HomeMy WebLinkAboutNotice to Bldg Official - Century Complete 5801 Eastwood Dr. Lot 12 - SignedPrint Form
Notice of Building Official of Use of Private Provider
Project Name: CENTURY COMPLETE HOMES — 5801 EASTWOOD DR. LOT 12
ParcelTa%ID: 130161300420005 — PERMIT# 1910-0658
Services to be provided: Plan Review_ Inspections X
Note: If the notice applies to either private plan review or private inspection services the Building Official
may require, at his or her discretion, the private provider be used for both services pursuant to
Section 553.791(2) Florida Statute.
Chad Bally, Division Manager, SE Florida
As the fee owner, I affirm I have entered into a contract with the Private Provider indicated below to conduct
the services indicated above.
Private Provider Finn: GFA INTERNATIONAL INC.
Private Provider: THOMAS MONTANO
Address: 607 COMMODITY COVE PORT ST. LLICIE FLORIDA 349
Telephone (772) 924-3575 Fax (7,72) 924-3580
Email Address (Optional): TmontanciAteamcfa.com
Florida License Registration or Certificate* PE84146
I have elected to use one or more private providers to provide building code plans review and or inspection
services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791,
Florida Statutes. I understand that the local building official may not review the plans submitted or perform
the required building inspections to determine compliance with the applicable code, except to the extent
specified in said law. Instead, plans review and/or required building inspections will be performed by licensed
or certified personnel identified in the application. The law required minimum insurance requirements for
such personnel, but I understand that I may require more insurance to protect my interests. By executing this
form, i acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel
and the level of their insurance and am satisfied that my interests are adequately protect ed. I agree to
indemnify, defend, and hold harmless the local government, the local building official, and their building code
enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to
perform building code inspection services with respect to the building that is the subject of the enclosed
permit application.
I understand the Building Official retains authority to review plans, make required inspections, and enforce the
applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes.
If I make any changes to the listed private providers or the services to be provided by those private providers, I
shall, within 1 business day after any change, update this notice to reflect such changes. The building plans
review and/or inspection services provided by the private provider is limited to building code compliance and
does not include review for fire code, land use, environmental or other codes.
The following attachments are provided as required:
1. Qualification statements and/ or resumes of the private provider and all duly authorized
representatives.
2. Proof of insurance for professional and comprehensive liability per Florida Statutes s.533.791 (16).
Individual Corporation Partnership
Print Name Print Corpor n Name Print Partnership Name
WJH %=1tCa p e
By: By: By:
(signature) (signature) (signature)
Print
Address:
Phone#
Please use appropriate notary block.
STATE OFT(.
COUNTYOF�iP
Individual
Print name Chad Bally
Address: 3 Governors Lake or
Naraoss, GA 30071
Print name
Address:
Phone# tulls+ste19 Phone#
Before me, this day of ,20_, personally appeared who
executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein
expressed
Corporation /l �I4TUIn• IpL.�I1l41'L1YC IST
Beforeme,this — 1 dayof- 1 `J ,29Z personally appeared L1
JA i�wFt LLC_ a corporation, on behalf of the state corporation, who
executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein
expressed
Partnership
Before me, this day of J 20_, personally appeared
partner/agent on behalf of_ _ _ _ _ _ _ _ _ _ _ _ a partnership, who executed the foregoing
instrument and acknowledged before me that same was executed for the purposed therein expressed
Personally known ✓ or produced identification_ type of identification produced
- gitature of Notary Print Name
Notary Public: NOTARYSTAMP
State d glii
ubirapn GG 2?022
Ny commission expires: