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HomeMy WebLinkAboutNOTICE TO BUILDING OFFICIALNotice to Building Official of Planning and Developmentservlces Use of Private Provider Building and Code Regulation Divlslon 2300 Virginia Avenue, Fort Pierce FL 34982 SCANIVEt Phone: (772)462-1553 Fax: (772)462-1578 BY http.--Hwww,stfucleco.izov/planninelpermittiniz.htm St LuCie Cn„- _. n Project Name: -M';�qfl E ParcelTaXID; Services to be provided: Plans Review Inspections 1� Note: if the notice applies to either private plan review or private Inspection services the Building Official may require, at his or discretion, the private provider be used for both services pursuant to Section 553.791, (2) of the Florida Statutes. I L3L4.1e4s --I-s ICCi'ict . -j-y) C the fee owner, affirm I have entered Into a contract with the Private Provider Indicated below to provide the services indicated above. Private Provider Firm; SOLC "0Z Ate1A,/E Ab/i 4ale 5 o ( Arc , Private Provider: AAAk go Lc i4c>a Address:_ l0.3 < 05 \kWM � j 7�.TE FJ- li 1 � ',S%J(?ITF.? FL 33y Phone: :SKI- 5/ S- F710 Fax: Email: �ntavtct.©-� � bl>1c�it^ Florida License, Registration or Certification I have elected to use one or more private providers to provide building code plan review and/or inspection services on the building that Is In the subject line 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, plan 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 Into the competence of the certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to Indemnify, and hold harmless the local government, the local building official, and their building code inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building official retains the 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 changes to the listed private providers or the services to be provided by those private providers, I shall, within one business day 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. 54 The following attachments are provided as required: Rev: 7/7/2014 1. Qualification statements and/or resumes the private provider and all duly authorized representatives. 2. Proof of insurance for professional and comprehensive liability in the amount of one million dollars per occurrence relating to all services performed as a private provider, Including tall coverage for a minimum of five years subsequent to the performance of the building code inspection service. Individual Corporation Partnership Print Corporation Name y` �n 'fit (Signature) Print 1 1 ((�� J l Name: &}56' YAP nPGtrCf—JrrS. Print partnership Name By: (Signature) Print Name: (Signature) Print Name: Address; Address: Telephone Af ress: foI `'e . t vr-r)TArew , i=1.3q957 Telephone N 7.12-2217 - 2gi9Q Telephone N Please use appropriate block. STATE OF COUNTY OF Individual Before me, this day of .zo(�nmle Personally appeared Corporation B fore ,this day of zo Personally" appeared t ��(j(c�v1GlVl�Llft-gj�re5:�of} Partnership Before me, this day of zo Personally appeared partner/agent on behalf of Who executed the foregoing Instrument, and acknowledged before me that same was executed for the purposes therein=(LYiC expressed i =--- �1E5 1 S fZ�'lc r S1C • , 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. foregoA Partnership, who executed the beforeimethtsameng ,andackntedfored before me that same was executed for the purposes therein expressed. Personally known • or Produced Identification_ Type of Identification produced ignature of Notary Print Name Notary Public: NOTARY STAMP BELOW ) Dlel� DOLORES C DIBENEDICTIS My commission expires: J S� My COMMISSION #FFia7339 EXPIRES January S, 2019 (4o71 aseorsa Flar(dauola SemIce.com