HomeMy WebLinkAboutNotice Of Building Official Use Of Private Provider1"-ritotice of Building Official of Use of'Private Pro' v der
project Name: Ocean Glass Townhomes-'I0101 South Ocean Or. Jensen Beach FL 34957
Parcel Tax 1D:.. �/..S O.Z -10.
Services to provided: Plan Review :. x Inspections X
Note: If..the notice .applies ao either private- review or private. inspection services; ;the Building Offcial may..require; at his.
or her discretionAhe.private' provider be -used for both services pursuant to Section 553:791(2) Florida Statute.
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Se, ' IAss 06c 2 ;. C r.'Ja ��Q 6P:I-W, L '
as the fee owner, .affir,in I have entered int a contract with"the Private Provider indicated below to conduct the services
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indicated above. RECEIVED "
Private Provider Firm: Universal.Enaineering Sciences
SEP 0:2 202'
Private Provjder:.Johri- Carl. Peterson st; Lucie County
Permittino
Address: 607 NW COMMODITY COVE PORT ST. LUCIE fL 34986
Telephone: (772) :924-3575 Fax: (772) 924=3580
Email Address (optional): gfaschedulinaCa7universalengineerina--coin
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 ofttie enclosed permit application, as aUthoriied by s: 553:791;
Florida Statutes. I understand Ghat the local�building offcial may not.review the plans submitted .or perform the
req'uired.'building inspections to determine compliance with the applicable code, except to the &tent.specified in
said law'. Instead; plans review acid/or required building inspections will tie performed by licensed.or certified .
..
.personnel 'identified in the..applicatiori. The law required minimum insurance requirements for such personnel,
but 1 understand that l ir►ay require more insurance -to protect'rny interests. By.'ezecuting this form; I Acknowledge'
that I have -made inquiry regarding the competence of the licensed or certifed.personrrel 'and the level of their
-insurance and am satisfied that rn interests are adequately protected. I agree to :indemnify, defend; and hold
hacrnless ttie local government, the local buildirig.official: and their building code enforcement personnel fr.'om •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 codeswithin his or her charge pursuant•to the standards established by s, 553.791; Florida,Statute`.: if. I.
make anychanges.to the listed private providers orthe.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
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 insurarice for professional and comprehensive liability per Florida Statutes s.533-391 (16).
Individual Corporation Partnership
Print Corporation. Name
Prllit Name Prieit Partnership Name
BY By.:.
(signature) (signature).gnatUre
Print name Pnnl name Print Warne_:�Qfc 1� Q.
Address: Address: Address: 1 S.E. V CAC 1-% t3/ Val.
Phone #: r. Phone.#: Phone #423
Please use appropriate notary block.
STATE OF . Florida
COUNTYOF
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. -
t
Corporation
Before me, fhis.. dayof 20 personallyappeared of
corporation, on behalf of the state corporation, who
executed the foregoing instrument and acknowledged before me that sante.was executed for the purposes therein expressed
Partnership .
Before me, this clay of 20b2 .I.. 12 v L �� .: y � . personallyapPeared�
partner/agent.on behalf of ri�a pa nersh;.who execute`dihe.foregoing instrument
and acknowledged before me tfiallsam as executed for the purposed thereinexpressed.
Personally known ; or•produced identification .•d/ type of. ideritification•producedL-).,,-2
Sigr atu • of Notary'Print Name'
i iaY� f;YAN.SCHNEtC `(
Notary Public: NOTARY STAMP,P • Ft . My commission expires:'-
. Notary Public • State of Florida / ' .•
WY t ' Commission A HH 054841
My Comm. Expires Oct 19,.2024