HomeMy WebLinkAboutNotice of Building Official of Use of Private Provider-z
Notice of Building Official of Use of Private Provider
Project Name: Creekside Plat #4, Lot # 127 9624 Potomac Drive, Fort Pierce, FL
Parcel Tax ID: 2327-502-0135-000-6
Services to be provided: Plan Review X Inspections X
Note: If the notice applies to either private review or private inspection services, the Building Official may require, at his
or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute.
I. D. R. Horton Inc.
as 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, Inc.
Private Provider: John Carl Peterson
Address: 607 NW COMMODITY COVE, PORT ST. LUCIE FL 34986
Telephone: (772) 924-3575 Fax: (772) 924-3580
Email Address (optional): gfascheduling(c�universalengineerin- corn
Florida License Registration or Certificate #:BU1721
I have elected to use one or more private providers to provide building code plans review and or inspection
services on the building 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 code, 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 required 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 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.
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 fora
minimum of 5 years subsequent to the performance of building code inspection services.
Individual
Corporation
Partnership
DR Horton Inc
Print Corporati 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 for the purposes therein
expressed.
Corporation
Partnership
Before me, this -13 day of
Before me, this day
APRIL , 2o2l ,
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
C'
Signature of Notary Print Name
Notary Public: NOTARY STAMP BELOW,
My commission expires: DINAPARRINO
MY COMMISSION # GG 93W3
po' EXPIRES: February 27, 2024
Bonded Thru Notary Public Underwriters
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