HomeMy WebLinkAboutAPPLICATION FOR PLANS REVIEWINSPECTIONSS7 LUCIE COUNTY CODE COMPLIA NCE OMSION
2300 Virginia Avenue �x Office. (772) 462-1553
Ft Fierce FL 34982 ' Fwc (772) 462-1148
° [AUG
ECEIVED
w o 0 2 2t0i9Z } U Application for ]Private Providelr for pamps Njc; ieW I Inspection
ZLX(A/E Agreement, Revised July 1tti)'i. County, Permitting
U St Lucie County Code Compliance }tvi:<v•
ca J-
fn PERMIT #:
DATE: 05/07/2018.-
STREET. ADDRESS: 4250 NORTH HWY AJ AI1N1Tt(�1,FOR7T-PE N9
Parcel N: 14 501 0017 000 9
TO: St. Lucie County Building Department
1 have elected to utilize MICHAEL A I I IF FL PE# 47520 / SI# 1061
(Name of. stlao Registered Architect !Engineer) ,date lte pAraLion Number)
M. L. E1f'��If�EERIN�e 468,47
NC t,rmridn %litotes)
FIRM NAME; - ----- -
ADDRESS: 2030 37TH AVE.,VERO BEAD FI 3960
TGh EPHONE i1: 7f 7 9-1257 FAX 9 1 772 5B9_4D41
as a private provider as authorized ins. 553.791, Florida Statutes. 1 hove cb: rt sd to use this "Private Provider" for:
(check all that apply):
PLANS IREVRE®W: _Building, Electrical, 'v; .tchanioal, •. plumbing.
(Amdavil Required)
X INSPECTION(%); _Building, _Electrical, I :chanicnl, - Plumbing.
FEE SIMME OWNER.'
I have elected to use one or more private providers to provide lm ildinl. W d('s ilan raview and/or inspections services
on the building that is the subject of the enclosed permit application, as tiurive izedby Part XII, chapter 468, Florida
Statutes & s. 553.791, Florida Statutes. I understand that the local buddiry. ): icial miry not review the plans
submitted or perform the required building inspections to determine ompl:a cc with the applicable codes, except to
the extent specified in said law. Instead, plans review and/or required (•udd I., inspecions shall be performed by
licensed or certified personnel identified in the application. The law: umii vi ninitnuin insurance requirements for
such personnel, but 1 understand that I may require more insurance to ;:.n.rc my ir.terests. By executing this form, I
acknowledge that I have made inquiry regarding the competence of the lit:rr:.cd or certified personnel and the level
of their insurance and am satisfied thatmy intetests are adequately prowc:i v
I agree to indemnify, defend and hold harmless the local governmen and i v: it building ufiicial(s) from any and all
claims arising from my use of these licensed or certified personnel to pm' i r buibla:g code inspection services
and/or plans review. With respect to the building that is the subject ct'the : i loscd pcnuit application, T understand
that if I elect to make any changes to the listed private providers or the wr•• •::s to be provided by those private
providers, the fee sirnplc owner I shall, within twenty-four (24) hours :aie .:ay change.%, update the notice to reflect
such changes. /)
o FEE SIMPLE OWNER:
GENE ROSS. OCEAN
R1
772-569-9$53—__. _
ri, INE#J
ELLIOTT MERRILL MANAGEMENT 835 20TH PI. VERO aEAGFT—, 964
(AbDRESS) I*1
(ADDRESS)
C21
NOTARY -
STATE OF COUNTY OF
OF dk
The roguing t}�trument was aclmowlcdged before me this��, 0;,p of AS
Hy K'.[S/ MycommisstonCyr •es:'--
Personally Known Produced ID Type ofi n,Wwal>r
Signature of Notary Public -- State of
i affirm that I am qualified under chapter 468 or 471, Florida Stamus to :•I- -vide building code plan review services
as authorized by s. 553.791, Florida Statutes pursuant to section 10.1, 1, 2 P r -rida Building Code with respect to the
building that is the subject of the enclosed permit application. I umiri:eb. r: hat the local building official may not
roview the plans submitted or perform the required building inspect sus ' ) letermine compliance with the applicable
codes, except to %be extent specified in said law.
