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Home My WebLink AboutAPPLICATION FOR PRIVATE PROVIDERM 2300 Virginia Avenue Ft Fierce, FL 34952 Application for Private Pirovedelr for Floats HX ; iiew (A/E Agreement, Revised July 1. St Lucie County Code Compliance PERMIT #: DATE: 04-25-2017•_ Ofile. (772) 462-1553 ] ICK (772) 4 2-1148 SCANNED BY St. Lucie Cook ! inspections STREET.ADDRESS: 5059 NORTH PI€RCE, €•L34949 -� Parcel it: 14146 110000.9999 — TO: St. Lucie County Building Department FL PE# 47520 / SI# 1061 ,have electcdtoutitize MICHAEI_A I l)F ej;� Yi;iionNumbc.) (Name of, State Registered Archncet/Engineer) �'� M. L. EN`81WERINGr INC t, Fioddo slatma> ADDRESS: 2030 37TH AVE VERO BEACH Fl '12960 ----- TELEPHONE lk 7L 72--' 257 FAX , 772LB9=4D41 as a private provider as authorized in s. 553.791, Florida Statutes. I havr clrc! :d to use this "private Provider" for: (check all that apply): PLANS REVIEW: ____Building, _,Electrical, :chznical, , Plumbing. (Affidavit Required) 't•I :ehan'tcnl, _�Plumbin X IidSFECTION(s): Building, _Electrical, g, FEE SI1vWLE OWI' FRI 1 have 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, •ts wir?v r ized by part XI1, chapter 468, Florida Statutes & s. 553.791, Florida Statutes. I understand that the local bui dtni,. ? : Icial may not review the plans submitted or perform the required building inspections to determine,:, nnp i:, e c with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required t: ud;l t ., inspec!ions shall be performed by licensed or certified personnel identified in the application. The law . V:tlt?ii : s ninimuin insurance requirements for such personnel, but I understand that I may require more insurance to , ? oix,. • my interesis. By executing this form, I acknowledge that I have made inquiryregarding the competence of I be kvcr:•.d or certified personnel and the level of their insurance and am satisfied that my interests are adequately pruu:r.'.t r I agree to indemnify, defend and hold harmless the local governmen iuld 1 v: tl building official(s) from any and all claims arising from my use of these licensed or certified personnel to pur fi r• budding code inspection services and/or plans review. With respect to the building that is the subject c f tl is :1- iosed permit application, T understand that if I elect to make any changes to the listed private providers or the qcr•• •: cs to be provided by those private providers, the fee simple,owner I shall, within twenty-four (24) hour•:.4tr •:ay thangcy, update the notice to reflect such changes- _ o FEE SIiViPLY, OWNER: GENE BOSS BRYN MAWR PROPERTY MANAGER (PRRJY NAM>: OF FELT SIMPLE OWNER) (SIGNATtntl•t. •?!-SIh4PL•C ER) 772-569-9853___.___ (DATE) N- )NE#1 ELLIOTT MERRILL MANAGEMENT B35 20TH Pl . VEROZEAw r -32966 t.] (ADDRESS) (AOURESS) (2 ) NOTARY: STATE OF COUNTY OF The foregoing instrument was acknowledged before me this ____ c:;tp of By My come iss un; c>: r Personally Known Produced TU Type of idem i t ica, t Signature of Notary Public — State of _,200_ I affirm that I am qualified under chapter 468 or 471, Florida Statu;ct m :-r � Mile building code plan review services as authorized by s. 553.791, Florida Statutes pursuant to section 10-I . � 2 t' , -rida Building Code with respect to the building that is the subject of the enclosed permit application_ I undr,:<ts: rY hat the local building official may not review the plans submitted or perform the required building inspecimrrs ' r -etermine compliance with the applicable codes, except to the extent specified in said law. 0VER I have reviewed the eonstructioa plans / documents to determine comphnnt:c ••r determined that the plans reviewed comply with the applicable codes. I accep ' h the applicable codes. i have Il responsibility for compliance with all provisions of the standard / technical codes and other'pertinent I;iw.s ; �• i signature as affidavit under oath, that the fallowing is true, and correct t:t rta . e rdinancus. I provide my seal and . of my lotowledge and belief. (a) The plans / documents were reviewed 6y myself. I am duly au-0im ire•_ the code and hold the appropriate licenses o perf irm plan review pursuant to or certificates. (b) I am qualified as a plan examiner under Part XH of Chapter 46x, Hi r i a Statuv..:s. (e) The plans comply with the applicable codes, standards, statute:, urtd 1 1 : 11 ol'd'uuurces or regulatory agency requirements. (d) The plans comply to the laws as to egress, Life Safety Codes, I ;• pt- a: t ,nsnuction and general arrangement and show the structural design. (a) The plans and design conform to the requirements of the techmr:il cr{ : s as u) strength, stresses, strain and stability, (fl To the best of my knowledge, the plans and specifications comb. . ; the applicable minimum building codes and the applicable fire -safety standards as determined b;. 