Fillable Notice to Building Official of Use of Private (Town of Fort Myers Beach)

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Notice to Building Official of Use of Private (Town of Fort Myers Beach)

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File type: PDF

U.S.A. forms for Town of Fort Myers Beach

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Town of Fort Myers Beach May 21, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
Notice to Building Official of Use of Private Provider
Project Name:
Parcel Tax ID/Strap Number:
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 used for both services pursuant to Section 553.791(2) Florida Statute.
I,
The fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the
services indicated above.
Private Provider Firm:
Private Provider:
Address:
Telephone: Email Address:
Florida License, Registration or Certificate Number:
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 private 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, land use, environmental or other codes.
Town of Fort Myers Beach May 21, 2020
2525 Estero Blvd. Fort Myers Beach, FL 33931
Phone : 239 765-0202 Permits @fmbgov.com Fax: 239 765-0909
The following attachments are provided as required:
1) Qualification statements and/or resumes of the private provider and all duly authorized
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
minimum of 5 years subsequent to the performance of building code inspection services.
Individual Owner:
(Owner’s Signature)
(Owner’s Printed Name)
Address:
Phone:
Corporation:
(Corporation Name)
(Signature)
(Printed Name)
Interest:
Address:
Phone:
Partnership:
(Partnership Name)
(Signature)
(Printed Name)
Interest:
Address:
Phone:
State of
County of
Individual Owner:
Before me, this day of
, 20 ,
personally appeared
who executed the foregoing
instrument, and acknowledged
before me that same was
executed for the purposes therein
expressed.
State of
County of
Corporation:
Before me, this day of
, 20 ,
personally appeared
of
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.
State of
County of
Partnership:
Before me, this day of
, 20 ,
personally 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.
Personally Known Produced Identification
Type of identification produced
(Seal)
(Notary Signature)
(Notary Printed Name)
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Notice to Building Official of Use of Private (Town of Fort Myers Beach)

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Completed 3 August 2020

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