HomeMy WebLinkAboutAPPLICATION FOR PRIVATE PROVIDERTLUV__�q 1011-
2300 Virginia Avenue,
Ft Pierce, FL 34992
Office (772) 462-1553
]. we ('772) 462-1145
Application for PrrAvate provider for plans 1%',c; jew I Impeptions SCANNED
(A/E Agreement. Revised July 1. _ Iii)1. SY
St Lucie County Code Compliance Olvi:: r St, LUCID r0nnt,
PERMIT # ;
DATE: 04-25-2017.-
STRgET.ADDRESS: 5061 NORTH 1 1118 A1A � PI€RCI=, €L-34-9�—
Parcelll: 141460100009999
TO: St. Lucie County Building Department
FL PE# 47520 / SI# 1061
1 have elected to utilize MICHAEL A I IIF satciiiYimtonNumber)
(Name ofStato Registered Architect/Engineer) rc,
co imd in chaptcr468,411, Florida statutes)
rIRMNAME: M. L. EWl EERING INC. -----
ADDRESS: 2030 37TH AVE VERO BEACH FI 32960 -----
TEi..EPHONE f•: 77( 2-5�9-1257 FAX# : 772-M9=4.041
as a private provider as authorized ins, 553.791, Florida Statutes. I have• ci:•r I sd W use this "private Provider" for:
(check all that apply):
PLANS REVIEW: __Building, _____Electrical, „ ' :chenical,, Plumbing_
(Affidavit Required) 'al .chan1cnl, —Plumbing.
)( IRISPECTION(s): _Building, Electrical,
FEE SANAME OWNER:
:
I have elected to use one or more private providers to provide buildin R I-uclr- rlan raviow and/or inspections services
on the building that is the subject of the enclosed permit application, .ty tiurw r ized by Part X1I, chapter 469, Florida
Statutes & s. 553.791, Florida Statutes. I understand that the local bui Idintt t: icial mny not review the plans
submitted or perform the required building inspections to determine (1tT1pi:) ec with the applicable codes, except to
the extent specified in said law, Instead, plans review and/or required t•wltl r ., inspeotions shall be performed by
licensed or certified personnel identified in the application. The law: until - s niniinuin insurance requirements for
such personnel, but I understand that I may require more insurance to p t otec • my interests. By executing this form, ➢
acknowledge that I stave made inquiry regarding the competence of Ibc licrr:ed or certified personnel and the level
of dteir insurance and am satisfied that my interests are adequately pros rcr v
I agree to indemnify, defend and hold harmless the local goventmen and i ,,: d building official(s) from any and all
claims arising from my use of these licensed or certified personnel to per ft r• builllo:g code inspection services
and/or plans review. With respect to the building that is the subject c i' n is : t - Iosod penult application, ➢ understand
that if I elect to make any changes to the listed private providers or the wr-. •: as to be provided by those private
providers, the fee simple.ownor [ shall, within twenty-four (24) hour,, efir •: ay t•,hangcy, update the notice to reflect
such changes.
o FEE SIMPLY OWNER:
GENE ROSS, BRYN MAWR PRO RTY MANAGER
(P[[MY NAME OF FER SI GB OWNER) (SMATURP0 1 F: S14 24)
/g7 772-569-9853— __. _ __
i'I. NEC)
ELLIOTT MERRILL MANAGEMEN 8 . VEROZEAGH F4=329o9 — t �
(ADDRESS)
(ADDRESS) 121
NOTARY -
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____ ca: - of
By My commigslon c:r
Personally Known Produced lU Type of idem I ica t
Signature of Notary Public — State of
'200_
•es: '
AMIIDAVIT )FOR iPLA.P: ate+.' ' FAN':
I affirm that I am qualified under chapter 468 or 471, Florida Statu:t:+ to ri - •vide building code plan review services
as authorized by s. 553.791, Florida Statutes pursuant to section 10•1.1 2 t' rlda Buildbig Code with respect to the
building that is the subject of the enclosed permit application_ I undrrcL: rY hat the local building official may not
review the plans submitted or perform the required building inspecimus ' i -etetmine compliance with the applicable
codes, except to the extent specified in said law.
aVER
I have reviewed the construction plans / documents to determine complriru.:c -1•
determined that the plans reviewed comply
h the applicable codes. 1 have
'
with the applicable codes. I acceli
with all provisions of the standard / technical codes and other'peninent lit ws ; :•
Il responsibility £or eomplianca
i rdinancus. I provide my seal and
signature as affidavit under oath, that the following is true. and correct t•.i vw ::.
of say lnowledge and belieF.
