➢Is: I affirm that l am qualified under s. 468 Florida Statutes to provide builrl:rIg : r; ection services as authorized by s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building•, ('tide 1 is mulorscood that the undersigned hereby accepts the responsibility for performing all of the required inspcitimiu• entilied in this document. I understand that inspections are required as detailed in Section 105 of the I' loi i I. Building Code, the permit card, and as prescribed by the local authority having jurisdiction. ) ftrther agree t,: I i dd -I Lucie: County harmless for such inspections, and accept responsibility for compliance with all other regi rniiw r• contained within. Upon completion of. the structure, I will provide the Building Official a certification tbatt•ic %o i.i. ire, electrical, gas, mechanical and plumbing systems have been erected in accordance with requirements o' !I:,: it i : nical cedes. The undersigned certifies that all work inspected (and approved) will ccc:fonv i. all applicable codes and standards; as well as all related permit documents. In the event of any conflict betwta•n r ul is and documents, the more restrictive shall apply. A log shad) be maintained of all inspections made hicl: i I : g the date of the inspection, the inspection performed using the permit "hard card" terminology and the a4•%tpr n. on of either approved or disapproved and an inspection report shall be forwarded to the Building Dena, t•• lent within 72-hours of making the inspection. Each inspection report shall bear the seal of the Architect / I :!I•:n_ •i )erforming the inspection, along with his / her signature and the date. The permit will expire'unless work-" , c r'r enced (anti receives an approved inspection "colored red on the permit hard card, red print indicates a rem i:-ec r. pectiou which satisfies the 180-day requiremcnf') within 180-days (60-days for demolition permits) from tl r• v,n•..: ate 91-the permit. All subsequent inspections shallbe made within 180-day time frameprior to permit expruirn•. 40 INSPECTIONS VVIILL 13F . PER O1RMIRDID SUBSEOAl1ENT TO PiERIVIRT EXPiIR3AT30N• ANM NQ 1- '•-PRCTIONS WILL BIL 11A1tTRL.E-1&FTE1@-THR_FAC7-. -- --- )4 r hiteet / : ngi or., (_11R D E FArchneet/Engraver) IGNATURE:i- ,)u•:.crl12.ngincerl Architecf ' Hn2::eer NOTARYt n Seal(': STATE OF _ CO9J1dT1<' OF The foregoing instrument was acknow edged before me this ,� day o' 2p0�rl t Byml )t71Ed R _t Lw Mycotnmission::s-mr:•:' " T TINELJACKMI�N Personally Known Produced 1D T e of i ati ca ' : ): Signature of Notary Public —State of f: ISStoNA18.202tu s Februaryts. 2020 1JJ)t9ar,'S7 f can Whenever the owner / contractor desires an inspection to be performed `): Bin•-•) a oth(:r-rtrstimte�tbwevt County Inspector, a now application form must be submitted mid approt.:•ci t)-, :,i J St Lucie County Building Official or Building Code Supervisor 1399ORE the subject inspection (a) is (are • t'Iil. WED tat The St Lucie County Building Department may at any / all times visit t.i:• ..:on ;•r •ietion sett, to ensure compliance —•••g •�dpo. m+am way at any / all tones visit tar i;Un I Acti011 srtL• to ensure compliance and / or for the purpose of spot inspections to verifying construction act t•inc, i ` nmpliance with the construction documeotg / draw° 121 iFailure to follow standard operating proeedures for inspections door tl 1,,.c. ,.i county may negate any finrt➢rcr approvals for yea or your firm to perform tdris typo of inspeceion. Yu a 3di+i n, irlcarnpicto or inacca f u will hInspee reports may result in failed inspections, wont stoppage awl + n. •,ermil expiration. All violators will he referred to 6lte Fr lD $ )P ➢t Should you have any gvestiena regarding this procedure, please contact Ini• S- 0 Building ®fdiciall or IBullaing Code Supervisor. Print Name Sigtratoao-s Cie Couoly Building Dcpertment (Date