HomeMy WebLinkAboutSUBMITTED PAPERS_2Planning & Development e�rvices
Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30 — Day Temporary Power Release
Date: 23 TV[,, 7011 Permit Number: i)OL/0l3
Property Address: 3 a -
THE UNDERSIGNED HEREBY REQUEST RELEASE OF. ELECTRICAL POWER TO THE ABOVE DESCRIBED PROPERTY,
FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENTS
IN PREPARATION FOR FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE REQUEST WE HEREBY
ACKNOWLEGE AND AGREE AS FOLLOWS:
1. This temporary power release is requested for the above state purpose only, and there will be no
occupancy of any type, other than that permitted by construction during this time period.
2. As witness by our signatures, we hereby agree to abide by all terms and conditions of this agreement,
including Building Division Policy, which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled "Requirements for 30 Day
Power for Testing" have been fulfilled and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be made in writing to the Building Official stating
the reason for the request. Power may be removed from the site and/or a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A fee of $100 will be required to lift the
Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST LUCIE COUNTY, AND THEIR EMPLOYEES FROM ALL
LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT OF THIS
TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE DISCONNECTION
ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
OWNER GNATURE DATE
io� 4v L—� d Tv 6eG,
GENERAL CONTRACTOR SIGNATURE DATE
ELECRICAL COAT ACTOR SIGNATURE DOE
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Gale Insulation
CERTIFICATE OF CORE FILL
JOB ADDRESS: 3;LScmre�Sjj BUILDING PERMIT#
This letter is to certify that Gale Insulation has installed %V30 square feet of
Core Fill in accordance with Florida Building Code.
INSULATION CC # CGC1512179
Gale Insulation
CERTIFICATION DATE:
THE AFFIANT,P?k j W, UAKl, IS PERSONALLY KNOWN TO ME
Sworn to and subscribed before me this 01q day of Ut,., a , 20 1 1 .
Notary Public, State of Florida
CASEY BINKLEY
MY COMMISSION # DD705789
EXPIRES August 16, 2011
(407)398-0153 FloridallolaryServlce.com
NAHa 3601-A CROSSROADS PARKWAY • FT. PIERCE, FL 34945
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FT. PIERCE (772) 465-9191 • VERO BEACH (772) 589-1514 • STUART (772) 283-3151 • FAX (772) 489-6758
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Contractor
Services
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INSULATION INSTALLATION CERTIFICATE
Gale Insulation BUILDER: bil�rWfS&) &tlf- _., SUBDIVISION:
JOB ADDRESS: 3PAW,,Qrqi, CITY:
PERMIT #: 1.1 vy 073 k LOT/BLOCK:
The undersigned hereby certifies that insulation has been installed in the above described property as follows:
1.Exterior CBS walls as been insulated with - -q i o a thickness of inches, which
according to 1rQ &.h'1 will yie d an "R" l_ue of -
Exterior Exterior frame walls has been insulated with to a thickness of inches, which according
to will yield an "R" value of
13toe- (�
2. Ceilings (flat) -has been insulated with to a thickness of 15 . inches, which according to
��' 17 will yield an "R' value of
Gei gs *an} has been insulated with ¢� to a thickness of inches, which according
to will yield an "R" value of
3. -IateFier knee walls has been insulated with �L L/&►`q to a thickness of o ,, inches, which according
to . will yield an "R" value of�.
4. Garage partition a s adjacent to conditioned living space has bRen insulated with a fiberglass batt to a
thickness of .. S inches, which according to ,iq &ill yield an "R" value of)
6.4
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General Contractor/B ' der Insulation Contractors Signature
License # CCTC1512179
Signature
THE AFFIANT, Paul W. Hash IS PERSONALLY KNOWN TO ME Sworn to and subscribed before me
this 2qt-day of S�,n •k-20 1 l
CASEY BINKLEY
Notary Public, State of Florida ,.o�:�"•°"�-
2 �;
MY COMMISSION # DD705789
.�. • o. EXPIRES August 16, 2011
4 7 s98-0153 FloridallotaryServwe.com
3601-A CROSSROADS PARKWAY • FT. PIERCE, FL
FT. PIERCE (772) 465-9191 • VERO BEACH (772) 589-1514 • STUART (772) 283-3151 • FAX (772) 489-6758
08/18/2008 18:27 56188192`�' < RIVIERA PAGE 01/02
eo�tfneintal FloridaTinenTk.'3450 W. S nrisnt Bvd:MSul erols 4301nc. _ \ 1705814
-SunfIse;'FL 333R:3
■ Tel: (954) 858.0'130 CAUTION!! l reshry in
lxed cement, morlar, . UNLOADING DrIver:are.proh�itod
r�E�DELB RGC t�'I�ENTGropp condreb or grout may ostrse•ehln Inluiy. Avoid from•dellvering concrete except•umor the
ntact wltlt ayes wheYe poeaible .and .wash trucks own power, and whore s� condNbn
co9
i ll�l�l l�1� IiIIE IICl19�i1 �Illl illl �ll I II mexpeset stein areas promptly with water. If 8ny. pormlt the sale and -proper opemllon or•hle
.ceent nlxtures.got Into eyes, rinso Immediately .'equipment, Drivors are nol'pennlded to
Il ,ti 2 add'reot Madly with water and get prowl medical • add water tb the mix nor to po beybnd the.
