HomeMy WebLinkAboutAPPLICATION FOR PRIVATE PROVIDER2300 Virginia Avenue
Ft Pierce, FL 34982
ST LU CI E f��il�T Y (COUR �CON�I�Lq ' ' 1(C�, DIVISION SCANNED
II'''' BY
(772) 462SI553cie County
(772) 462-1149
Application for Pirivate ProVidert fOT FIMD3 Wbc'-) ieu'v ! 1ivaQg;t aeons
(A/E Agreement. Revised July I. _:001.
St Lucie County Code Compliance Olvis v
I>ERMIT#: DATE: _08-11-2017 '
STREET.ADDRESS:
4200 N HWYA1A, UNIT909 FT. PIERCE,-FL•34949
— -- --
Parcel 9: 1423-501-0161-000-6
TO: St Lucie County Building Department
I have elected to utilize MICHAEL A LUE FL PE# 47520 / SI# 1061
(Name of Stato Registored Architect l Engineer) ,state lteaiaratien Number)
((A�s reeoggnntied in chapt" 468, 411, Florida S(atatcs)
FIRM NAME: M. L. EWSM' RING, INC.
ADDRESS_ 2030 37TH AVENUE VERO BEACH, FL 32960 ,__--
TELEPHONE #; ( 772 ) 569-1257 FAX # i . 77L) _5694041
as a private provider as authorized in s, 353.791, Florida Statutes. I h:tvc• cl:•r! sd to use this "Private Provider" for.
(check all that apply):
PLANS REVIEW: Building, Electrical, t+chzni al,, Plumbing.
(ARdavilRequired)
X INSIPECTION(s); _Building, _Electrical, .,I :cbenicnl, __Plumbing.
FEE SIMPi.E OWNEM
I have elected tome one or more private providers to provide building uulra dan review and/or inspections services
on the building that is the subject of the enclosed permit application, •is iinrry r !zed by Part X11, chapter 468, Florida
Statutes & s.553.791, Florida Statutes. I understand that the local buildini, r: ieial may not review the plans
submitted or perform the required building inspections to determine 1tmp1:a x with the applicable codes, except to
the extent specified in said law, Instead, plans review and/or required t•cil I i -Inspections shall be performed by
licensed or certified personnel identified in the application. The law: ctmii vs ninitnuin insurance requirements for
such personnel, but I understand that 1 may require more insurance to p tv. • my inte, ests. By executing this form, I
acknowledge that I have made inquiry regarding the competence of I l,c Licrr:•ed or certif led personnel and the level
of their insurance and am satisfied that my Interests are adequately prwres r
I agree to indemnify, defend and hold harmless the local government and i v: it building official(s) from any and all
claims arising ftom my use of these licensed or certified personnel to pci l'i r• builila% code inspection services
and/or plans review. With respect to the building that is the subject vI'll ic : ! • losed penult application, I understand
that if I elect to make any changes to the listed private providers or the wr cs to be provided by those private.
providers, the fee simple owner I shall, within twenty-four (24) hours ati: ,ny changcs, update the notice to reflect
such changes. '�o COPY
o FEE SIMPLE OWNER:
MR
GENE ROSS OCEA
N HARBOR SOUTH PROPERT M A ER
E.
(PR!N-r NAMOF FEES LEE R) (SIGNATUR!•O: i! ESNIFEE rywNER)
l� 4 7% 772-562-9853 _
(D)VrE) •rl iNEN:)
ELLIOTT MERRILL MANAGEMENT, 835 20TH PLACE, -VERO_.13 a Nr r i�n60
(AbURESS) t*I
(AOURFS3) i. r J MY COMMISSION #FF132752
NOTARV: Vf 7
�86 EXPIRES September 28, 2018
STATE Dy
C®UNTV ®9 llt�� F
The fo+ogoing instrpryte�nt� ww�os acltnowledged hoforo me this �c:++; OI'
By %� e I ( My commissiel+ c>:r as:
Personally Known _ roduced ID Type of ide
Signature of Notary Public — State of
1CJIJAD: 511X 1
i affirm that am qualified under chapter 468 or 471, Florida Statttes �0 :•1
as authorized by s. 553.791, Florida Statutes pursuant to section I0•I, -� 2 r
buildblg that is tho subject of the enclosed permit application- 11111001 %b:I•;
review the plans submitted or perform the required building inspec Imris ' 1
codes, except to the extent specified in said law.
pP!Eld
� 20d
(2)
J1'ILIE A i3—P.RRSTf
MY COMMISSION #FF132752
WoaFit r�PiiGiVs Vi�ea0:3
hat tl'1e local building official may not
-etemlino compliance with the applicable
I have reviewed the construction plans / documents to determine compliancc ". h the applicable codes. i have
determined that the plans reviewed comply with the applicable codes. I a;Vcc)) ' Il responsibility for compliance
with all provisions of the standard/ technical codes and other'pertineat It,,•:v , I rd)nuacos. I provide my sel d
signature as affidavit under oath, that the following is true•und correct to mo , c • of my lOtowledga aan
and belief
(a) The plans / documents were reviewed by )myself. I am duly authnt irr•: o perfurm plan review pursuant to
the code and hold the appraptiate licenses or certificates.
