HomeMy WebLinkAboutSUBMITTED PAPERSOFFICE USE ONLY:
DATE FILED:
PLAN REVIEW FEE: RECEIPT NO.: 7 �A PERMIT NUMBER:
CONCURRENCY FEE: RECEIPT NO.: CERT. CAP. NO.:
ALL INFO MUST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
$POG & CODE REGULATIONS DIVISION
BY 2300 Virginia Avenue
Ft. Pierce, FL 5652
St. Lucie /
CpIlllty 772-462-15531553
APPLICATION for BUILDING PERMITS rYa �—
CERTIFICATE of CAPACITY/ZONING COMPLIANCE +, p
PROJECT INFORMATION
1. LOCATION/SITE ADDRESS:C'j1Fra1t
2. PROJECT NAME: �1% SITE PLAN NAME:
3. PROPERTY TAX ID #: I ��j�{' ,r'�Q QQ Sa bon I A
4. LEGAL DESCRIPTION (attach extra sheets if necessary): 40/tk 6wip to." t tv:a -Uw tT Z u--% zs;, t
5. PLAT BOOK 6. PAGE NO. 7. BLOCK NO.
9. PARCEL SIZE (ACRES/SQ FT.).�`,,! /-WCL LOT DIMENSIONS: ,,, J bb 9LL
8. LOT NO. ;�Q
10. COMPLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTIVITY: J g'P►Qvl
11n1M(%A oao L
`� N-, 28•qZ SUP
11. , SETBACKS (ACTUAL) FRONT:
BACK: /,0 ' RIGHT SIDE: ,?w LEFT SIDE:
12. TYPE OF CONSTRUCTION (Check all appropriate boxes)
aAl'NEW CONSTRUCTION [ ] EXPANSION/ADDITION
[ ] RESIDENTIAL. [ ] COMMERCIAL
[ ] OTHER (SPECIFY)
13. DESCRIPTION OF PROPOSED USE: r sw+0 -S , IMtM
[ ] INTERIOR RENOVATION
[ ] INDUSTRIAL
14. SQ. FT OF CONSTRUCTION: 0a. 15. SF. FT 1 st FLOOR:
16. VALUE OF CONSTRUCTION: $
The value of construction is used to determine the amount of permit fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent. with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
OWNER INFORMATION
NAME: `J / p��b�°t.�/ ffl
ADDRESS: ,d
� I.
CITY: ��-� r ei('Li STATE: ZIP:
PHONE (DAYTIME): (�'�. L{ — �jfp Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME):
CONTRACTOR INFORMATION zq�gq (
ST. of FL REG.CERT #: ST. LUCIE COUNTY CERT #: C?(— )4TI It D
BUSINESS NAME:
QUALIFIERS NAME: , Ur -A NMS
ADDRESS: L f) Y2 5 1 ULla
CITY: STATE:
PHONE (DAYTIME): ^ :C G 2 FAX NO. Email:
ARCHIT/ENGINEER:
ADDRESS: 1. 13
OPHONE (DAYTIME): �%-
BONDING COMPANY:
ADDRESS:
CITY:
MORTGAGE LENDER:
ADDRESS:
CITY:
a
STATE: r
STATE:
STATE:
ZIP: 3Z94
ZIP: 3 - tleew
ZIP:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it will be voided and returned to you by mail.
CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
OWNER Olt CONT1 'T� IGNATURE
STATE OF FLORIDA
COUNTY OF 5 - l.V Lt
The foregoing instrument was acknowledged before
me this �* day of (141 %14-1 20�_,
by
who is perso
,wgq known or has produced
CONTRACTOR, SIGNATURE
STATE OF FLORIDA
COUNTY OF > FLyt.t,,,L—
The foregoing instrument was acknowledged before
me this _L;�3_day of , 20
by
who is personally known or has produced
as identification.
Signature 9f Notary Signature
Commis on No. py,, Jg1AES F. ROUAN
JAME�W Commissi Lam' .__MY_�OMMISSION # DBQ�
�; ;; MY COMMISSION D 603726 —November , 2
*; '�' EXPIRES: undeiv+riters
EXPIRES:November4,2012 r' v�° BondedlhruNo YPub
• cffk BondedThruNotaryPubUoUndewters •P,roF"'`
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY BP #: / • f�`07 C
SECTION
4-
TOWNSHIP
a 4
RANGE
MAP NO.�
r
ZONING
�u Q
LAND USE
LOT CVG %
TAZ NO.