OVER
ULIE A BARRETTCOMMISSION#FF132752IRES
=39"J�
September 28, 2018FloridallotarySemce.com
I have reviewed the construction plans] documents to determine comp] rincc •r
determined that the plaits reviewed comply with the applicable codes. I
h the applicable codes. i have
'
avx.up
with all provisions of the standard /technical codes and other'pertinent la;.:s ; :
signature as affidavit under oath, that the following is
Il responsihi{ity for compliance
rdiriancus. I provide my seal and
trueand correct Ei rue . e
• of n)y knowledge and belief.
(a) The plans / documents were reviewed Sy myself. ] am duly aulliry in :
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 xrl OeChaptei• 46:c, I1. i
(e) The plans comply with the applicable
.i Statut,:s.
codes, standards, statute:, and 1:
requirements.
d Ord blaiices or regulatory agency
(d) The plans comply to the laws as to egress, Life Safety Codes, I; l:r ur+
and show the structural design.
instruction and general arrangement
(a) The plans and design conform to the requirements of the technie:d c:•c
: ; as 14) sm:ngth, stresses, strain and
stability,
(i) To the best of my knowledge, the plans and specifications corn)>:v w
I the, applicable minimum building
codes and the applicable firo-safery standards as determined b; ihc: 1 •t
; 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 buiNaig. it i ection services as authorized by
s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building ('ud'a I is understood that the undersigned
hereby accepts the responsibility for performing all of the required inspon tow. , en; lied in this document, i
understand that inspections are required as detailed in Section 105 of the I. NJ; 1 Building Code, the permit card, and
as prescribed by the local authority baving jurisdiction. I further agree to Indd -1 Lucie County harmless for such
Inspections, and accept responsibility for compliance with all other regi t-tins:• -- contained within. Upon completion
of the structure, I will provide the Building Official a certification that t +e an 1.,:. ire, cleciical, gas, mechanical and
plumbing systems have been erected In accordance with requirements o' Hi : li 1: nicol codas.
The undersigned certifies that all work inspected (and approved) will ccvdonr' I. all applicable codes and standards;
as well as all related permit documents. In the evant of any conflict between :• I is and documents, the more
restrictive shall apply. A log shall be maintained of all inspections made i cl'1 1: g the date of the inspection, the
inspection performed using the permit "hard card" terminology and the clv%ig, a. on of eitber approved or
disapproved and an inspection report shall be forwarded to the Building I vInu r• tent within 72-hours of making the
inspection. Bach inspection report shall bear the seal of the Architect / I nl::nP•1 performing the inspection, along
with his/her signature and the date. The permit will expire'unless work •:• ;vrr enced (and receives an approved
inspection "colored red on the permit hard card, red print indicates a recu'*c( r. pection which satisfies the 180-day
requirement") within 180-days (60-days for demolition permits) from ti.t.: o n.: ate orthe permit. All sub t
inspections shall be made within l80•daytimefinite prior topermit expratior. VOINSPECTIONS �
PERFORiVIE@DSUIaSEO>IENTTOPEANdITE%PlRATIONAlVI7Ivt)Iti•PECTIONS J/'ry%
6iAN0?I EID �n i e EB-TNE-FACT". ,: 2P. \G E N S • e.
o Architect / Engineer: •'.
MICHAEL A LUE FA-
• _T�p 7520 '
(PRINTED NAME OFArchitecll Engineer) -R� (SIGNAnameul05/07/2018 772-569 STATE OF
(DATE)__..
