Fillable Form 2: Building Construction Services (Charlotte County BCC)

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Form 2: Building Construction Services (Charlotte County BCC)

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Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
AFFIDAVIT PROGRAM
Affidavit Program
PLANS REVIEW AND INSPECTION BY AFFIDAVIT
day of
Signature of Owner
Sworn to (or affirmed) and subscribed before me this
20
by
Type of Identification
Notary Name (Printed)
Commission NumberNotary Signature
Personally Known OR Produced Identification
Printed Name of Owner
Owner Name
Street Name
Unit #
Street Number
Street Type
Contractor Name Contractor Phone #
I, the undersigned, have read the above statement and agree to abide by it.
Permit Number Project Name
I,
, the fee simple owner, affirm that I have entered into a contract with the Engineer/Architect
indicated below to conduct the services indicated above.
Plans Review Inspection
Services to be provided:
Engineer/Architect Firm Engineer/Architect Name
Address
Telephone # Fax # E-mail
Florida Registration or License Number
I have elected to use the aforementioned engineer/architect 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 the 2017 (6th Edition) Florida Building Code (FBC) sections 105.14 and
107.6.
I understand that the Building Official may not review the plans submitted or perform the required building inspections to determine
compliance with the applicable coded, except to the extent specified in the said code. Instead, plans review and required building inspections
will be performed by the licensed personnel identified in the application. 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 that the Building Official retains the authority to review plans, make required inspections, and enforce the applicable codes within
his or her charge. The building plans review and inspection services provided by the engineer/architect is limited to building code compliance
and does not include review for fire code, land use environmental or other codes.
Print Form
Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
AFFIDAVIT PROGRAM
Affidavit Program
Fact Sheet
Background
Under Florida Building Code (FBC), Section 105.14 (Permits issued on the basis of an Affidavit) and Section 107.6 (Affidavits).
The building official may accept a sworn affidavit from a registered architect or engineer stating that the plans submitted conform to the
technical codes. For buildings and structures, the affidavit shall state that the plans conform to the laws as to egress, type of construction and
general arrangement and, if accompanied by drawings, show the structural design and that the plans and design conform to the requirements of
the technical codes as to strength, stresses, strains, loads and stability. The building official may without any examination or inspection accept
such affidavit, provided the architect or engineer who made such affidavit agrees to submit to the building official copies of inspection reports
as inspections are performed and upon completion of the structure, electrical, gas, mechanical or plumbing systems a certification that the
structure, electrical, gas, mechanical or plumbing system has been erected in accordance with the requirements of the technical codes. Where
the building official relies upon such affidavit, the architect or engineer shall assume full responsibility for compliance with all provisions of
the technical codes and other pertinent laws or ordinances. The building official shall ensure that any person conducting plans review is
qualified as a plans examiner under Part XII of Chapter 468, Florida Statutes, and that any person conducting inspections is qualified as a
building inspector under Part XII of Chapter 468, Florida Statutes.
NOTE: A contractor's contractual and legal obligations are not relieved by any action or inaction by an architect or engineer participating in
this program.
Purpose
The Affidavit Program is designed to provide owners and contractors in Charlotte County an alternative permitting process. Under the
program, plans submitted with the affidavit are processed without review by County plans examiners. The County may however, conduct
unannounced inspections to ensure compliance with FBC and other applicable law.
Applicability and Exceptions
Permits issued on basis of an affidavit shall not extend to the flood load and flood resistance requirements of the Florida Building Code.
Permitting and Inspection
The submission and processing requirements for a permit under these regulations are essentially the same as those for a regular permit. Upon
acceptance by the Building Official of the Affidavit Program application, the permit request will be processed. When the program is used, the
County will neither conduct a review of plans nor perform required inspections. The architect or engineer submitting the affidavit assumes full
responsibility for plans review and required inspections. The Building Official may however, schedule progress inspections at any time during
construction to ensure compliance with the FBC and applicable law.
Print Form
Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
AFFIDAVIT PROGRAM
Affidavit Program
Fact Sheet
Insurance Requirements
The architect or engineer shall perform building code inspection services on a building project under the affidavit program only if the architect
or engineer maintains insurance for professional liability covering all services performed under the affidavit program. Such insurance shall
have minimum policy limits of $1 million per occurrence and $2 million in the aggregate for any project with a construction cost of $5 million
or less and $2 million per occurrence and $4 million in the aggregate for any project with a construction cost of over $5 million. Nothing in
this section limits the ability of a fee owner to require additional insurance or higher policy limits. For these purposes, the term "construction
cost" means the total cost of building construction as stated in the building permit application. If the architect or engineer chooses to secure
claims-made coverage to fulfill this requirement, the architect or engineer must also maintain coverage for a minimum of 5 years subsequent to
the performance of building code inspection services. The insurance required under this subsection shall be written only by insurers authorized
to do business in this state with a minimum A.M. Best's rating of A. Before providing building code inspection services within a local building
official's jurisdiction, the architect or engineer must provide to the local building official a certificate of insurance evidencing that the
coverages required under this subsection are in force.
Plans Change