FLOOD ZONE
FIRM MAP #
1ST FLR ELV
MAX HGT
CONST TYPE
OCCUP TYPE
MAX OCCUP
# OF FLRS
WATER
SEWER
SPRINKLERS
STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 1/1990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODEaq
AREA
FEE
FEE
(RADON)
LIBRARY
PUBLIC BLD
PUBIC BLD
PARKS
IMPACT
IMPACTFE
IMPACT
IMPACT
FEE
COR ION
FEE
FEE
GENERAL
SCHOOL
ROAD
CREDIT
Y
N
LAW ENF
IMPACT
IMPACT
IMPACT
FEE
FEE
FEE
FIRE/EMS
DRIVEWAY
Y
N
DRIVEWAY
ADMINISTRATIVE
IMPACT
REQUIRED
FEE
VARIANCE FEE
FEE
SPECIFY
MECHANIC ROOF
NON -CONFORMING
MISCELLANEOUS
SUBS
ELECTRIC GAS
LOT OF RECORD
FEES
REQUIRED
PLUMBING
FEES
DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
11
201 Z.
RECEIVED
DATE
a
COMPLETED
p
I'INITIALSA
b
PLANNING & DEVELOPMENT SERVICES DIVISION
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Ave
Fort Pierce, FL 34982
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
01' '4i 7VKI &t, will be using the following sub -contractors for the
(Compa y/Individuaal rName)
7-f, project located at 6
�— (Street address or Property Tax ID #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning Department of St. Lucie County.
Trade
Name of Company/Contractor
St. Lucie County/ .
State of Florida
License Number
Electrical
1� v%(�S
Plumbing
y7 ale, i4. H �Z .
.HVAC/
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMIT ISSUE DATE:
NUMBER:
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS flDIVISION
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: J20 6 6,S
State of Florida Certification Number (Ifapplfcame): 9001313
.— C— have agreed to be the
(Company Name/Individual Name) ((��
�cGtrP sub -contractor for %C r i�
(Type of Trade) (Primary Conn tor)
for the project located at 6 // `rc-. F-/
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL SIGNATURES ARE REQUIRED
�� — /•/, _Z // Z1.2,
SIGNATUR4LJ ! PRINT I
Business Name:
Address:
City/State/Zip:
Phone:
OFFICE USE ONLY:
email: &A h1a S/0 /a I% t", c w e
PERMIT # ISSUE DATE
PLANNING-& DEVELOPMENT SERVICES DIYARTMENT
77OF FLORIDA, COUNTY OF
711ARY
PUBLIC
The foregoing instrument was acknowledged before me
this `-0 _day j 201_—
by
Personally Known or Produced Identification
Type of Identification Produced:
JAMES F. ROUAN
MY COMMISSION # DD 803726
EXPIRES: November 4, 2012
;p N` Bonded Thru Notary Public Underwriters
SLCPDS Re
Building and Code Regulations Division
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PERMIT #
i (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
` CD-31 I- , and hereby affirm that one of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515, Florida Statutes: (Please initial the method used for pool.)
The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F1246-91(Standard Performance Specifications for
Safety Covers for Swimming Pools, Spas, and Hot Tubs).
�//All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85deeibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing, self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck.
I understand that not having one of the above installed at the time of final inspection, or when the pool is completed for contract
purposes, will constitute a violation of Chapter 515, F.S., and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to $500.00 and/or up to 60 days in jail as established in chapter 775, F.S.
I understand that the St. Lucie County Building Inspections Department assumes no liability for the final inspection of one of the
above protective devices, or the lack of maintenance, or the removal of such after the swimming pool has been finalized.
