HomeMy WebLinkAboutNotice to Building Official of Use of Private Providery
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APR 8 0 2021
ST. Luoe County, Permitting
,
No`tice'to Building Official of Use of Private Provider
.Project=Name:. DR Horton' Creekside Plat #4.. Lot 9 - 3313 Homestead Drive, Fort Pierce, Florida
Parcel'Tax ID(s): 2327-502-0017-000-3
$ervices to be ProKid.ed Plans ,Review Inspections X
X ;
D.R. Horton Inc. , ;the fee owner; affirm I have entered into a contract with
w-
;,, ' the,Private Provider Indicate ,beloto conduct the'services, indicated above
,Private Provider Firm: Liniversal:Engineering Sciences < ;
Private Provider: John Carl Peterson
r' Address:..'...' 607, NW Commodity Cove, Port St. Lucie, FL 34986
'Telephone: 77.2-924.-3575.. ,; Fax: 772-924-3580
E=mail'Addtess: gfaschedulingCa)universalengineering.com
Florida License; Registration or+:Certificate No.: Florida License No. 13017,21.
1 have" elected to,use one or, more alternative providers.ton provide_ building code plans review.and/or inspection'"'
services on the building or, structure; that is the subject,of the enclosed permit application,' as authorizedby;_
S.553.791, Florida Statutes,. (;understand that the local building'official may not,review the plans subri itted or.7 '
perform the required building inspections to -.determine compliance with the applicable codes;.'except,.to rtlje_t S >
extent specified,in said.law . Instead, plans review :and/or .required building inspections will be performetl
licensed or certified.personnel identified�in the�application. The law requires'minimum'insuranoe requirementsa�
for such. personnel, but•I understand that I may require more insurance, to protect my interests.` Byexecutigg
this' form,_ (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 buildi9g..official,,and their building code
enforcement personnel from'any and all -clams 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.
lViderstand.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 f,make;any changes to the lsted,private providers; orahe services to be. provided by those private providers,
l''shall,; within 1 business day:after any: change, update'this notice to reflect such changes. The building plans
• review•and/or.inspection service's, pro..vided'.by the private provider is limited to building code compliance and
does, not include; review for,f re code, land 'use,, environmental or other codes.,
i•, , . _
Notice to Building: Official_UE& BID Form Page l of 2 04/19 R1.0
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
Its: Assistant Secretary
Address: 1.430 Culver Dr NE,..
Palm Bay, FL 32907
Partnership
Print Partnership Name
By:
(signature)
Print
Name:
Its:
Address:
Telephone Telephone
No. 321-733-7972 No.:
Corporation .
Before.me this 13 .... day of
APRIL , 2o21 ,
personally appeared
Brian W. Davidson of
DR Horton Inc 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.
I
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
17 1 P O
Print Name
Notary Public: NOTARY STAMP BELOW
My commission expires: ''igDINAPARRINO
.; *. MY COMMISSION # GG 93SU3
EXPIRES: February27,2024
Bonded Thru Notary Public Underwrllers
2 of