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HomeMy WebLinkAboutAPPLICATION FOR PRIVATE PROVIDERSt. 2300 VirgirtiaAvenue Ft Pierce, FL 34982 0F.ice.. (772) 462-1553 1's�x (772) 462-1145 SCANNED gal BY Lucie CouW$plication for Trivate provider folrplains Id,e , jew / Insperf'sons (A!E Agreement. Revised July 1. _ 1 H)1. St Lucie County Code Compliance Zvi<r pERM1T #: DATE: 06-29-2017 _ STREET.AODItESS: 5167 NORTH U8 A1A 1=nRr PI€RGE,€L3494J----- parcel A: — TO: St. Lucie County Building Department I have elected to utilize MICHAEI A I FL PE# 47520 / SI# 1061 (Name of. State Registered Archncct/ Engtnecr) ,crate Itegistmtion Number) M. FlrsaxnmE: IINC. t,rtedaasawrs) L. EN(TJ EERNG ------.. ADDRESS: 2030 37TH AVE VERO BEACH_ FI 19960 TGl EPHONE •: 7 1-1257 FAX 9 t 772-569_041 as a private provider as authorized in S. 553.791, Florida Statutes. I have- clt•rl sd to usa tliis "Private Provider" for: (check alt that apply): -PLANS REVIEW: !Building, ^Electrical, 'v;.chanical, •, Plumbing. (Affidavit Required) •%.I ,chantOnl, _,Plumbing, X INS>PECTION(s): _Building,,__Electtical, FEE SYMFIL;E OWNFR: i have elected to use one or Marc private providers to provide buildinl: Will}, ,ian review and/or inspections services on the building that is the subject of the enclosed permit application, as iiurt,rr ized by part XII, chapter 468, Florida Statutes & s. 553.791, Florida Statutes. I understand that the local butIdml!. ,: lcial may not review the plans submitted or perform the required building inspections to determine i mip i:a cc with the applicable codes, except to the extent specified in said law, Instead, plans review and/or required t•tulil t ., inspections shall be performed by licensed or certified personnel identified in the application. The laW'k:tltti vs ninimutn insurance requirements for such personnel, but I understand tbat 1 may require more insurance to p t tasc • my interests. By executing this form, I acknowledge that I have made inquiryregarding the competence of Iltc licrr:-cd or certified personnel and the level of their insurance and am satisfied that my interests are adequately prui nc:r r 1 agree to indemnify, defend and hold harmless the local governmen an.1 i ,.: tl building ofiicial(s) from any and all claims arising from my use of these licensed or certified personnel it, i:trf, r• buiidn:g code inspection services and/or plans review. With respect to the building that is the subject c f the : I - tosed permit application, T understand that if I elect to make any changes to the listed private providers or the Ner-- es to be provided by those private . providers, the fec sbriple.owner I shall, within twenty-four (24) hour-, +tti •: ay changes, update the notice to reflect such changes. Z__2 . n © FEE SIMPLY, OWNER: ER: GENE ROSS. OCEAN 3CCII`7 772-569-9$53 _ ,'I- MEH;) ELLIOTT MERRILL MANAGEMENT 835 0 H PI • VEROZEAGH—,—F 3 (AbDRESS) tu7 (ADllRESS) 123 NOTARY' STATE OF COUNTY OF j:nihomUe f The fo oing insitwent was acknowlcdged before me this ul UlnC 204—+ By Of Cl MyconmmisFlQll C:a' 'e$: Persona Ivy Known Produced ID Type ofiden=ilical:I Signature of Notary ublic— State of=: AF16'EFDAVIIT FOR 1pLAII; H E v t ZW : i affirm thatl am qualified under chapter 468 or 471, Florida Statu:cw w :,n -vide building cude plan review services as authorized by s, 553.791, Florida Statutes pursuant to section I0•I. 1 2 i• r,rida Building Code with respect to the building that is the subject of the enclosed permit application. I under::u: r, hat 111c local building official may not review the plans submitted or perform the required building inspecimiis , i -eter mine compliance with the applicable codes, except to the extent specified in said law. 0NER a j%JLIE A BARRETTMY COMMISSION #FF132752EXPIRES September 28, 2018 ' FlaridaNafaryServiCe.com I have reviewed the cmatructiot_ r._=1)s / documents to determine compluml:c ••, determined that the plans reviewed comply the h me applicable codes. i have ' with applicable codes. I acccp with all provisions of the standard / technical codes and other'pertinent is; s ; : Il responsibility for eomal6ance I rdinancos. I provide my seal and signature as affidavit under oath, that the following is true.nad correct t, ulu ; ,_ . of ny Jnowledge and belief: (a) The plans I documents were reviewed by myself. I am duty awdin; izo 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 Xr1 of Chapter 4Ex, I:lu• i a Statute,$. (c) The plans comply