11tc 1.; ; I authority in accordance with the Florida Building Code and chapter 633 Florida Statutes, Inspections: I affirm that I am qualified under s. 468 Florida Statutes to provide builrl:np, ; r; ection services as authorized by s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building. Ctldl,' t is uudorstood that the undersigned hereby accepts the responsibility for performing all of the required inspccttnns . eotilied in this document. 1 understand that inspections are required as detailed in Section 105 of the I• lot t I. Building Code, the permit card, and as prescribed by the local authority having jurisdiction. I further agree br IndtI -I Lucie: County harmless for such inspections, and accept responsibility for compliance with all other regt i-rnw- cent:tined within. Upon completion of the structure, 1 will provide the Building Official a certification that t•u }it t.c. ire, electrical, gas, mechanical and plumbing systems have been erected in accordance with requirements o' :I it: 11 t: nical codes. The undersigned certifies that all work inspected (and approved) will cool. Our I . all applicable codes and standards; as well as all related permit documents. In the event of any conflict bebywe,i : I :s and documents, the more restrictive shall apply. A log shall be maintained of ail inspections mach hicP; I! g the [tote of the inspection, the inspection performed using the permit "hard card" terminology and the to mp a• on of either approved or disapproved and an inspection report shall be forwarded to the Building I INX t•• ,ent within 72-hours of making the inspection. Each inspection report shall bear the seal of the Architect / I o;•:n:-1 rerforming the inspection, along with his/her signature and the date. The permit will expire unless work ,:r•rr meet (:md receives an approved inspection "colored red on the permit hard card, red print indicates a recn a r% pectiou which satisfies the 180-day requiremcmP') within 180-days (60-days for demolition permits) from t1w :.;t1•..: ate 91-the pen -nit. All subsequent inspections shall be made within180-day time frame prior to permitexpratita•.'d0INSPECTIONS !'V1i LBE o Architect / Fngineer: , G� • . • .. • y0 10 MICHAEL A. LUE 1 C E •'• 2 (PRIM EONAMEOFArchiteet/Engineer) (S[GNATURL-::' :;: .•cil lvngmcerl� �s �' 04/25/17 77-569-1257 ?f NO 47g •:�G M. (DATE) (pl n vat ?0 • 2030 37TH AVE., VERO BEACH, FL 32960 :O Fop . *. (ADDRP,SS) .. �••,. ' . Q'• .So.•�RIDP.•:4�.• Architec•e ' runt:: leer NOTA&RYz Seal: ' r• �.�4Z'KN1AN STATEOE FLORIDA Af9OOMWsih�NaFF962316 EXPIRES February is. 2o2o COUNTY -OF oar a®ac•m ctQ4enom s. mmm The foregoing instrument was M owledged before me this 25Tay o+ APRIL By MICHAELA. LUE naycommission Mtn•>: _A2/J8/70?n Personally Known __� Produced ID T e of idanffca litill: Signature ofNotaryPublie—state of F:l Whenever the owner / contractor desires an inspection to be performed' n anp •s : othi:r than the above or a St Lucie County Inspector, a new application form must be submitted and approve d tr.• :1: St l.ucie County Building Official or Building Code Supervisor BEFORE the subject inspection (s) is (are - Ill tit : RAREa ' Ca] The St Lucie County Building Department may at any / all times visit t v ;.ui ;. •letiotr sit• to ensure compliance The St Lucie County Building D,,� .,ment may at any / all times visit car cvn : •ac - .sitt• to ensure compliance [2] and I or for the purpose of spot in6 .`;ions to verifying construction act •d,a; i • i,, - . _npliance with the construction documents /drawings. ]Failure to follow standard operating procedures ror faspections for Sr l.t.n w County many negate any further approvals for you or your term to perform this typo of inspection. In flddi%i-• n, Incomplete or inaccllQ'ate Inspection reports may result in failed inspections, work stoppage a:w + n• ,ermil expiration. All violators will be referred to the M B N I Should you have any questions regarding this procedure, please contact t:,,. i, ' cie County Building Department 4 ]Building Official or Building Code Supervisor Print Plante signature -- — Date