HomeMy WebLinkAboutNotice to Building Official of Use of Private Providerel
RECEIVE[
APR 3 0 2021
ST, Lucie County, Permitting
Notice to Building Official of Use of Private Provider
Project Name: DR Horton - Creekside Plat #4, Lot 125 - 9616 Potomac Drive, Fort Pierce, Florida
Parcel Tax ID(s): 2327-502-0133-000-2
Services to be Provided: Plans Review
Inspections X
1, D.R. Horton Inc. , the fee owner, affirm I have entered into a contract with
the Private Provider Indicated below to conduct the services indicated above.
Private Provider Firm: Universal Engineering Sciences
Private Provider: John Carl Peterson
Address: 607 NW Commodity Cove, Port St. Lucie, FL 34986
Telephone: 772-924-3575
Fax: 772-924-3580
E-mail Address: gfaschedulingC@-universalengineering.com
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 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.
Notice to Building Official_UES BID Form Page 1 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 $.l 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
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
Partnership
Print Corporati Name
Print Partnership Name
By:
By:
(signature)
(signature)
Print
Print
Name: Brian W. Davidson
Name: .
Its: Assistant Secretary
Its:
Address: 1430 Culver Dr NE,
Address:
Palm Bay, FL 32907
Telephone Telephone
No. 321-733-7972 No.:
Corporation
Before me, this 13 day of
APRIL , 202l
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.
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
Notary Public: N:OTARY:STAMP BELOW
!) 1 tJ �C3- , 00'
Print Name
�:
My commission expires: j��1 W�;• � DINAPARRINO
MY COMMISSION # GG 936643
paF EXPIRES: February 27, 2024
''? os.i„Q• Bonded Thru Notary Public Underwriters
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