Fillable Lake County Building Services Post Office Box 7800 (Lake County Board of County Commissioners)

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Lake County Building Services Post Office Box 7800 (Lake County Board of County Commissioners)

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BROWSE LAKE COUNTY BOARD OF COUNTY COMMISSIONERS (FL) FORMS

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PART I, CONTRACTOR COMPLAINT FORM
Please return to:
Lake County Building Services
Post Office Box 7800
Tavares, Florida 32778
Tel: (352) 343-9653 Fax: (352) 343-9771
Office Use Only: Case # Cert#
Type or Print
Name:
Address:
City, Zip
Home
Phone
Work
Phone
Cell
Phone
SUBJECT OF COMPLAINT
Contractor’s Name:
Business Name:
Address:
Phone Number:
License Number:
Note: A copy of this form will be sent to the SUBJECT of your complaint pursuant to 455.225(1)
Florida Statutes.
Economic Growth Department Page 1 of 4 BF09 Contractor Complaint
Building Services Division Revised May 4, 2015
Have you contacted subject concerning
complaint?
(Please check one)
Yes No
If yes, Dates Contacted:
Please give full details of your complaint. Include facts, details, and dates. Please attach copies
of bills, documents, records, correspondence, and contracts.
(Please use a separate page if necessary).
Florida Statutes 837.06, False Official Statements: Whoever knowingly makes a false statement in
writing with the intent to mislead a public servant in the performance of his official duty shall be
guilty of a misdemeanor of the second degree.
Signature (required to file complaint) Date
Economic Growth Department Page 2 of 4 BF09 Contractor Complaint
Building Services Division Revised May 4, 2015
click to sign
signature
click to edit
I
n addition to your complete written statement, we are requesting documentation of your contractual
relationship with the contractor and evidence of supporting allegations.
Please answer as many questions below as possible to assist us in investigating your complaint. Copies
of any of the following would be appreciated:
C
ontract between you and the contractor
Proof of payment to contractor (canceled checks-front and back, receipts, closing statements, etc.)
Liens, judgments and notices to owner, including copies of related work orders, bills, sub-contracts
Warranties
C
heck the category that best summarizes the work the contractor did for you or that you were
involved in:
Built a house Built addition to house
Remodel house Built commercial structure
Remodel or built addition to commercial structure
Re-roof entire house Roof work, commercial
Electrical work Built a pool at house
Air-conditioning or heating work at residence
Other, as follows:
BASIC BACKGROUND DATA
1. Was contract in writing? Yes No
2. C
ontract price $ Date on contract:
3. A
pprox. Date work began:
A
pprox. date work ended
__________
4. Is the work site located inside city limits? Yes No
5. Street address of work site:
PART II, CONTRACTOR COMPLAINT FORM
Economic Growth Department Page 3 of 4 BF09 Contractor Complaint
Building Services Division Revised May 4, 2015
These questions may relate to building code compliance by contractor.
Please answer these questions to the best of your knowledge.
1. Was a permit obtained from the Building Department? Yes No
2. If no, was a permit required? Yes No
3. P
ermit Number:
_______________________________________
4. Final inspection passed? Yes No
5. Wh
o pulled permit?
__________________________________
6. Certificate of occupancy issued? Yes No
7. Was the permit obtained on time? Yes No
8. Were any inspections missed or performed late? Yes No
9. I
f certificate of occupancy not issued, why?
FINANCIAL QUESTIONNAIRE
1. T
otal contract price: $
__________________________________________
2. T
otal paid to contractor: $_______________________________________
3. W
hat is actual or estimated cost to finish the job if you hire another contractor?
____________________________. Please attach estimates from licensed contractor(s).
4. H
ave you had to pay subcontractor or suppliers which contractor should have paid
?
Yes No
5. Are there now unpaid bills owed to subcontractors or suppliers which contractor should have paid?
Yes No
6. W
hat is the total of such unpaid bills? $
______________________________
7. D
id contractor sign any statements to the effect that all bills have been paid?
Yes No
8. Have you fired the contractor? Yes No
9. Has the job now been completed by you or a new contractor? Yes No
Department of Growth Management Page 4 of 4 BF09 Contractor Complaint
Building Division Revised June 1, 2009
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Lake County Building Services Post Office Box 7800 (Lake County Board of County Commissioners)

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Completed 18 July 2020

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