treatme it. Sawing, •or grtntiing' of concrete curb- IIN3, except upon the avthortrallon of
masonri unite. My'MSUlt In the rsiense Of dust •tlrb Puichssel/FnlnhtL$ar'S Agent• and his
F104 15): F_RbF- 0) :.[ ONCRETF_. ' PLANTnarilcle which, without the use of proper eye or acmplgrice of risk tot any Ions or damage.
rFsptralr ry piotgcdon, could cause - eye or nomd' I ackn6wh0ge rtrat "I nave roodti<+d and
3 77A EI.IJ Xl`Z . F1DW, Irritation The Material' Setely Data Sh6ets•for , awnf& rite r?tstermis listed on this ticket.
`�7%)."�4>J�f•-1 4�►. thg prcducta' cold by Corillnental'FllirldsI'undertir5nddnd6proe•tothd•terms or?
C'Rtb line crossed al Purchbggr/Purcha' &i - AgdMt request.• Initials of Rurchassr/Purcha oes Malerinl : Inc, are oballabio upon requeat. ' hor0he front and back of ffri;: verof; •
Agent - TOTAL,
WATER
lnfliala'of Purchnser/Pun haser•'s Agent sckhOWledging addition of water at Punchsapr/IourchassrB YARDS ON.TRUCK/GALS.OF WATER ADDED. _IO
Agonl requoai• .. "1 a A: a IF Q, 6
' ARRIVAL TIME, . START'ROUR TIME . FINISH POUR.TINIE LEAVE JOB TIME f ti
IMIRC HAS'ER!
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PURC14ASERIPURCMERS'AGENT.:.'. •P.O.NUM9ER/MD,EHEuzy ZONE ' J013NUM� TINETICKETFO TIC`KFr
5909077
SOLD TO , •DELIVOI TO
RICHARD K. DAUIS:.CONSTRUCTi13M 1511105 1AEsI .I>i, 0WAY MOAT? ED
Concrete Dlspaml:.'
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D®Ilvery Instructions
Special .instructions
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RIVIERA PAGE 02/02
COntinOntal Flarldn Mati orals Inc.
13450 W. SUnrIQEr 131vd.; Suit' 430
1705813
SunrisE, FL 3331n
Tel: (954) 858'0'ra0 : CAUIIONH Fieghly mixed cement. matter, -UNLOADING 1]dugrg3ro'ptoltlDlrCd
concreb. or grout may cauee•skin Injury. Avold from delivering concrate:excepi under the
contact with oyes where possible and wash twit's (w n POW or, and whom condmons
exposet skin areas promptly with water. If any permit the -safe and proper operation of his
cement nixtures got Into eyes, flnse•Immedlatoly equlpment, -Prlvers orn nol-pormiUed to
and r pt atedly whh water :antl got prompt- medical •aM water to the nrx nor to go beyond the
trnatme nt. Sawing, or grinding of concrelo ' curb Ohs,-acept upon the authorization of
meBonq unit,. moy rosull -In the- ralease of dust th<i PLIfchO15er/Pf) mhrMr'3 Agent* and his
FORT F!IER6:;E-M) CfahlE FIE •f C. Pl-AITT partlolos which, wltttbut the use of proper eye or acceptance of flak for any foss or dap,age.
resplrstt ry protection, could cause eye or noSo • I gcknowlsdge that 1 have reeslved and
3778• SEL U I TZ ROAD Irdraddn The Mstorial Safety Dare 9heets -for '-aa:epovl rhr" mote . fs'4�ed on this fkfccl:
t r Inc pre ducts sold by Continontnl Florida .'I underarend'and agree ro'the forme on
Curb,llge o ossoa aµt'Pu cl aRer/Purr haser's Agent reques4 Inl&kIS of Purchaser/Purchaser';: 'Materlel ► Inc. are aval0619) upon request. ' both the front and back of this Wlcot,
Agent TOTAL WATER
:Initiate of Purchascr/Purcheser'a.Agent acknowledging addiflon of woeret Purchoser/Purchaser';I VARDS-ON•TRUCK/ GALS t7F. WATER ADDED ADDED
Agent rOqueel. 1 O 9 to. 7 T •6 6 .4• a• X
AHRIVAL TIME START POUR TIME - FINISH POUR TIME LEAVE JOEI TIME
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PURCHASER'S AGENT % G-
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fir" 01CTE TICKET
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