2030 37TH AVE., VERO BEACH, FL 32960 '.� F0 R��'�tj%
(APDRP,SS) •• �••• •1 ..�•a•?�S�Tei, , � l"'rC�d��
Architect lcnr.: leer Mr GOWSSION S FF962316
NOTA]RYt Seal: • - EXPIRES February 16.2020
STATEOF FLORIDA aor oleo ea r�s. eoiep
COUNTY OF �A
The foregoing instrument was ac cnowledged before me this V day o+ I' l� 200M18
By MICHAEL A. LUE My commission 11 r• : -L9241-8/2090
Personally Known _.Produced ID eofi entific liunr
Signature of Notary Public—Stateof_FI t�/IllNYI0.UJ/-L__n��`—�d.(�, to
Whenever the owner / contractor desires an inspection to be performed'+, tnrr l a other than the above or a St Lucie
County Inspector, a new application form must be submitted and approved tr• :•1: St Lucie County Building Official
or Building Code Supervisor BEFORE the subject inspection (s) is (are' I'IiI: °•:-lZ,A4f:1)
Cx7
The St Lucie County Building Department may at any / all times visit tar -fiction sin• to ensure compliance
--
The St Lucie County Building Department may at any / all times visit tar ,:orv, t •.tetlon suo to ensues compliance
and / or for the purpose of spot inspections to verifying construction act %-lf mi 1 • in compliance with the
construction documenLa /drawings,
Failure to follow standard operating procedures for inspections for 144 i aa, w County may negate any further
approvals for you or your firm to perform this typo of inspection. In addi,i•'n, incomplete, or inaccurate
inspection reports may result in failed inspections, work stoppage a:w +,j� ••ermil expiration, All violators
vwill be referred_ to the FL. ID.H.P.BL
$hould you have any questions regarding this procedure, please contact 1:1" S• ' oic t=ounly 8uitding DepartmenL
o (Building Official or Building diode Supervisor
Print Name Signature — -- ?Date
E23
e
f—
ST LUCIE COUNTY CODE cCORRAAN- cCE 91WRON
RECEIVED
2300 Virginia Avenue
Ft Fierce, FT 34982
AC) #,C2 $ 462- 553
ST. Ludi ;t6untv}TerrxrM 148
Application for Private Provider for Plans Rlr) iewr / Inspections
(A/E Agreement, Revised July 1. 2001.
St Lucie County Code Compliance llvi:: r
PERMIT #: DATE: 05/07/2018._ '
STREET.ADDHESS: 4250 NORTH H1My A1A I IINII_TFQR-T-P1EReE—Ft---�9
Parcel Ik 1423 5_ 01 nnnQ n(]n 4
TO: St. Lucie County Building Department
1 have elected to utilize MICHAE A Il1F FL PE#47520/SI#1061
(Name o£S1ate Regrstored Architect r Engineer) ,+rate llcl;1. limn Numb,,)
co imd in chapur468, 471, Florida Statutes)
FIRM NAME: M. L. E(fgIEERING, INC.
ADDRESS: 2030 37TH AVE. VERO BEAD FI 32960 -----
TELEPHONE #: 7( 7�9-1257 FAX €F 1 772-5.69=4941
as a private provider as authorized in s. 553.791, Florida Statutes. I have ulrri sd to use this "Private Provider" for:
(check all that apply):
PLAINS RZVMW: !Building, �Elcctrical, „ ' ::chzn i nut, •. Plumbing.
(SrRequired) :chanic:tl, - Plumbing.
X ❑N5PE1PEC'9'I®Id(s): _Building, Electrical, •II _
FEE SIMPLE OWNER!
1 have elected tome one or mare private providers to provide building Lo lr. Ilan review and/or inspections services
on the building that is the subject of the enclosed permit application, IFaiurN izedbypart Xll,chapter 469,Florida
Statutes & s. 553.791, Florida Statutes.I understand that the local bwldm)j. I: join] may not review the plans
submitted or perform the required building inspections to determine -:omplo ce with the applicable codes, except to
the extent specified in said law. Instead, plans review and/or required (•t:II,I I ., inspections shall be performed by
licensed or certified personnel identified in the. application. The law: tantil:•s ninimum insurance requirements for
such personnel, but I understand that I may require more insurance to i,I oix,.' my irate, ; ests. By executing this form, I
acknowledge that I have made inquiryregardingthe competence of IIIc liucr:.ed or certified personnel and the level
of their insurance and am satisfied that my interests are adequately praux:: r
I agree to indemnify, defend and hold harmless the local govemmeo nod i I.: d building official(s) from any and all
claims arising from my use of these licensed or certified personnel tt: i rr f, r• bltilda:g code inspection services
and/or plans review. With respect to the building that is the subject cf il,c : I - lased penult application, I understand
that if I elect to make any changes to the listed private providers or the �cr es to be provided by those private
providers, the fee simple.owner I shall, within twenty-four (24) hour,-, at) :- •:ay ehangcy, updnte the notice to reflect
such changes.
o FEE SIMPLE (OWNER:
GENE ROSS. OCEAN
tMi r'd SIVE, i?WNER)
772-569-9853__-_
I'I. INEIh)
ELLIOTT MERRILL MANAGEMENT 835 20TH PI . VEROZEAGH—, F-3296fl—
(ADURESS) [VI
(ADDRESS)
123
NOTARY. rI.