(a) The plans / documents were reviewed liy myself, I am duly auilv:i i%t••:
the code and hold the appropriate licenses or certificates.
o perform plan review pursuant to
(b) I am qualified as a plan examiner under Part xu of Chapter 46 R• 1'1-r i
(c) The
a Statutes.
plans comply with the applicable codes, standards, statute:, and 1 1:
it ordinances or regulatory agency
requirements,
(d) The plans comply to the laws as to egress, Life Safety Codes, t; i:r- «rr
and show the structural design.
ns uclion and general arrangement
(e) The plans and design conform to the requirements of the technical cc•{
: ; as to stxungth, stresses, strain and
stability,
(0 To the best of my knowledge, the plans and specifications comp:• �,
1 the applicable minimum building
codes and the applicable fire -safety standards as determined b, iliu 1 •:;
I authority in accordance with the
Florida Building Code and chapter 633 Florida Statutes,
Rnspectiongt
I affirm that I am qualified under s. 468 Florida Statutes to provide buil Lrip, it" i action services as authorized by
s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building. r'rlde I Is undorscood that the undersigned
hereby accepts the responsibility for performing all of the required inspetmow. - entitled in this document, i
understand that inspections are required as detailed in Section 105 of the I• lot r I. Building code, the permit card, and
as prescribed by the local authority having jurisdiction. I fiuther agree t: 1:idd -1 Lucin County harmless for such
inspections, and accept responsibility for compliance with all other regt 1 -i-ii1 :• :• contained within. Upon completion
of the structure, I will provide the Building Official a certification tbatt•t_ tie,.,:. ire, electrical, gas, mechanical and
plumbing systems have been erected In accordance with requirements o! :hc it t : nicld codes_
The undersigned certifies that all work inspected (and approved) will cci-`orir, i. all applicable codes and standards;
as well as all related permit documents. In the event of any conflict betw.:(!ri :• ul 1s and documents, the more
restrictive shall apply. A log shall he maintained of all inspections made incl, i I 1 g tit: date of the inspection, the
inspection performed using the permit "hard card" terminology and the di:N-p+ a• onaf either approved or
disapproved and an inspection report shall be forwarded to the Building Oviv.i 1 • tent within 72-hours of making the
inspection. Each inspection report shall bear the seal of the Architect / I lini 1) _1 cerformino the inspection, along
with his / her signature and the date. The permit will expire'unless work •,:r rr enced (and receives an approved
inspection "colored red on the permit hard card, red print indicates a reel r-a r. pectiou which satisfies the 180-day
requirement") within 180-days (60-days for demolition permits) from t1w :•.11•..: ate orthe permit. All subsequent
inspections shall be made within 180-day time frame prior to permit expiration•. 10 iNSPECTION� ..
PERF0I31VLEFD SPJBSEOIUENTTO PERMIT E%PiIiRATION• AND NO 1�:•P�C:TIONS WI ! 1� . AN7 ' .
....,
IZANnzEIDrAFaER-To->E-FAa T . ���P,,. i•y��
•'LNG.'• �CENS
o Architect/Engineer: �� • G
MICHAEL A. LUE ___ No 47520 ' m
(PRINTED NAME. OF Architect/Engineer) IGNATUR13:0 .\x•; •ctl l•:ngineer)_-* _,*
=..
04/25/17 7-569-1257 -0 STATE OF
(DATE)
2030 37TH AVE., VERO BEACH, FL 32960 'O R 1 O •' ��
APChiter! Ent!% leer •; CHRUMNE L JACKMAN
NOTAlR4i: Seal:
STATE OF FLORIDA rosy COMMISSION N F8
COUNTY- OF �B EXP fRE 6.2020
sw tm am�20
The foregoing instrument was ac owledgcd before me this 25TKy o' APRIL— _,
By MICHAEL A. LUE hay cotnmission 1:N-:trr•r: ___02/1 Iron
Personally Known Produced fident"Scaliun:
Signature of Notary Public — Stste of_:
J•
lJorT
Wlieneverthe owner/ contractor desires an inspection to be performed `r wrr-) a other Than the above or a St Lucie
County Inspector, anew application form must be submitted and approved 9t• : : St i_ucic CountyBuilding Official
or Building Code Supervisor 13EFORE the subject inspection (s) is (arc - CI I RMF:D
The St Lucie County Building Department may at any / all times visit to • ;or 1 • etiori site to ensure compliance
The St Lucie County Building li - - ment may at any / all times Via"4•v 4:on•,•i ar' s h to ensure compliance
and! or for the purpose of spot irr, 1fions to verifying construction act %-1!mi i i -' npliance with the
construction documeotq / drawings,
121
(Failure to rollow standard operating procedures for inspections for f�l Ell, t.t County may negate any furthr
approvals for y0on or your form to perform this typo of inspection. In nddi, i n, incaotpletc or Naccucate
inspection reports may result in failed inspections, work Stoppagea:lj +nr •-ermil expiration. All violators
will he rara_rrpd on Ph.. Cr. fn D D n
J ave any gvcationa regarding this procedure, please contact I:n• c-
G+ l
y 'o IDuilding Official or Building Code Supervisor
Print Name liignatu¢c
cia L'-onoty Building Deportment