HomeMy WebLinkAboutNotice of Building Official of Use of Private Providerr
.7
Notice of Building Official of Use of Private Provider
Project Name: Creekside Plat #4, Lot # 1 A- 3457 Trinity Circle, FL
Parcel Tax ID: 2327-502-0009-000-4
Services to be provided: Plan Review X Inspections X
RFCRIL�Q
per �1gy2
t let
90 /
oc"-P epd
Co41 y el)h
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(aD-universalengineerinq.com
Florida License Registration or Certificate #QU1721
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 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: 1430 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 . Partnership
Before me. this 1:3 day of
. APRIL , tiVl ,
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.
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 V ; or Produced identification Type of identification produced
Signature of Notary Print Name
Notary Public: NOTARY STAMP BELOW
My commission expires: :'`Y? DINAPARRINO
MY COMMISSION # GG 935643
+�o EXPIRES: February27,2024
foF F :°•' Bonded Thru Notary Public Underwriters
2 of