(b) I am qualified as a plan examiner under Part X11 of Chapter 469• I'br i .t Statuv..:s,
(a) The plans comply with the applicable codes, standards, statutes Brad I ,: Il olrihnatces or regulatory agency
requirements.
(d) The plans comply to the laws as to egress, Life Safety Codes, IN'w n: t n6truction and general arrangement
and show the structural design.
(a) The plans and design conform to the requirements of the technical c:•(: ; as to stn:ngth, stresses, strait and
stability,
(f) To the best of my knowledge, the plans and specifications compiv die a),lmlicuhle minimum building
codes and the applicable fire -safety, standards as determined b; the I •; ; I authority in accordance with the
Florida Building Code and chapter 633 Florida Stntutes,
I nspeelions:
I oflirin that I am qualified under s. 468 Florida Statutes to provide buitd:np, it, i ection services as authorized by
s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building, ('udc• 118 understood that the undersigned
hereby accepts the responsibility for performing all of the required inspe,u tnna - emitted in this document. i
understand that inspections are required as detailed in Section 105 of the Hot I. Building Lode, the permit card, and
as prescribed by the local authority having jurlsdietion. I fiuther agree t,s In tit I -I Lucie County harmless for such
Inspections, and accept responsibility for compliance with all other regt rr,nt:•' • contained within, Upon completion
of the structure, I will provide the Building Official a certification that t•,c e.n,.r•, ire, ciccurical, gas, mechanical and
plumbing systems have been erected in accordance with requirements o' :lie It t: nic:d codes.
The undersigned certifies that all work inspected (and approved) will coafonr. I. all applicable codes and standards;
as well as all related permit documents. In the event Of any conflict between :•"I is and documents, the more
restrictive shall apply. A log shall be maintained of all inspections madt• 'snd61 I I g the date of the inspection, the
inspection performed using the permit "hard card" terminology and the t %ig, a• on of either approved or
disapproved and an inspection report shall be forwarded to the Building 1)t•purt icnt talthin 72-hours of making the
inspection. Cach inspection report shall bear the seal of the Architect / 1 nl;;n_ t wo-forming the inspection, along
with his / her signature and the date. The permit will expire unless work •> • t,rr enced (and receives an approved
inspection "colored red on the permit hard card, red print indicates a rest Trot r% pecliou which satisfies the I80-day
requirement") within 180-days (60-days for demolition permits) from if.,. mu..: ate oribe permit. All subsequent
inspections shall be made within180-day time frame prior to permitexptmtior. VOINSPIiCTION5'WILLB$
PL+RFORMEO SURSEOIUENT TO PERMIT EXPIRATION- ANHI N0 1 ti `•P�CTp OISIS WILL BEW ILL BE
o Architect/En ineer-
MICHAEL A. LUE
(PRINTED NAME OF ArahiLeer/Engineer) -R� (SIG RE,-' A,4T:•cc g,�ecLr) T
AUGUST 11, 2017 772-569-1257
(DATE) (Pin xJj 1.`
2030 37T 32960
(ADDRM)
MY COMMISSION a FF962316
EXPIRES FeDtunry 18.2020 Architec•r + I(nir. tear _
NOTARY: 1401i�sae•53 ctumxas!iwvl n Seal: m
STATE OF
STATE COUNTY OF 0 Fk ® 6
The foregoing instrument was acknowledged before methis 11THdayof AUGUST _
By MICHAELA.LUE My commissioncrnrrs: 02/18f2020
Personally Known X Produced ID Type fl identified Iron:
Signature of Notary Public — State of
Whenever the owner / contractor desires an inspection to be performed `r unp•) a other than the above or a St Lucie
County Inspector, anew uppllcation farm must be submitted and approvv4i I) ri i St Lucic County Building Official
or Building Code Supervisor 13EVORE the subject inspection (s) is (are • I'lilt:•; 1ZA(f:l)
C*3
The St Lucie County Building Department may at any/ all times visit tar cons•t •icelort sun to ensure compliance
The St Lucie County Building Department may at any / all times visit or cw a acelun 51to to ensure compliance t21
and/or for the purpose of spot inspections to verifying construction act v oiN i • in compliance with the
construction documents / drawings,
Failure to rollow standard operating procedures for inspections for ti lam ra County may negate any'hfrther
approvals for you or your firm to perform this type of inspection. In addi%i•• a, inconipiete or inaccuo ate
Inspection reports may result in failed inspections, work stoppage gait + n• •-ernnil eNi iration. All violators
will he referred to the FL Q.Hi)Ar t
Should you have any gvestionq regarding Us procedure, please contact I:u• S• ' cie, Conniy Building DepnrtmenL
0 Building Official or Building Code Supervisor
Printme Signature — --- Date