HomeMy WebLinkAboutNotice To Use A Private Provider=� S y0lec°
' �ZZ Enginieering Services, LLC
St. Lucie county
Permitting Notice to Building Official of
Use of Private Provider
Project Name/Address:
13239 NW HARBOUR RIDGE BLVD PALM CITY FL
Parcel Tax ID: 4425-604-0012-000-8 Permit No:
Services to be Provided: X Inspections _Plan Review
NOTE: If the notice applies to Plan Review services the Building Official may require, at his or her
discretion, the private provider also provide required building inspections pursuant to Section 553.791(2),
Florida Statutes.
ROBERT A & BETH ANN,ALTENKIRCH
the fee -
owner, affirm 1 have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Firm: SkyeTec Engineering Services, LLC
Private Provider: Keith A. Bowman, P.E.
Address: 9570 Regency Square Blvd., Ste. 410, Jacksonville, FL 32225
Telephone: 86&404-4130 Fax: 904-482-4299
Email Address: kbowman@skyeteceng.com
Florida License, Registration or Certificate #: PE 80568
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 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 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 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, landuse, environmental or other codes.
9570 Regency Square Blvd.
Jacksonville, FL 32225
866-759-3832 www.skyetecengineering.com
skyeTec
Engineering Services, LLC
The following attachments are provided as required:
1. Qualification statements and/or resumes of the private providerand all dulyauthorized 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 minimumof 5 years
subsequent to the performance of building code inspection services.
Individual Corporation Partnership
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4rint:Corporation Name
y:
(Signature) (Signature)
Print QQ ¢'�,P int
Name:l�O6er 14C:h ex
Address:I-M HG rb Do r Its:
R i dg e r 1 M. Pa I m � jbyr-` Address:
S1770 Phoneslokz s'_5/ yg
Please use appropriate notary block.
STATE OF'F!QbAO,
COUNTYOF sA..Wue.
Individual
Before me, this day of
20-2,a
��+rdoer+ Ci i-}-en ICtrch
appeared
who executed the foregoing
instrument, and acknowledged
before me that same was
executed for the purposes
Wd;
., Notary Public State of Florida
Robin Sullivan
My Commission GG 929907
Expires 11/06/2023
Corporation
Before me, this day of
,20J
appeared
Of
.a
corporation,
on behalf of the state corporation,
who executed the foregoing instrum-
ent and acknowledged before me that
same was executed for the purposes
therein expressed.
P ally known � or produced identification . Type of identification produced
Signa re of Notary Pnn Name
[ NOTARY STAMP)
Print: Partnership Name
(Signature)
Print
Address:
Phone:
Partnership
Before me, this day of
20_,
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.
9570 Regency Square Blvd.
Jacksonville, FL 32225
866-759-3832 www.skyetecenlEineering.com