HomeMy WebLinkAboutNotice to Building Official of Use of Private ProviderOr
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y Notice.
,to ,Builqing, Official of
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Use of Private Provider
p�pJb°cl''CreeCcsrfe,F?lat4,, Lotk48 @ 3246; Trinity .Cir; Fort Pierce,....
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' ' Services toabe provided P14us�Reuiew Jnspections
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£ th,riottCe ,applies to e�tlZer private plai�J reviews or:riatel �nsp60tla-0services Elie Bilk
Off�cxal ma re uiSreT at' lies or ;her iscretton, the ' r�vate ro�ider be u's,�do hot�1 se i es
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pursuant; to ,SectrorE 553 '791(2;)lorid'a: Statute i r
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isjthe{ fee o�mer, affirm have entered lnto a Faritrac with the ri to l r`gvi�ier" t{ la�tc i bet'ayt W cdndilet
•`''_ �th�s�ervices�nd�cated+above. ' -
Provider Firm Universal Engineering Sciences, Inc:
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'< � Prtuate Provider Richard E Hoa
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zt;:ldress t 820,;Brevard Avenue Rockledge Flor�da12955
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'Flor�da'Licebse, Re'g�stratiort oz Certificate # Florid L cue "49976
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I Iiavtic�, elpctnd to; fuse one or •more' prrvdte ,,providers ko rov�de uxhi� c de p a}� Y , �il,.,l,.
�nspectionyse vices,.on the�tb�t�ld ng that�'Is thes.0 jgtta,o�,�he.ene�o d p�rr��1t'npplicat�°�, as �uJhori��d hj
Sar:g1 y °k`lor�(1ja' Statj tes t I ,:'u�]derstand ltliatJ thet " Deal ; bu'1(]jin ofi'cial V n gt �`ev1ew t e lris
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x,Jae�rfor the xegta�red budding �nspectiops,tq p i Wlt ,n pi},arA e :w th the apt};cal le;eodes,
sr r except tokthe,ptept specified mt:,satd,law, Jt}ste"ad',,anise!tew aq�/roX reouized b*y11d1#1$ irlspYect�oT,sAy
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#e ie form rib licensed ar,cea ifw$;pexsonricl �der�tj'fed in tie a lie d , The Iaw reciu red }91. 4M
' t f nsuc. rtce r i�ir r epts tfor, such yperspl pelt t 'I , 4 er-sthfi tl��c�t I`rt}ay yeg4,ir , Q� ' i s rice lc� :prot ect
interests $y, a ecutmg this, qrm; rI :acknowledge it at have made nou�ry regarding the'coin ei nc, of
:the ,l, ngr�estsicensed Qrcred nnf iirihtYtlair
adequately. , fptected'3 I agree {to ;iritlemr+ify; ; le end, 'and 1%old harmless :tlle 1gca1 goueiriment; :the local
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r ' I'tY'buildirig a£f,cial,► ar cljtheir'builiiingseode,erifnr.,cem rtt lac gnml firer �.y and ail' pl ims aka ,l gnl ? '
oithesea:liceiise or c`e tified.personneltto per qra bi�ild•.itg code ins cotton,ser�iees wjtj�@resnecx.tn
1, } ,.':budding that istthc-sub'Eetaofithe:eriolosei ermit a l c io a1
'II' understand` the Building pQf eial tretains, a ttk�or ty to review ,jilans, n�lce trequire,¢ inspeg�jons, ,allci
` enforce.the;applicable'Ycodes:withm�his;orrber,charge purs�nt,to the stai}dardS;esjahlxShedlbX s� 53,'�9,1,
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i'Floiida Statutes I I make any ch-4nges�-tolthe listed pt'ivate prow ders}or tl�e•:serviees to,be��prcivided by
thosd-`private .providers,rI shall, :within"1 business day after.,any change,;} o dteithis ngtice, ,rglleq, such
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} changes The- ' bui.ldifig;plAns Toview.an�c�r:inspection service¢ provicl�d bys itlie �x�vaieYprovtd@rlls �i}r�i�0 .
r t .' rto'buil'dingcode,;compliance and' oesc�not; n�lude review for.fixe Fq�le,;lan l;use, erlvirQnipen�al qr 4tl� l t,
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A`,of'
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The following attachments are provide 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, in the amount of $1 million per
occurrence relating to all services performed as a private provider, including tail coverage for a
minimum of 5 .years subsequent to the performance of building code. inspection services.
Individual
(signature)
Print
Name:
Address:
Telephone
No.
Please use appropriate notary block.
STATE OF Florida
COUNTY OF Brevard
Individual
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
DR:Horton Inc
Print Corporati Name
By:
(signature)
Print
Name: Brian W. Davidson
us:_Assistant Secretary
Address: 1430 Culver Dr NE,
Palm Bay, FL 32907
Telephone
No. 321 M3402
Corporation
Partnership
Print Partnership Name
By:
(signature)
Print
Name: .
Its:
Address:
Telephone
No.:
Before me, this 9. day of
October , 2020,
personally appeared
Brian W.-Davidson _ of
DR Horton Inc a
corporation, on
lichalf 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 purposes therein expressed.
Personally known ; or Produced identification Type of identification produced
Signature of Notary Print Name
Notary Public: NOTARY STAMP BELOW
My commission expires:
AW.. DINAPARRINO
MY COMMISSION # Gd O%Ii ".
o` EXPIRES: February ' .,' 24 .
Bonded 7hru NdW Public LIMirwrlteni'
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