STATE OP' d�1 oY1
CoUNTVOfF vJe! {
The negoing in ument was acknowledged before me this�i Gap ul LtL> { l _ A
HY PtY1B Sys My aammissl;m c::r es: _ _ q
�ersonallyKnown Produced ID fidemilica;:•I ___
Signature of Notary Public— State of:
AMDAVIITFOR AID tte' P' ECW:
I affirm that i am qualified under chapter 468 or 471, Florida Statues w :•n -vide building code plan review services
as authorized by a. 553.79 t, Florida Statutes pursuant to section 10•I, 7, 7 P s -rida lluitding Code with respect to the
building that is the subject of the enclosed permit application_ I under xb: r; hat Ilm iocal building official may not
review the plans submitted or perform the required building inspect nls I I -etetmiine compliance with the applicable
codes, except to the extent specified in said law.
OVER
:=.^.a �'•._ L9E A BARRETT
'.y. MY i=OMMISSION #FF732752
''•'.�'o. �o`;'.' EXPIRES September 28, 2018
(40�) 9S8'e15a Floritlallota ryService.com
I have reviewed the construction plans / documents to determine comp] ialiec -I
determined that the plans reviewed comply with the applicable I '
h the applicable codes• i have
codes. accep
with all provisions of the standard / technical codes and other'peninent It!u:y ; : !
11 rt:.eponsihility for compliance
rdinuncus. 1 provide my seal and
signature as affidavit under oath, that the following is true and correct t:r u,d : c
• of a)y lmowledge and belief:
(a) The pints / documents were reviewed by myself. ] am duly aids,; izx-.,
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 X11 of Chspti: 46x. 1:1, r 1
.a Statutes.
(a) The plans comply with the applicable codes, standards, statute!, and ! i:
it ordimitices or regulatory agency
requirements,
(d) The plans comply to the laws as to egress, Life Safety Codes, t;. ;n n: ,
msuvctiou and general arrangement
and show the structural design.
(e) The plans and design conform to the requirements of the technirni c:•c
: s as itt strength, stresses, strain and
stability,
(f) To the best of my knowledge, the plans and specifications corrpv "�
! the applicable minimum building
codes and the applicable fire -safety standards as determined b; !hi; - ,;
I authority in accordance with the
Florida Building Code and chapter 633 Florida Statutes,
IInspecdio➢ s:
I affirm that I am qualified under s. 468 Florida Statutes to provide buil,;:np, !r; action services as authorized by
s. 553.791, Florida Statutes pursuant to section 104.3.2 Florida Building. (',uk• I is uudcrstood that the undersigned
hereby accepts the responsibility for performing all of the required Inspection:, , entitied in this document. 1
understand that inspections are required as detailed in Section 105 of the I• [(it; I. Builtliog Code, the permit card, and
as prescribed by the local authority having jurisdiction. ) further agree to I:. if,1 -1 Lucie: County, harmless for such
Inspections, and accept responsibility for compliance with all other regt -rule^, • conraiced within. Upon completion
of tile structure, I will provide the Building Official a certification that rv; Nit i .. !re, electrical, gas, mechanical and
plumbing systems have been erected In accordance with requirements o' :hr. it , : nic:d ends_
The undersigned certifies that all work inspected (and approved) will ce;dor!n 1, all applicable codes and standards;
as well as all related permit documents. In the event of any conflict betNw.vo .!-I :s and documents, tho more
restrictive shall apply. A log shall be maintained of all inspections madr L;cla I ! g the date of the inspection, the
inspection performed using the permit "hard card" terminology and the Ji:r iI,, n. on of eitbcr approved or
