HomeMy WebLinkAboutAPPLICATION FOR PRIVATE PROVIDERSri' LUCNE CIO _ TY (C®D'F-0MF11,W)\[(..- Dl[VIl'RON
2300 VirginiaAvettue
Ft Fierce, FL 34992
SCANNED
BY
St. Lucie Cnl lnty
Ofiicr. (772) 462-1553
Fim (772) 462-1145
Application for F rivate PT-Oviderr fan• F9Ri's �� < , iew / lwksPeeltaolms
(A/E Agreement. Revised July 1. _ i 4)1.
St Lucie County Code Compliance "i:+"
pERIAIT #:
DATE: 04-25-2017.
STREET.ADDItESS: 5055 NORTH HM AJA FnRr PIERCI=, €L-3444-9—
Parcel It: 14146 110000 1199
TO: St. Lucie County Building Department
FL PE# 47520 / SI# 1061
1 have elected to utilize M IC 114 A l ;tote It r, ar,uen Nam6cr)
(Name of. smtc Registored Architect! Engineer)
co imd in chap1cr 46a, 471, Florida Sratulcs)
rin4NAME: M. L. EI IOEERING INC. -----
ADDRESS: 2030 37TH AVE.,VERO BEA. CH FI a2960 -----
TEl EPNONE #: 77Z- 1-1257 FAX # , 772-589=41)41
as a private provider as authorized in s, 553.791, Florida Statutes. I h:: c cl: r� sd to use this "private Provider" for:
(check all that apply):
PLANS REVIEW: Building, ^&lcctdcal, v; ..chan ical, • �iumbing.
(Altdavitkequired) I :chan'tc:tl, _ Plumbing,
X INSPECI'ION(s): ,Building, _Electrical,
FEE SIMPLE OWNER-'
I have elected to use one or more private providers to provide building, ,_odr4 thin review and/or inspections services
on the building that is the subject of the enclosed permit application, n ti ir: r r ized by Part XII, chapter 468, Florida
Statutes & s. 553.791, Floridastatutes. I understand that the local buildmt,.:: ieial may not review the plans
submitted or perform the required building inspections to determine 1 'mpi:a ce With the. applicable codes, except to
the extent specified in said law, instead, plans review and/or required ! (uLl r ., inspections shall be performed by
licensed or certified personnel identified in the application. The law : t: tali t s ninimurn insurance requirements for
such personnel, but I understand tbat I may require more insurance to ;:: •.xrc my interests, By executing this form, I
acknowledge that I have made inquiry regarding the competence of the lice r:•ed or certified personnel and the level
of their insurance and am satisfied that my interests are adequately pr%11cc:t v
I agree to indemnify, defend and hold harmless the local governmen a •J i r: d building ufficial(s) from any and all
claims arising from my use of these licensed or certified personnel a: in:rfi r buil de:g code inspection services
and/or plans review. With respect to the building that is the subject (If the : i Iosed pcno(t application, f understand
that if 1 elect to make any changes to the listed private providers or tltc (:r • : es to be provided by those private
providers, the fee simple.owner I shall, within twenty-four (24) hourw :4tir :my cliangcs, update the notice to reflect
such changes.-
o FEE SIMPLE OWNER,
GENE ROSS, BRYN MAWR PROPE TY Mnn1AGER
(PRiNY NAME OF FF,E SIMPLE OWNER)
SIGNATtlm (g: I. F, IMPL ) ER)
S�3 (7 772-569-9$53—__-___
- i'I
(DA-TE)
ELLIOTT MERRILL MANAGEMENT 835 20TH Pi . VEROZ€AG—F�
tM�
(At)DRESS)
�• (AnllRESS) — — t23
NOTiARV:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____, 01s, of
By lily commigm,11% c::r
Personally Known Produced ID Type of idetr i
Signature of Notary Public -- State of
_,200
.as:
A M IDA V LL LL JF(DR Y NAF H 11 "J I E V 9
I affirm that am qualified under chapter 468 or 471, Florida Statu:w% �o :,n •vide build Iag code plan review services
as authorized by s. 553,791, Florida Statutes pursuant to section IO i. 7 r r •rids Building Code with respect to the
building that is the subject of the enclosed permit application_ I undvi:;4:i-, hat the loyal building official may not
review the plans submitted or perform the required building inspeu mns ' i letetmine compliance with the applicable
codes, except to the extent specified in said law.
0M
I have reviewed the construction plans / documents to determine complcvu.:c '•r
determined that the plans reviewed comply the
h the applicable codes. I have
'
with applicable codes. I accop
with all provisions of the standard / technical codes and other'pertinent t;i trys :
Il responsibility for compliance
t rdinancus. I provide my seal and
signature as affidavit under oath, that the follov(ing is true. and correct t•.t t,re -e
. of'uy latowledge and belief:
(a) The plans / documents were reviewed by myself. I am duly audim b .,
the code and hold the appropriate licenses or
o perfirrm plan review pursuant to
certificaies.