with the applicable codes, standards, statute:, and I t : 11 ordbiaaices or regulatory agency requirements. (d) The plans comply to the laws as to egress, Life Safety Codes, it pr W t and show the structural design. nitiluction and general arrangement (e) The plans and design confann to the requirements of the technical c;•,:: s as ttt strength, stresses, strait and stability, (t) To the best of my knowledge, the plans and specifications cornpiv >,, I the applicable minimum building codes and the applicable firo-safety standards as determined b; ih:i r.;; 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 bulEnil., i r; ection services as authorized by s. 553.791, Florida Statutes pursuant to section 104,3.2 Florida Building. (•udtl Lis undongood that the undersigned hereby accepts the responsibility for performing all of rho required insprrnnw , entilied in this document, t understand that inspections are required as detailed in Section 105 of the I• lit t I• Building Code, the permit card, and as prescribed by the local authority havingjurlsdietion. I further agree trt 1:i d,1 -1 Lucie County, harmless for such inspections, and accept responsibility for compliance with all other regt r•rntt::• conraiced within. Upon completion of the structure, I will provide the Building Official a certification tbatriL, sit i.r. ire, electrical, gas, mechanical and plumbing systems have been erected In accordance with requirements o' ! he it t : nicad codcs- The undersigned certifies that all work inspected (and approved) will cen9'onn 1. all applicable codes and standards; as well as all related permit documents. In the event of any conflict betvw.vri ::I is and documents, the more restrictive shall apply. A log shall be maintained of all inspections made irtrlu I : g the date of the inspection, the inspection performed using the permit "hard card" terminology and the dv%iw a• on of either approved or disapproved and an inspection report shall be forwarded to the Building I )cptrre- lent within 72-hours of making the inspection. Cach inspection report shall bear the seal of the Architect / F og; i---t terforming the inspection, along with his / her signature and the date. The permit will expire unless work :• •,:rrr enced (and receives an approved inspection "colored red on the permit hard card, red print indicates a reel r•-c r. poetiou which satisfies the 180-day requirement") within 180-days (60-days for demolition permits) from tf,t• :.sit•..: ate oribe permit. All subsequent inspections shall be made within 180-day time frame prior to penitit expirati(w. 'd0 INSPECTIONS WIILL BF PEi3FORMEED SUBSEQUENT TO PIE1dIV XT EXPiRA.TJION• AND NO J�.•.PECTiONS WILL BE o Architect / Engineer: MICHAEL A. LUE (PRINTED NAME OF Architect Engineer) (S(GNATUnE+ :;ix,•:•ctll•"nginccr) 06/29/17 772-569-12 7 2030 37TH AVE., VERO BEACH, FL 32960 ,ennnccc; . - ks"> CHRISTINE L JACKMAN Architeet + 1+rre: leer N®TA1R�17 - " MY COMMISSION N FF962316 Seal: _ STATE ®F FL,xWHEs FeWtury 10, 2020 — — COiUNTY s.�mn 29Tu JUNE rho foregoing instni , _'day o+ -)00 2017 By MICHAEL/I. LUE 1,2ycommission—021T�/2021! Personally Known X PredueadID T eofidenfificalian: Signature of Notary Publie— State of FL o Whenever the owner / contractor desires an inspection to be performed'r any) a other ilian the above or a St Lucie County Inspector, anew application form must be submitted acid approv t•ti 17; • :) c St Lit cie County Building Official or Building Code Supervisor BEFORE the subject inspection (s) is (are - PHR -RMbJ) • C:r] The St Lucie County Building Department may at any / all times visit bir c.on;•i •iotion sits io ensure compliance The St Lucie County Building Dr. --fitment may at any / all times visit t n r.w, ,.• s h to ensues compliance C21 artcons or for the purpose / spotdraw t ;lions to verifying construction act %.aic:; i i . 'nplianee with the construction documett155 / drawinss, ' 1F41ilure to follow standard operating procedures for Inspections for tit l a.o w Cbmyty may negate any further approvals for you or your firm to perform this type of inspection. In nddis i-• n, incomplete, or inaccurate Inspection reports may result in failed inspections, work stoppage a:ul : w nermh expiration. All violators will be referred to tlto EL B N ➢L Should you have any questions regarding this procedure, please contact i:w S• ' cie Couny Building Department O Building Official or building Code Supervisor Print Name signature — --- ]lDnte ST LU(CAE CC `, TY (COUR CO' P1i.,91A 2300 Virginia Avenue Ft Fierce, FL 34982 �)F,Ice.. (772) 462-1553 ),Im (772) 462-1148 SCANNED BY St. Lucie Colan�is Application for iF R idate FTOVidelr fOy FIRIng W',r;'eW / Bn gliee (A/B Agreement, Revised July 1. 