HomeMy WebLinkAboutUSE OF PRIVATE PROVIDERNotice of Building Official of Use of Private Provider
Project Name: Pallas Residence-2504 Kerr Street, Fort Pierce, FL 34947
Parcel Tax ID: 2419-601-0010-000-0
Services to be provided: Plan Review.., X. f Inspections X
Note: If the notice applies to either private review or private inspection services, the Building Official may require, at his
or her discreti rivate provider be used for both services pursuant to Section 553.791(2) Florida Statute.
as the fee owner, affi4 I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Firm: Universal Engineering Sciences
I
Private Provider: John Carl Peterson j
Address: 607 NW COMMODITY COVE PORT ST. LUCIE FL 34986
Telephone: (772) 924-3575
Fax: (772) 924-3580
Email Address (optional): gfascheduling@_universalengineering.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 priivate 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 provided 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 per Florida Statutes s.533.791 (16).
Individual Corporation Partnership
Print Corporation Name
Print ame , Print Partnership Name
By J_t2z& 1 iM—�-�'�S - By: - - By
(signature) (signature)
Print name l Pgr%i,& Print name
Address: Address:
Phone Phone #:
Please• use appropriate t),ptary W. . -.:.j
STATE OF (Florida
COUN�OF � Al f
Individual
Print name
Address:
Phone #:
(signature)
n
Before me, this ✓ day of ,2021 , personally appeared ( Ct.� � 1 CACI' •who
executed the foregoing instrument, and acknowledged afore me that same was executed for the purposes therein
expressed.
Corporation
Beforeme,this dayof 20 , personally appeared of
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 purposed therein expressed.
Personally known ; or produced identification type of identification produced
Signature of Notary Print Name
Notary Public: NOTARY STAMP
r'*0.y °4`.
e
STEPHANIE N EPSTEIN `
? ��•�
Notary Public - State of Floric:
Commission # GG 3315.8
My Comm. Expires Jun 16. 21-
My commission expires: