HomeMy WebLinkAboutNotice to Building Official of Use of Private Providerr
Notice to Building Official of Use of Private Provider
Project Name: DR Horton - Creekside Plat #4, Lot 124 - 9612 Potomac Drive, Fort Pierce, Florida
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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
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
E-mail Address: gfaschedulingO-universalengineering.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 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
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The %flowing 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
DR Horton Inc
Print Corp Name
Print Partnership' Name
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:
Telephone Palm Bay, FL 32907
No..
Telephone
Telephone
No. 321-733-7972
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 forthe purposes therein
expressed.
Corporation
Partnership
Before me this 13 ...... day of
APRI L
Before me, this day
, 2o21 ,
of , 20_, personally
personally appeared
appeared
Brian W. Davidson of
partner/agent on behalf of
DR Horton Inc a
,
corporation, on
a partnership, who executed the
behalf of the 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.
Personally known V ; or Produced identification Type of identification produced
PO
Signature of Notary Print Name
Notary Public: NOTARY:STAMP BELOW
My commission expires: rw4ny..V- OINAPARRINO
*: MY COMMISSION # GG 9M3
EXPIRES: February 27, 2024
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