disapproved and an inspection report shall be forwarded to the Building 1)cpo, t• .cnt within 72-hours of making the
inspection. Cach inspection report shall bear the seal of the Architect / F n!:;n ••! lerforming the inspection, along
with his I her signature and the date. The permit will expire'unless work •:• -avrr mead (and receives an approved
inspection "colored red on the permit hard card, red print indicates a rerun c( r. pectiou which satisfies the 180-day
requiremcne') within 180-days (60-days for demolition permits) from tfir :,:t!•..: ate ofrhe permit. All subsequent
inspections shall be made within 180-day time frame prior to permit exp!nniro•. 'd0 INSSPECT'IONS WILL HE
PPRFO➢RMED SUBSE0UF-NT• TO PERMIT EXPI(RATI®N: ANF1 NO 1) l,PRCTIONS lV flea,
HANQL,F D `•A TER-TIIE-FACT'". ,�.•` AN T/jO�,,
o Architect / Engineer: P • •N • •'1'l `
MICHAEL A. LUE � • • SF'•,�G•
(PRIMMD NAME OF Architect/Engineer) (SIGN ORE', n,:•; •cc/Find—,r�• 'e
No 47520 •;m
05/07/2018 772-56 -1257
(DATE)• STATE OF •'�+
2030 37TH AVE., VERO BEACH, FL 32960 �.OnT—
APChite(^: I?Ili::!ear -y`I " v-- c--
NOTARVt Seal: = F "'t 6SiONNFF062316
5T'ATEOF FLORIDA WltAF®brutry18.2020
COUNTY OF n wriainon Fcna.teu s.,+e
The fore oing inshvg antent wa�dged before me this _1___ day o+ MR� 200�1 g
By MINAELA. LUE Mycommisston!:>-,ta•:•: �y1-8/2090
Personally Known _� Produced ID a of i ntificaii n:�Tl
Signature of Notary Public—StateofEl_:
Whenever the owner / contractor desires an inspection to be performed',o ang-u a other than the above or a St Lucie
County Inspector, a new application form must be submitted and approt •: ct b; • :-1., St Lucie County Building Official
or Building Code Supervisor BFFORR the subject inspection (a) is (art VI?It:•: 4?, J)
The St Lucie CountyBuilding Department may at any / all times visit t.w con;•i action site to ensure compliance
The St Lucie County Building IIbpilnment may at any / all times visit au• co,,� j action s a• to ensure compliance
and / or for the purpose of spot inspections to verifying construction act •i:, .m i - in compliance with the
construction documents / drawings.
Failure to rollow standard) operating procedures for inspections fort I.u, to Cou» ty may negate any further
approvals for you or your firm to perform this type of inspection. In ;add isi•,n, incomplete or inaccurate
inspection reports eetay result in failed inspections, work stoppage utut + ❑* ',ermil expiration. All violators
will be referred to tits i'D $1P R
Should you have any questions regarding this procedure, please contact i:n• S-
0 Building Official or Building Code Supervisor
cie (omoty Building Department
!Print Name Signature — -- Date
E21
I
SDI ILtU(CIE (CQ��1�`ITy (C®®E cCOI�tiI�A,�ANCE 4�1iWSI®N
u t�
' EIVEnn
2300 Virginia Avenue OC£cc 772) 462-1553
462-114>i
Ft Fierce FL 34982 ] ttx 772)
��ST. Lucie County, 1`E171711likrip I
Application for Finest® PTmvider foir PIRDS fieiew I InsPecta®au�
(AfF Agreement. Revised July 1.:
St Lucic County Code Compliance 01%'i:4 r
PERMIT #: DATE: 05/07/2018,_
sTREET.ADDRESS: 4250 NORTH LIWY Al A III LT F -T--P E.�,a�u9
Parcel R:-1423 501 0049 nnn 8
To: St. Lucie County Building Department
FL PE# 47520 / SI# 1061
lhaveelectedtoutilize MICH E yyllej;e,i.trntian Number)
(Nameof Scam Registered Architcut I Engineer)
t� EIII,rledaostamms)
PuaNAME: M. L. EAF ERNG, NC
------..
ADDRESS: 2030 37TH AVE.,VERO BEACH FI s9960
TGI,EPxortE tt: 772- 9-1257 FAX # i 772-.569=4.041
as a private provider as authorized Ins. 553.791, Florida Statutes. I h:ivc- cirri sd to usu this "Private Provider" for:
(check all that apply):
—PLANS REVIEW: _Building, Electrical, „ ' +chanical,, Elumhing
(AlndavitRequired) .0:cha1lcnl, _ Plumbing.
