Letter 12 1C3 Closeout for Permit Completition Certifications by E1j5WAIF

VIEWS: 15 PAGES: 4

									Letter 12-1C3                                                                  (04/19/2012)

TO:
emy.delgado@dot.state.fl.us;

CC:
dorothy.sargent@dot.state.fl.us; van.humphreys@dot.state.fl.us;

alan.obaigbena@dot.state.fl.us (Only if any of the Water Management District Permits Apply)
SUBJECT: CLOSEOUT FOR PERMIT COMPLETION CERTIFICATIONS
Job Description:
Financial Project Number:
Federal Aid Project Number:
Contract Number:
County - Section Number:

This is to advise that Contractor’s Name, Internet E-Mail Address, has satisfactorily completed all contract items
if applicable below.

Florida Department of Environmental Protection (FDEP)
Notice of Termination (NOT)
HB#____________________________________________________N/A_____

Southwest Florida Water Management District (SWFWMD)
Individual or General Permit-Statement of Completion
HB#____________________________________________________N/A_____
Notice General Permit (written letter that project is completed)
HB#____________________________________________________N/A_____

St. Johns River Water Management District (SJRWMD)
Individual Permit-As-Built Certification
HB#____________________________________________________N/A_____
Individual or General Permit-Annual Status Report (each June)
HB#____________________________________________________N/A_____
Notice General Permit (written letter that project is completed)
HB#____________________________________________________N/A_____

Suwannee River Water Management District (SRWMD)
General Permit-Sections A, B, C-As-Built Certification
HB#____________________________________________________N/A_____
Individual or General Permit-Annual Status Report (each June)
HB#____________________________________________________N/A_____
Notice General Permit- As-Built Verification & written letter that project is completed
HB#____________________________________________________N/A_____

US Army Corps of Engineers (ACOE)
Individual Permit-As-Built Certification
HB#____________________________________________________N/A_____
Nation Wide Permit (NWP)-Self-Certification Statement of Compliance
HB#____________________________________________________N/A_____

US Coast Guard (USCG)
Bridge Completion Report
HB#____________________________________________________N/A_____
                                                  CPAC
                                              NOTES/HINTS/TIPS
                                                Letter 12-1C3

*Some permits may have more than one completion requirement. List all applicable Hummingbird
document numbers.




                              PERMIT FORM REQUIREMENTS
                                       10/06/2011

Federal    Permit        As-Built            As-Built        Contractor CCEI or In-     Contractor    EOR
and/or     Types       Certification       Certification     Provides 3  house PE        Sign as     Sign &
 State                   & Other             & Other           Sets of  Sign & Seal      FDOT’s      Seal As-
Agency                 Permit Forms          Permit           As-Builts   As-Built      Authorized    Built
                                            Submittal         Plans &   Certification     Agent       Cert.
                                            Deadlines         Certified    Form         (Spec 7-2)    Form
                                                               Survey
                         40C-4.900(3)        at least 48
          All Permit
SJRWMD                 Commencement         hours prior to                                 Yes
            Types
                            Notice         commencement
                          40C-1.181
                                            within 30 days
          Individual    (13)/EN-45 As-
SJRWMD                                          after           Yes          Yes
            Permit           Built
                                             completion
                         Certification
          Individual
                        40C-4.900(4)
              or                            Annually each
SJRWMD                  Annual Status                                                      Yes
           General                              June
                           Report
            Permit
          Individual
                         547.27/SOC         within 30 days
              or
SWFWMD                  Statement of            after           Yes                                    Yes
           General
                         Completion          completion
            Permit
                        40B-1.901(14)        at least 48
          All Permit
 SRWMD                 Commencement         hours prior to                                 Yes
            Types
                            Notice         commencement
                        Section A, B, C-    within 30 days
           General
 SRWMD                     As-Built             after           Yes          Yes
           Permit
                         Certification       completion
           Noticed      (Revised 7/02)      within 30 days
                                                                          Yes (No PE
SRWMD      General         As-Built             after
                                                                           required)
            Permit        Verification       completion
          Individual
                        40B-1.901(15)
              or                            Annually each
 SRWMD                  Annual Status                                                      Yes
           General                              June
                           Report
            Permit
Federal      Permit        As-Built             As-Built       Contractor CCEI or In-     Contractor    EOR
and/or       Types       Certification        Certification    Provides 3  house PE        Sign as     Sign &
 State                     & Other              & Other          Sets of  Sign & Seal      FDOT’s      Seal As-
Agency                   Permit Forms           Permit          As-Builts   As-Built      Authorized    Built
                                               Submittal        Plans &   Certification     Agent       Cert.
                                               Deadlines        Certified    Form         (Spec 7-2)    Form
                                                                 Survey
                                              within 60 days
            Individual       As-Built
  ACOE                                             after         *** Yes       Yes
              Permit       Certification
                                               completion
             Nation
                         Self-Certification   within 60 days
              Wide                                                                           Yes
  ACOE                     Statement of            after
             Permit
                            Compliance         completion
             (NWP)
                                                                  “Only
                          D7-(1106-09)
                                                                 Certified
            All Bridge       Bridge             at project
  USCG                                                           Survey;       Yes
             Permits       Completion          completion
                                                               As-Built not
                             Report
                                                                Required”
             ***NEW SECTION 7 AS-BUILT SPECS - IMPLEMENTED IN JULY 2011 WORKBOOK
   NOTE: All WMD Noticed General Permits require a written letter of project completion. Deadline is
                             within 30 days after project completion.




Visit the District Construction website for any missing permit forms. Look in the Environmental section for
“Permitting Forms.”

http://dotsd2ww01.d2.dot.state.fl.us/web/206--Const/index.asp

								
To top