211)1. St Lucie County Code Compliance 71vi:cl` .PFRM1T #: DATE; 06-29-2017_ STREET.ADDItESS: 5167 NORTH HI8 A1A FnQT PI€RCS€�.349�9 �— Parcel fl: TO: St. Lucie County Building Department FL PE# 47520 / SI# 1061 1 have elected to utilize MICHAE A I 1 I • ;fate itc,iYtntioa Number) (Name of. slate Regislored Arehmca I Engineer) i' o tzed in chapter468, 471, Florida Statutes) rlRMNAME: M. L. EWHEEERING INC. _-----.. ADDRESS: 2030 37TH AVE VERO BEACH El 22960 TELEPHONE •: 7(7 9-1257 FAX u 1 772-569_041 as a private provider as authorized in G. 553.791, Florida Statutes. I hnvt• clvrl sd to use this "Private Provider" for; (check all that apply)_ PLANS REVIEW: Building, �lcctrical, „ 'o;:chznical, , Plumbing (Affidavit Required) 't•I ;cllanical, _ Plumbing. X —INSn CTIoN(s); _Building, Electrical, FEE Sn. AME OWNER,' i have elected to use one or mare private providers to provide building ,_iA rs dan review and/or inspections services on the building that is the subject of the enclosed permit application, •ts iiurbn• iced by Part XII, chapter 468, Florida Statutes & s, 553.791. Florida Statutes. I understand that the local bul Idrnl.. I : Iciel may not review the plans submitted or perform the required building inspections to determine .: amp f:a cc wjih the applicable codes, except to the extent specified in said law, Instead, plans review and/or required (•whl r ., inspections shall be performed by licensed or certified personnel identified in the application. The law ; vLtuh t•s ninirnurn insurance requirements for such personnel, but I understand tbat I may require more insurance to ;u tua my interests, By executing, this form, I acknowledge that I bave made inquiry regarding the competence of 1110 lici r:_d or certified personnel and the level of their insurance and am satisfied that my interests are adequately prolrir r I agree to indemnify, defend and hold harmless the local governmen ar,d i r,: d building utlicial(s) from any and all claims arising from my use of these licensed or certified personnel to perft r• bui(ila:g code inspection services and/or plans review. With respect to the building that is the subject c f me 'I loted permit application, T understand that if l elect to make any changes to the listed private providers or the %cr-. es to be provided by those private . providers, the fec sbnpte,owner I shall, within twenty-four (24) hour% %tti:•- •: ny thangrx, update the notice to reflect such changes. o ITEE SIMPLY, (D%tKER: GENE 3tJ/I 772-569-9851 __- rl- tNEB;) ELLIOTT MERRILL MANAGEMENT 835 20TH PI . VERO-136AGH o o�_—ucowo (AnuREss) t"� '(AbDRESS) - -- — (23 STATE®lE Iy� The fo�j[�G`going instrument was acknowledged before me this � Cu4 of Hy My commission c::r'es:__z1 Personally Known Produced ID Type ofidemiliti:al:•1 Signature of Notary public --State of I affirm that am qualified under chapter 468 or 471, Florida Statwt:..():,n •vide building code plan review services as authorized by s. 553.791, Florida Statutes pursuant to section 10•I, -, 2 ( • i,rida Building Code with respect to the building that is the subject of the enclosed permit application_ I undm:"Iz r: hat the local building official may not review the plans submitted or perform the required building inspecimus ' I -etemline compliance with the applicable codes, except to the extent specified in said law. 0VER rooa,.��:Ma w�%'� eeaisa I have reviewed the constructiot. ._:s / documents to determine comphnnl.:e •r• determined that the plans reviewed comply the h me applicable codes. I have ' with applicable codes. I accep with all provisions of the standard / technical codes and other'perticient Ii1,as e• Il responsibility for compliance I rdinancus. I provide my seal and signature as affidavit under oath, that the following is true.and correct t:i t:w .:. of my 3mowledge and belief. (a) The plans / documents were reviewed by myself. I am duly amhrn ire•_ the code and hold the appropriate licenses or o perform plan review pursuant to certificates. (b) I am qualified as a plan examiner under Part X1I of t haptia' 46x. I -I, r i a Statutes. (o) The plans comply with the applicable codes, standards, statute!, and I I: it ord'utemces or