(b) I am qualified as a plan examiner under Part XII of Chapter 4EN, l.*I, r i
a Statut,:.s.
(c) The plans comply with the applicable codes, standards, statute:, anti ! 1:
it ordinances or regulatory agency
requirements.
(d) The plans comply to the laws as to egress, Life Safety Codes, I, ,:v n: 4
nsnvctiort kind general arrangement
and show the structural design.
(e) The plans and design conform to tite requirements of the techmcnl c;•.::
s as to strangth, stresses, strain and
stability,
(f) To the best of my knowledge, the plans and specifications corm);•• w
i the applicable minimum building
codes and the applicable firo-safety standards as determined b� ilro t •l
; i authority in accordance with the
Florida Building Code and chapter 633 Florida Statutes.
Ri spee6ri 4St
I affirm that I am qualified under s. 468 Florida Statutes to provide builrLtig i r i ectinn services as authorized by
s. 553,791, Florida Statutes pursuant to section 104.3.2 Florida Building. Cod: i is understood that the undersigned
hereby accepts the responsibility for performing all of the required inspccooit. , entitled in this document. I
understand that inspections are required as detailed in Section 105 of the I• lot , b Building Code, the permit card, end
as prescribed by the local authority having jurisdiction. I further agree 4: I:,sit 1 -1 Lucie County harmless for such
inspections, and accept responsibility for compliance with all other regt rills t:• t, cenraiued within, Upon completion
of the structure, 1 will provide the Building Official a certification thatt•t: %u;.,:, ire, electrical, gas, mechanical and
plumbing systems have been erected in accordance with requirements o' Iln: I- t: nical endcs_
The undersigned certifies that all work inspected (and approved) will cenfOrm i. all applicable codes and standards;
as well as all related permit documents. In the event of any conflict betty wo :• I +s and documents, the more
restrictive shall apply. A log shall be maintained of all inspections made lncl- t I : g the date of the inspection, the
inspection performed using the permit "hard card" terminology and the dcN;p, n. on of either approved or
disapproved and an inspection report shall be forwarded to the Building I epo - lent within 72-hours of making the
inspection. Lech inspection report shall bear the seal of the Architect / I ng n-'•i )erforming 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•'ct r. pectiou which satisfies the 180-day
requirement") within 180-days (60-days for demolition permits) from tit• :•sir..: ate of -the permit. All subsequent
inspections shall be made within 180-day time frame prior to permit expi-ado •. 10 INSPECTIONS WILL BE
PERFORMEiD Sill3 YQUF-NT TO PERMIT E%PIRAT9®N: ANyH] NO 1ti,'.I?EIC:TIONS WILL 5Z , t
HAN13L D "AFTER -THE -FACT".
o Architect / Engineer: �J.' \ C E N • �� �'.
MICHAEL A. LUE s �� v s� ••,�
(PRINTEDNAME OFAnhiteet/Engines) (S(G ATURE I V A.:'r: •cil l•:nginccs * _ O 4 752r� i Cn e
04/25/17 772- 69-1257 `,
(DATE) — (Put ,fig ---^�ATE OF *:
2030 37TH AVE., VERO BEACH, FL 32960 �_' �:� " _� , P•,����a
(ADDRP,S$) - .. �'' US" • ; R i O• . • �� ,o
!, o
Architect : wiz,. leer O/V ENGe�`
NOTAIt4f: Seal: CN NE L JACKAAAN
STATE OF FLORIDA W COMMISSION O FF882318
COUNTY OFAMMIAM PXPIRES Fetimery 18.2020
The foregoing instrument was ac mowledgcd before me this 25Tid6y o' APf'RIL___ _" Ft M-N t^ s.,,)
By MICHAEL A. LUE my ci nmission t:% ,rra o-: _0y 18/2020
Personally Known—ProducedlD T Of identification �_ /1
Signature ofNotaryPbblie— State of f_: � `' *=)
Whenever the owner / contractor desires an inspection to be performed''r. an'r•> a other than the above or a St Lucie
County Inspector, anew application form must be submitted and approx-:•ti h;.: i : St l.ucic County Building Official
or Building Code Supervisor BEFORE the subject inspection (s) is (arc ' P HR -RA"f D
' Cxl
The St Lucie County Building Department may at any / all times visit t•rr con•: i •.retiort site to ensure compliance
The St Lucie County Building D Mont may at any / all times visit tar t:on o-t •ac, 51to to ensure compliance
and! or for the p trpase of spot in =,ions to verifying construction act vdrex i • it .- npliance with the
consruction documents / drawings.
121
Failure to follow standard operating procedures for inspections for si 7,o.n ra CbuntY may negate any further
an®rov_aIs for you or your form to perform this Hype of inspection. IIIeddi i" n, incomplete or inmccucnte
Ply result in failed inspections, work stoppage a:ut n •-ermtl expiration, All violators
i Ee IFL._19.$.N.IR. C
tucstiona regarding this procedure, please contact tag- A• ' cie Conory Building Department
is !Building Official or Building Code Supervisor
(Print Name Signature -- — Date