Community Development Department
Building Division
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
BuildingConstruction@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
”To exceed expectations in the delivery of public services”
For Office Use Only
PLANS EXAMINERS
INITIALS
12/2009, mag
20
I have elected to use one or more private providers to provide building code plans review and/or inspections 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
adequateley 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, udate 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.
into a contract with the Private Provider indicated below to conduct the services indicated above.
Project Name:
Parcel Tax ID:
Services to be Provided:
Plans Review
Inspections
NOTE: If the notice applies to either private plan review or private inspection services the Building Official may require, at his or
her discretion, the private provider be sued for both services pursuant to Section 553.791 (2) Florida Statute.
Notice to Building Official For Use of Private Provider
I,
, the fee owner, affirm I have entered
Private Provider Firm:
Private Provider:
Address:
Phone:
Fax:
Email Address:
Florida License, Registration or Certificate #:
Location/Address:
Lot:
Block:
, 20
day of
The foregoing instrument was acknowledged before me this
County of
State of
by
Signature of Notary
Notary's Printed Name
Notary Seal
of
Name and Title of Officer or agent
Name of Corporation
a
state or place of incorporation
corporation, on behalf of the corporation, who is personally known to me
or has produced
as identification and who did/did not take an oath.
Signature of owner:
Please Print Full Name