Plans changes and revisions submitted to Building Construction Services under the program must be approved by the architect or engineer of
record and posted at the job site. All changes and revisions must be included in the final signed and sealed as-built drawings.
As-Built Drawings
As-built drawings, signed and sealed by the architect or engineer, must be submitted to Building Construction Services prior to issuance of the
Certificate of Occupancy.
Inspections
Inspections shall be performed at each phase of construction as required by the applicable codes. The architect or engineer, or his/her duly
authorized representative, shall perform the required inspection, provided however, all required reports and certifications bear the signature of
the architect or engineer. For the purposes of this Program, duly authorized representative means an employee of the firm, corporation or
partnership who is licensed under Florida Statutes 471,481 or 468(xii). A copy of the current licensure of the architect or engineer and all
persons performing plans review or inspections must be on file with the Building Official.
Notice of Scheduled Inspections
The architect, engineer or duly authorized representative shall provide notice to Building Construction Services Department of the date and
time the required inspection will be performed no later than 3:00 pm on the business day prior to the inspection. E.g. by 3:00 pm Friday for a
Monday inspection. This should be done by emailing to PrivateProviderInspections@CharlotteCountyFL.gov
The Building Official or his designee may visit the building site as often as necessary to verify that the architect or engineer is performing all
required inspections.
Print Form
Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
AFFIDAVIT PROGRAM
Affidavit Program
Fact Sheet
Inspection Postings and Reports
Upon completing the required inspections at each applicable phase of construction, the architect or engineer shall, prior to leaving the project
site, post each completed inspection on the job card indicating a pass or fail. In addition, the architect or engineer shall record such inspection
in a report to the Building Official within two (2) business days. These inspection reports shall be signed and sealed every two weeks and sent
to the Building Official. Inspection reports reflect those inspections required by applicable codes for each phase of construction. Both the
plans and the record of all required and completed inspections shall be maintained at the building site at all times for review by the County
Inspector. The architect or engineer shall report to the Building Official any condition that poses an immediate threat to public safety and
welfare.
Certificate of Compliance
Upon completion of all required inspections prior to receiving the Certificate of Occupancy, the architect or engineer shall prepare a
Certificate and Compliance containing a summary of the inspections performed and a sworn statement by the architect or engineer that the
state inspections have been performed and, to the best of the architects knowledge and belief, the building construction complies with the
approved plans and applicable building codes. This statement required of the architect or engineer shall be substantiated in the following form:
“To the best of my knowledge and belief, the building components and site improvements outlined herein and inspected under my
authority have been completed in conformance with the approved plans and the applicable codes.”
Effect of Noncompliance
Architects and/or engineers whose plans, inspection notices, inspection reports or certificates of compliance are found to be deficient may be
barred from further participation in this program.
Print Form
Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
Reviewed by Building Official or Designee
AFFIDAVIT PROGRAM
Affidavit Program
Affidavit
I, the undersigned, am an
Architect Engineer
duly registered by the State of Florida, whose license is in good standing. I hereby
certify to the best of my knowledge and belief, the following:
1. The attached plans conform to all technical codes applicable to this construction, including all local amendments to said codes, if
any.
2. The attached plans conform to the laws as to egress, type of construction and general arrangement and, if accompanied by
drawings, show the structural design.
3. The plans and design conform to the requirements of the technical codes as to strengths, stresses, strains, loads and stability.
4. The building or structure shall be inspected and inspection reports submitted to the Building Official as outlined in the Affidavit
Program Fact Sheet.
5. Provide evidence of any person conducting plans review is qualified as a plans examiner under Part XII of Chapter 468, Florida
Statutes, and that any person conduction inspections is qualified as a building inspector under Part XII of chapter 468, Florida
Statutes.
I further state that I understand that the Building Official will rely upon this affidavit and I further agree to assume full responsibility for the
compliance with all provisions of the technical codes, including any local amendments, and other pertinent laws or ordinances, and I
further agree to hold Charlotte County harmless from any claims of any parties arising out of the plans submitted herewith, including any
changes that may subsequently be made to these plans.
Further affiant saith naught.
Permit Number
Job Site Address
Florida Registration or License Number
Engineer/Architect NameEngineer/Architect Firm
Signature
Embossed Seal Required Below.
Date
Comments
For Office Use Only
Print Form
Building Construction Services
18400 Murdock Circle, Port Charlotte, FL 33948
Phone: 941.743.1201 FAX: 941.764.4907
Zoning 941.743.1964
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
Application Date
Permit Number
2
For Office Use Only
0
CSR
12/2017 JG
AFFIDAVIT PROGRAM
Affidavit Program
Certificate of Compliance
I hereby certify that to the best of my knowledge and belief, the building components and site
improvements outlined herein and inspected under my authority have been completed in conformance
with the approved plans and the applicable codes by the following affiant, who is duly authorized to
perform plans reviews and inspections pursuant to Florida Building Code, Sections 105.14 and 107.6.
E-mail
Street Name
Unit #
Street Number
Street Type
Permit Number
Engineer/Architect Firm
Engineer/Architect Name
Telephone #
Fax #
Florida Registration or License Number
Signature
Embossed Seal Required Below.
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Form 2: Building Construction Services (Charlotte County BCC)

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Completed 21 January 2021

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