HomeMy WebLinkAboutNotice to Bldg Official - Century Complete 6504 Santa Clara Lot 10 - Signed (2)Print Form
Notice of Building Official of Use of Private Provider
Project Name: CENTURY COMPLETE HOMES — 6504 SANTA CLARA LOT 10
PafcelTaxlD: 130161103390008 — PERMIT# 1910-0387
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 Firm: GFA INTERNATIONAL INC.
Private Provider: THOMAS MONTANO
Address: 607 COMMODITY COVE PORT ST. LUCIE FLORIDA 34986
Telephone (772) 924-3575 Fax (7,72) 924-3580
Email Address (Optional): Tmontanofdleamafa.com
Florida License Registration or Certificate#: EP 84146
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. 1 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 ad. 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 enforcethe
applicable codes within his or hercharge pursuant to the standards established by s. 553.791, Florida Statutes.
If I make any changes to the listed private providers orthe 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
Print Name Print Corp"on Name
WJH F AtC.Z am ry Compete
By: By:
(signature) (signature
Print
Address:
Please use appropriate notary block
STATEOF �— L�
COUNTYOF PUm C�
Individual
Print name Chad Bally
Address: M Gwemors L'a1xe Dr
Non:mss, GA 30W
Phone# (321)345-1819
Partnership
Print Partnership Name
By:
(signature)
Print name
Address:
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
Beforeme,this— lev clay of 2090 personally appeared j(tpf
(L�l t_t_C 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 _ 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
L4reof Notary
Print Name �9
Notary Public: NOTARYSTAMP W commission expires:
�1ssr Nbdd
otary Public State rN Fa lJ��
NO Brittany L Rubino
41 +� My Cemmiasan GG 271979
vran Eypirea 1012812022