HomeMy WebLinkAboutNotice to Building Official of Use of Private Provider;.r
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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 128 - 9700 Potomac Drive, Fort Pierce, Florida
Parcel Tax ID(s): 2327-502-0136-000-3
Services to be Provided: Plans Review X Inspections X
1, D.R. Horton Inc. , the fee owner, affirm I have entered into a contract with :.; :';t,ti V Q
the Private Provider Indicated below to conduct the services indicated above. a_
Private Provider Firm: Universal Engineering Sciences
. Private Provider: John Carl Peterson
Address: 607 NW Commodity Cove, Port St. Lucie, FL 34986, k
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Telephone: 772-924-3575 s' Faz:. 772 924.,3580 i4 `
E-mail Address: gfascheduling@universalengineering.com z ° ,', `:'•. 'y r"'
Florida License, Registration or Certificate No.: Florida License.N9.,'BU1721
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I have elected to use one or more alternative providers to .provide,building code plans review and/orIh§ ectldn
services on the building or structure that is the subject•.of.the:jericlosed permit application, as eiitherized'by
S.553.791, Florida Statutes. I understand that the local buildihb official may not review the plans sd6initte( or
perform the required building inspections to determine'compliance with the �applicsb a codes, excepfao the
extent specified in said law. Instead, plans review and/or,, required building irispectwns; wili. be :performed by
licensed or certified personnel identified in the application: The law req61r0,9;miniinum insurance requirements
for such personnel, but I understand that I may requireimore insurance touprgtectimy•interests. By..6xecuting,
this form, I acknowledge that I have made inquiryregarding the competence,`•of..the licensed or• certified
personnel and the level of their insurance and am satisfied _that,my,interest' are adequately.protected: I agree
to indemnify, defend, and hold harmless the local govemment,,,the,1., I building'gfficial, and their„ htailding code
it
enforcement personnel from any and all claims prising from my�use'offthese licensed or certifed;personnel to
perform building code inspection services with respect 46 the Liuildmg or structure -that is they subject, of the`
enclosed permit application.zet
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I understand the Building Official retains authority,to,review plans, Make.required,insl5ections, and enforce the
applicable codes within his or her charge pursuant to the: 'standards,4establi"shed by S'553;791•, Florida Statutes.
If I make any changes to the listed private providers or`tlie services to,be' prowd.ed by those private providers,
I shall, within 1 business day after anybhangeftbpdaie this' notice to refiect,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 r .i
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Notice to Building Official_U8S`BIDf Form, f ,Page 1 of 2 'rt. :04/•19 R1.0•
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The following attachments are-prpvide as required:
1. Qualification -'statements 'and/or resumes of the private provider and all duly authorized
representatives. „ .....
2. Proof dFinsurance.for professional and comprehensive liability in the amount of $1 million per
occurrencefelaiing :to ,all services performed as a private provider, including tail coverage for a
minimum of S, year5's68sequent to the performance of building code inspection services.
Individual Corporation Partnership
OR Horton Inc
r_, •� ,' , , .l?r>ini Corporati Name Print Partnership Name
r >: By, — By
(signature) �_,' (signature) (signature)
Print Print Print
Name: , Name: Brian W. Davidson Name:
Address.:' its: Assistant Secretary Its:
Address' 1430 Culver Dr NE, Address:
Teleplibne Palm Bay. FL 32907
NO.
�•< Telephone Telephone
No; 321-733-7972 N0.'
Please use appeopriatg; notary block.
STATE OF • Florida
COUNTYX OF Brevard
j
z ,,:Individual' Corporation Partnership
is
Before me, this day of Before me `this 13 day of Before me, this day
a , 20 personally" AP:IIL , 202� of , 20_, personally
t appeared "" .._ personally appeared appeared
;Whd:executed the fo;pgoing,_instrument, Brian W. Davidson of partner/agent on behalf of
andtacknowledged before me that same DR' Horton Inc , a
tiwas executb&fbr. the purposes therein corporation, on a partnership, who executed the
fressed:: "' behalf ofthe state corporation, who foregoing instrument and acknowledged
executed the foregoing instrument and before me that same was executed for
acknowledged before me that same was the purposes therein expressed.
"~ executed for the purposes therein
expressed.
l?rsonally;knbwni �/ ;'or Produced identification Type of identification produced
Sig', ureofNotar3! Print Name
Notary Public: NOTARY'STAMP BELOW
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My commission expires: r :1:. DINAPARRINO
MY COMMISSION # GG 935643
' z� �o? EXPIRES: February27,2024
ok i ?•' Bmded Thru Notary PubHa Undewrltem
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