regulatory agency requirements. (d) The plans comply to the laws as to egress, Life Safety Codes, lviw n: t and show the structural design. nsttuction and general arrangement (e) The plans and design conform to the requirements of the technir;d c:•c : i as In srtungth, stresses, strain and stability, (f) To the best of my knowledge, the plans and specifications core pi, I the applicable minimum building codes and the applicable fir"afety standards as determined b� Ilic: r.; ; I authority in accordance with time Florida Building Code and chapter 633 Florida Statutes. )Inspeedionst I affirm that I am qualified under s. 468 Florida Statutes to provide builri:np, I r; action services as authorized by s, 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building r.'ttd t t is und<astood that the undersigned hereby accepts the responsibility for performing all of the required inspcl:ncns - entitled in this document. I understand that inspections are required as detailed in Section 105 of the 1• lot I I• Building Code, the permit card, and as prescribed by the local authority havingjurisdiction. I further agree tit 1:I:It l -I Luc in County harmless for such Inspections, and accept responsibility for compliance with all other refit nitre• contained within. Upon completion of the structure, I will provide the Building Official a certification tbatt•r_ ,c i.c. ire, electrical, gas, mechanical and plumbing systems have been erected inaccordanee with requirements d IIIt: II t: nictd codes_ The undersigned certifies that all work inspected (and approved) will conform I. all applicable codes and standards; as well as all related permit documents. In the event of any conflict betwocn :•,I! Is and documents, the more restrictive shall apply. A log shall be maintained of all Inspections malt- Inclrt 1: g the date of the inspection, the inspection performed using the permit "hard card" terminology and the dctip ii. on of either approved or disapproved and an inspection report shall be forwarded to the $uilding 1)rprart••Icnt within 72-hours of making the inspection. Each inspection report shall bear the seal of the Architect / I It;,:1i_ I terforming the inspection, along with his / her signature and the date. The permit will expire'unless work > •,:m•I• i• enced (:md receives an approved inspection 'colored red on the permit hard card, red print indicates a foci r•-cc r. pectiou which satisfies the 180-day requirement") within 180-days (60-days for demolition permits) from Lt.,- :si1•..: ate orihe permit. All subsequent inspections shall be made within 180-day time frame prior to permit exp17;1it1". 40 INSPECTIOPIS WILL 13E o Aaebitect/lEngineer! MICHAEL A. LUE (PRINTED NAME OF Architect/Engineer) (SIGNATURE I A, ;'r: •ct / Irngincer) 06/29/17 772-569-12 7 (DATE) (PI n ud1 --"--- ` 2030 37TH AVE., VERO BEACH, FL 32960 psif s CHRISTiNE L JACKMAN APch9tet•r : iett2i Iaer' STATE NOTARrm 'F My COMMISSION 0 FF962318 Seal: STATE O& FL EXPIRES February IS.2020 TheforCOUNTY ng ' • 29TF , JUNE The for oing instrumen w is y o 200 2017 By RHAELA. LUE hey commissionrt_ltrt•o-: UZTT!#/202IT SignatPersonure Known X Produca—StaedlD Typ ofiden'ficaliug/ ,ice`_ Signature ofMotaryFulilic—State of FL (/ Whenever the owner/ contractor desires an inspection to be performed'•v. an•r.) a other than the above or a St Lucie County Inspector, a new application form must be submitted and approved b.• :,I., St 1-ucic County Building Official or Building Code Supervisor BEFORE the subject inspection (s) is (are, N ilt:-: PMf:I) tx] The St Lucie County Building Department may at aryl all times visit bw con I action sin- to ensure compliance Eke St Lucie County Building Dr,^q-mcnt may at any/ all times visit ta,• , •ar ( to 121 and-/ or for the purpose of spot in, ;ions to verifying construction act k•d,c:4 , ;,c toensure compliance i'• ot, ee with the construction documeotss / drawing's Failure to follow standard operating procedures for inspections for Sr 1,e.n ,4 (County may negate any farther approvals for you or your firm to perform this type Of inspection. In addi, i-• n, Incomplete or imaecug"nte Inspection roports may result in failed inspections, work stoppage ga ,o + u, I-ermil expiration. All violators will be referred to the FL. )D $ da 1R. Should you have any questions regarding this procedure, please contact r„- e- ' tic Cono,y Building Deportment 0 Building ofeing or 3011ding Code Supervisor Print Nagne Sbgktmkare — ]Date