HomeMy WebLinkAboutNotice to Building Offcial of Use of Private Provideri
Notice io Building Official of Use of Private Provider
Project Name: DR Hortol - Creekside Plat #4, Lot 7 - 3323 Homestead Drive, Fort Pierce, Florida
Parcel Tax ID(s):
Services to be Provided:
I. D.R. Horton Inc.
the Private Provider In
Private Provider Firm:
Plans Review X Inspections X
, the fee owner, affirm I have entered into a contract with
below to conduct the services indicated above.
Private Provider: John Carl Peterson
Sciences
Address: 607 NW Commodity Cove, Port St. Lucie, FL 34986
Telephone:
E-mail Address:gfaschedulinqCcDuniversalengineerinq.com
Fax: 772-924-3580
Florida License, Registration or Certificate No.: Florida License No. BU1721
I have elected to use one or more alternative providers to provide building code plans review and/or inspection
services on the building or, structure 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 codes, 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 requires 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 protected. 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 or structure 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 tlhe 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.
Notice to Building Official_UES BID Form
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04/19 R1.0
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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 Corporation Partnership
(signature)
Print
Name:
Address:
Telephone
No.
Please use appropriate notary Iblock.
STATE OF.. Florida
COUNTY OF Brevard
Individual
Before me; this day of
, 20_, personally
appeared
who executed the foregoing instrument,
and acknowledged before me thatsame
was executed for the purposes therein
expressed.
I
DR Horton Inc
Print Corporati Name
By:
(signature) '
Print.
Name: Brian W..Davidson
Its: Assistant Secretary
Address: 1.430 Culver Dr NE,
Palm Bay, FL 32907
Print Partnership Name
By:
(signature)
Print
Name:
Its:
Address:
Telephone Telephori.e
No. 321-733-7972 No.:
Corporation
Before me, this 'I 3 day of
APRIL ,2021,
personally appeared
Brian W. Davidson of
DR Horton Inc a
corporation, o'n
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 purposes therein expressed.
Personally known V ; or Prodced identification Type of identification produced
Signature of Notary
Print Name
I
Notary Public: NOTARY STAMP BELOW. .
I
My commission expires: :' DINAPARRINO
;' MY COMMISSION # GG 935643
EXPIRES: February 27, 2024
oF;fk° Bonded Thru Notary P N16 Undiariders
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