)( INSPIECTION(s): Building, Electrical,
FEE SIMPLE OWNER-
1 have elected to use one or more private providers to provide building Lrxlr. ilan review and/or inspections services
on the building that the subject of the enclosed permit application, •is tirirt,r r ized by Part XII, chapter46r, Florida
Will(,
statutes & s. 553.791, Florida Statutes. I understand that the local buiir!ini,. +: icial arty not review the plans
submitted or perform the required building inspections to determine ,: milp. to ere with the applicable codes, except to
the extent specified in said law. Instead, plans review and/or required is uild i ., inspeciiuns shall be performed by
licensed or certified personnel identified in the application. The law: taitiii:•s ninimutn insurance requirements for
such personnel, but I understand that I may require more insurance tit i.C: my interests. By executing this form,)
acknowledge that I have made inquiry regarding the competence of ll,c liter: ed or ceiifed personnel and the level
of their insurance and am satisfied that my interests are adequately proi.xic v
I agree to indemnify, defend end hold harmless the local governmen and i v: d building ufiicial(s) from any and all
claims arising from my use of these licensed or certified personnel to jwrft r• buihletg code inspection services
and/or plans review. With respect to the building that is the subject t1f ilic :; , lised Purtnit application, ) understand
that if 1 elect to make any changes to the listed private providers or the cr•••: as to be provided by those private
providers, the fee simple:owner I shall, within twenty-four (24) hour,'.+t0,: :ny tllangos, update the notice to reflect
such changes. ---I
a FEE SIMPLE OWNER'
GENE ROSS, OCEAN HARBOR SOUTH M Fg
7777;7--
(SIG14ATt OWNER)772-569-9$53—__.___i'i, +NE 1f:)
f E)
ELLIOTT MERRILL MANAGEMENT 835 20TH PL. VEROZEAGH F4— —
(AODRESS)
(AI)DRES5)
E23
NOTARY-
STATP D7
COUNTY OF T-, t V e-
Thecegoiog ins ent was acknowledged before me this GI:� of _ 200
13y.`=��'m4- SS M commission CNI, •es: ---
--
personally Known Produced ID a 'demitica:•1
Signature of Notary Public- State of,ru--: __
AMDAVi'IC` 190R(jPLMN ItE IIERW:
I affirm that I am qualified under chapter 468 or 471, Florida Stam,c.N m :•I - •vide building code plan review services
as authorized by s. 553.791, Florida Statutes pursuant to section 10•I, 1, 2 1' r •rida Building Code with respect to the
build big that is the subject of the enclosed permit application- I undei sb: r: hat the local building official may not
review the plans submitted or perform the required building inspeclx:ris , I -etermino compliance with the applicable
codes, except to the extent specified in said law.
OVER
;+'SPY Pp ••.
°'_
JULIE A BARRETT
��fr��Y�
MY COMMISSION #FF132752
"`..�ro�n�'�`
EXPIRES September 28, 201 a
(Ge7) 398-0183
FlorieallolaryService.---
I have reviewed the construction plans / documents to determine compliancc •,•
determined that the plane reviewed comply with the
h the applicable codes. i have
'
applicable codes. I acc.ap
with all provisions of the standard / technical codes and other'pertinent ]itc" ,; :
Il responsihility £or compliance
1 rdinancus.
signature as affidavit under oath, that the following is true• and correct t:r tnc .
I provide my seal and
of :ny Jcnewledge and belief.
(a) The plans / documents were reviewed by myself, l am duly auihm ixc•:
the code and hold the appropriate licenses
o perform plan review pursuant to
or certificates.
(b) I am qualified as a plan examiner under Part XII of Chapti r 469 1:1.,• i
(a) The plans comply with the applicable codes, standards, 1
.t Statuteot
statute:, and 1:
requirements,
it onihumces or regulatory agency
(d) The plans comply to the laws as to egress, Life Safety Codes, t j I:o rite
and show the structural design.
•nsnucfon and general arrangement
(e) The plans and design conform to the requirements of the technical c:•{
, ; as to srxength, stresses, strain and
stability.
(f) To the best of my knowledge, the plans and specifications corals:.• ",
codes and the applicable fire -safety standards as determined b; un:
1 flue apitlic+able minimum building
r •t
Florida Building Code and chapter 633 Florida Statutes.