I, the contractor, agree to instruct the owner of the proper use and maintenance of such safety
-e
coNTRAcx6R SIGNATURE OWNER SIGN RE
STATE ORIDA, COINTY OF
OTARY PUBLIC
The foregoing instrument was acknowledged before me
this -- day of 20
by
Personally Known ��or uced Identification
Type of Identification produced:
EE--
JAMES F. ROUAN
MYCOMMISSION # DD 803726
EXPIRES: November 4, 2012 Bonded Thru Notary Public Underwriters
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (If applicable): C9 L 0 J S712i0
P,vz f
Name/Individual Name)
have agreed to be the
vw1 ' sub -contractor for
(Type of #ade) (Pi' ary Contractor)
for the project located at Z f" i &, "Ji A .
(Protect Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Building and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORIGINAL SIGNATURES ARE REQUIRED
�l�S-z61`z-
SIGN RE PRINT N DATE
Business Name:
Address:
City/State/Zip:
Phone:
7` email:
OFFICE USE ONLY:
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)462-1553
FILLED LANDS AFFIDAVIT
I, the undersigned, am the owner of the following described property,
Z,C61i 1 so pl�
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development - Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
-Ij
Date
ACKNOWLEDGED BEFORE ME THIS DAY OF J Wes! .20
BY lefo WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
SIGNAT)ORE OF NOTARY PUBLIC
COMMISSION NUMBER
AS IDENTIFICATION.
"f-1 "I " S 900v-�
TYPE OR PRINT NOTARY
(SEAI*MES F. ROUAN
MY COMMISSION # DD 803726
EXPIRES: November4,2012
p�� �. Sanded Thru Notary Public Underwriters
SLCPDSD Revised 08/24/2010
JOSEPH E. SMITH, CLERK OF THE CIRCUIT' COURT' --SAINT LUCIE COUNTY
FILE # 3670463 OR B( ,` \3359 PAGE 2078, Recorded 02/02/2012 ---, 12:09 PM
NOTICE OF COMMENCEMENT
TO BE COMPLETED WHEN CONSTRUCTION VALUE EXCEEDS $2,500.00
PERMIT #: TAX FOLIO
State of Florida, County of Indian River, the undersigned hereby gives notice that improvement will be made to certain real property, and in
accordance with chapter 713, Florida statutes, the following information is provided in this notice of Commencement.
1. LEGAL DESCRIPTION OF PROPERTY (AND STREET ADDRESS IF AVAILABLE):
MONTE CARLO COUNTRY CLUB -UNIT TWO- LOT 201 (OR 3251-16581 2661 Conifer Dr Fort Pierce FL 34951
2. GENERAL DESCRIPTION OF IMPROVEMENT:
Installing a swimming pool and deck
3. ®OWNER INFORMATION or ❑LESSEE INFORMATION (If Lessee contracted for the Improvement)
Name: _
Address:
b. Interest in property: Owner
c. Name and address of fee simple titleholder (if other than owner):
4. CONTRACTOR:
a. Name: CRYSTALPOOLS
Address: 4684 N. US1. VERO BEACH. FLOFUDA. 32967
b. Phone number: 772-567-3067
S. SURETY COMPANY (IF Applicable, a copy of the payment bond Is attached):
a. Name & Address:
b. Phone number: Bond amount:
6. LENDER/MORTGAGE COMPANY:
a. Name & Address:
b. Phone number:
7. PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE
SERVED AS PROVIDED BY SECTION 713.13 (1) (a) 7., FLORIDA STATUTES:
a. Name & Address:
b. Phone number fax number:
8. IN ADDITION TO HIMSELF OR HERSELF,
a. Owner designates of to receive
a copy of the lienor's notice as provided in section 713.13(1) (b), Florida statues.
b. Phone number:
9. EXPIRATION DATE OF NOTICE OF COMMENCEMENT:
(THE EXPIRATION DATE IS ONE (I I YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED).
WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTERME EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,
PART I, SECTION 713.13, FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS IN IT ARE TRUE TO THE BEST OF MY
KNOWLEDGE AND BELIEF (SECTI N 92.525, FLORIDA STATUTES
SIGNATUR F OW ER kv WNER'S AUTHORIZED OFFICER/DIRECTOR/PARTNER/MANAGER
SIGNATORY'S TITLE/OFFICE
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS 30v DAY OF JANUARY 2012 . BY:
Sze S se-4 re -
NAME OF PERSON TYPE OF AUTHORITY NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED
®PE ALLY KNOWN OR OPRODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED
James F. Rouan
NOT RY SIGNATURE NOTARY PRINTED NAME NOTARY SEAL
41:
�'.� JNAESF.ROUAN
y?� MY COMMISSION 8 DD BM720
EXPIRES: Novembtr4, 2012
h• BmdedlMUHaWNPitLaUnLm�n
=a
STATE Of FLORIDA
ST. LUCIE COUNTY ?