; I authority in accordance with the
Rnspections:
I nfftrm that I am qualified under s. 468 Florida Statutes to provide builrt:ng i r t ecticn services as authorized by
s. 553.791, Florida Statutes pursuant to section 104,32 Florida Building. rude I is mtdonteod that the undersigned
hereby accepts the responsibility for performing all of rho required inspcia+nw• , enti lied in this document. I
understand that inspections are required as detailed in Section 105 of the I• ioi , I. Building Code, the permit card, and
as prescribed by the local authority having jurisdiction. I further agree b; kill - I Lucin County harmless for such
Inspections, and accept responsibility for compliance with all other regt r -raw contained within. Upon completion
of the structure, I will provide the Building Official a certification thatt•+e ,u i.c. re, electrical, gas, mechanical and
plumbing systems have been erected in accordance with requirements o: Il+e 1, r: nical codes.
The undersigned certifies that all work inspected (and approved) will ccvrt:nr. 1. all applicable codes and standards;
as well as all related permit documents. In the event of any conflict betwct•,I :• ,lI is and documents, the more
restrictive shall apply. A log shall be maintained of all inspections math- Inc],1 I : g the date of the inspection, the
inspection performed using the permit "hard card" terminology and the tloig, a• on of either approved or
disapproved and an inspection report shall be forwarded to the Building I?rlutrt lent within 72-hours of making the
inspection. Each inspection report shall bear the seal of the Architect / I nl;:n_••I rerforming the inspection, along
with his / her signature and the date. The permit will expire'unless work •s -:nc enceel (nnci receives an approved
inspection "colored red on the permit hard card, red print indicates a recu:-cx r. pecticu which satisfies the 180-day
requirement') within 180-days (60-days for demolition permits) from tl,+• :.:11- :ate orihe permit. All subsequent
inspections shall be made within I80-day time frame prior to permit expl itiov. 10 11d4SPI CTIONS YJ&D 80 r r t
PERFOPti RDSUBSEOUENTTOPERMITE%PPIRATION-AMDNOI-PECTIONSWP t? t1TfiONj'♦♦♦
PiANQL.EID "A,FTEdd-TPIE-FACT". �� .....
o Architect/Engin¢er: ' �+ F �•,C�♦;
J�HAEL A LUE 0 ' 1 �
(PRINTED NAME OF Architeet/En ineer)
6 (SIGNA71URE+0 :t: •r; •ci/1nginccrJ: O �
05/07/2018 772-569-125 T iA W
(DATE) (PI nNi —'--.' w.-'—S 1 . ((/+
2030 37TH AVE., VERO BEACH, FL 32960 . �'f�••, F �OQ'•?:
(ADDRESS)
Architect: En2:leer. 1DJ ?�:"' WV� —" :t''-- --
NOTARY; Seal: MY CV1J?AIStSICN 0 FF6623%
STATE ®F FLORIDA ?, „ taxPlni s F®nntory te• 2020
COUNTYOR 1n1n1An1 oni��� wo+isncroa Fb bMa .�
The foregoinginsttvm�`D antic w s ii T i6wled cd before me this —d o+ � y 2
B MIHELA. LUE g M commissi n1:>-,+rt->: T--' 2n
y y �2J.'LS/9n�18
Personally Known Produced ID T of_ide tiftcali n:
Signature ofNotaryPublic—Stateof I ' AI
Whenever the owner / contractor desires an inspection to be performed'r mrr , a othta than the above or a St Lucie
County Inspector, a new application form must be submitted and approv:-ci ts;.• -1 i St Lucie County Building Official
or Building Code Supervisor BEFORE the subject inspection (a) is (are • I'I ilt r•: ,( MF.1)
[Y]
The St Lucie County Building Department may at any /all times visit tar con•. i •teelon silo to ensure compliance
The St Lucie County Building Laynitment may at any/ 11times visit tar con .., xenon stU• to ensure compliance 121
and/or for the purpose of spot inspections to verifying construction act nu::: i in compliance with the
construction documents / drawings.
Failure to follow standard operating procedures for inspections for `,i t aa- w COunty may nogatc any further
approvals for you or your firm to perform this type of inspection. in addi,I.-n, laeaomplete or inaccurate
inspection reports may result in Tailed inspections, work stoppage a:,ji t t, -ermh expiration. All violators
will be referred to th. Be ID p HL
Should you have any questions regarding this procedure, please contact i n• u ' Cie t:ounty Building Department
® Building ®fticial or Building Code Supervise,
Print Name §ignatuo-e — --- Vate