THIS IS TO G.ERTIFYTHAT THIS IS A
TRUE AND CORRECT COPY OF THE
ORIGINAL.
J9jW,PH/0.0MITFI,0j_R4�. I-.'
BY:
J F` �
Deputy Clerk
Date: , a - 3' - 1:�__Q 1c
i94
Ida LOT 202
I o (OCWPHW)
FFEs901.8
zs,
r�
n�
iC
r
r
8,4' r •
.. Z 86.3'
H z E m 5.1' x
At
r3 m y�j tD O0. 13.7' N
ap�i
o
b 33Nmg 2
O o a 6
0
a
a O 1 ro_75t° al w -
V
140 1&0, TC
r
d
N
-- -- _ 1
g S 00'50'42- w a150.6Off- C,
S ( o LOT 200=?1w��'�-
(VACANT)
o
n1 DESCRIPTION:
d LOT 201. MONTE NU COUNTRY CLUB UNIT TWO, as recorded in Plot Book 23, 02u NOVEL2'
age 28 ('A' through 'B'), the public of St Lucie County, Florida - I
• � AREA: 18IBMSq. Ft.; 0. 3 Aerea# LEGEND
VEYORS' NOTES:
avey of desaiptidn as fumished by client
rnds shown hereon were not abstracted or researched by this office for casements and/err
w—of—tiwy record.
we ore no above ground encroachments, unless otherwise shown.
2 u+dgramg improvements were located.
wrings shown hereon are based an the centerline of Conifer Drive as platted and bears N
i'S2' E
aperty Iles 8n Flood Zane X as seed firom the Notional Flood lasuronce Program Rate Map.
comity Pond Number 12111CO175 F. with an effective dote of August 19. 1991. Revieed June
999.
r search of the public records was performed for encumbrances of other matters of title:
wratio n ehown hereon are ASSUMED.
ie survey to not covered by professional liability insurance.
his document, together with the concepts and designs Presented herein, as an Instrument of
w, is Intended only for the specific purpose and client for which it was prepared. Raise of
or improper reliance an this document without written authorization and adaptation by
motions or deletions to is without
ap report by oto ther err then the
ut written consent of the signing party, ai9ntn9 party is prohibited
w
nless o eompartson is shown all bearings and distances are the same'os plat values.
17IFiED TO. FFASTAL CONSTRUMNLim Akfaj
I
W
DUE - DRAINAGE 4 unU11r EASF]fE1fT Fib Fptq�p
FIRC ®FpuHp s/e tt�N Rib rti CAP CL - cfNTERUME
06 — OVETiHFJiD U74M t0es EP - r OF PANE7<IE?IT
IR - &A IRON Rt10 p - OE1.TA ANGLE
R/WSite— RIGHTS —It M #CAP R - ARC
DE - ORAINAGE EASEMENT y O�Ph- TS VA1fMNlREBAR
CERTIFICATION
1 hereby certify that the survey represented hereon was
performed under my supervision and it complies with the
minimum technical standards, os set forth by the Floldo
Board of Surveyors & Mappers in Chapter 61G17-6 of the
Florida Administrative Code, pursuant to Section 472.027,
Florida Statutes, and further that there are no viaible, above
ground encroachments unless shown or noted.
CHRISTOPHER D. GOLDING
Professional Surveyor & Mapper
Florida CatiRecte No. 6090
I� r HUGHES & ASSOCU
,URVEYIN01 G, INC.
7s2 N.W. AVIIVS ST.
`9f0RT SAINT Luc1E, FL 3M
01/15/2006 04:51
772462E."
SLC INSPECTIONS
PAGE 01/01
St Lucie County Inspections
2300 Virginia Avenue
Ft Pierce, FL. 34982
(7.72) 462;2' 02
CERTIFICATE OF TERMITE -TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT # tiX Slot- OO�TOB ADDRESS
B
PEST CONTROL
PEST CONTROL LICENSE #__V e j 4`f 46
We, the undersigned; bereby certify that we have pretreated the above -described construction for
subterranean termites in accordance with the standards of the National Pest Control Association.
Square feet of area treated:
Percentage of solution: ' Z�
Date of treatment:V�
❑ Footing
1st Treatment
❑'Re -treat
❑ Slab
❑ 1st Treatment
❑ Re -treat
❑ Driveway
❑ 1st Treatment
❑ Re -great
❑ P ols
1st Treatment
❑ Re -treat
Chemicals used:
Total gallons used:
Time of Treatment: 1 45 0.13 o
FOC104.2.6 Certificate ofPratetlive Treatment forpmvention of termites.
A weather resistant jobsite posting baardd shall be provided to receive
duplicate Treatment Certificates as each required protective treatment is
completed, providing a copy -for the person the permit is issued to and
another copy far the building permit files. The Treatment Certificate shall
provide the product used, identity. of the applicator, time and date of the
treatment, site location, area treated, chemical used, percent concentration
and number of gallons used, to establish a verifiable record of protective
treatment. If the .roil chemical barrier method for termite prevention is used,
final exterior treatment shall be completed prior to final building approval.
St Lucie County requires for the tinstl Inspection for CO, a Permanent
Sticker tb be placed on the electrical passel box cover, listing. all the
treatments and dates of applications.
❑ Other
13.1st Treatment
❑l Re -treat
❑ Perimeter for Final Inspection
NOTE.
Signature of exterminator
There must be a completed form for each required treatment or re -treatment and this form must bean
the job site to be picked up by the inspector at time of each inspection or the scheduled.inspection will
fail and a re -inspection fee charged.
R01,4rd 6113102 dms
03/11/2012 13:57 7727705961 CRYSTAL POOLS PAGE 01
03/16/2012 03:25 772 y 469
K.S.M.ENG. PAGE; 01/d1
KS i
GHLEi+CHE1R & >MaoW>♦LI.IAM ENGINEERING AND TESTING INC.
KELLER, SS03ASTIAN(772)sag -071� 1
MARTIN f77�f 337-775s p0. BOX 784 377, SE6 ": FL 329�8-13�7 �SOURNE ,321) 7MB488 I
PAR LEACH 337- 845�7445 www.kamengincering.net ST. LUCIE (772) 229-9093 1
FAX RE CH (W9 E-Mail: KSMOKSMENGINEERIN+0.NET FAX (772) 589-6469
C A.: 5693 SOIL COMPACTION REPORT
ASTM D 1.567 and ASTM D 2922
DATE TESTED March 15, 2012
PERMIT # /g ca - 003 d
CONTRACTOR : Crystal Pools of Indian River
JOB LOGATiON Fort lConifer Drive
Pierce, Florida
J013# : 12D226-1po1SHlkrr1
PO#, Searcy
ITEM TESTED Pool Be
7 PEN DRY MAX. DRY PERCENT
TEST LOCATION DEPTH
OF SAMPLE READ DENSITY PROCTOR VALUE COMPACTION
111 1 97.1
2
3
4,
5 North
6
7
a
g East
10
11
12
Soil Descriptiart:
Brown Sand
in Place Moisture:
10,3 Percent
Optimum Moisture:
11.E Percent
Max. Dry Density:
111.1 P.G.F.
0, -1'
37 107-9
95.0+
1• - 2'
3+ It
95.0+
Z - V
35 ,.
9510+
3' _ 41
Q' -11
37 111.1
38 1Q7-8
97.0
95.b+
it - 2'
38 N
95.0+
2' - S'
37
96-0+
3' - 4'
0' -1'
37 111.1
39 108.3
97.5
95.0+
1, - 2'
38
96-0+
7 _ 3'
33
9510+
3' - 4'
38
@ Test Locations the Density &
pene,E0tetwj$ . ings Indicate
«a�L.,VMel NP&action Meets
w
Natural Grade.
VV
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permK number and submit to the apprapriate 1mara 9enliment_
OW ", Public Works
�: �� Gcaui�t�i, FL
G. KQIIBr, pE.: 37293 r SI U� NO.: 860 ! Julie E. K�Iler, oQ:'D