Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
NOTICE TO BUILDING OFFICAL
REV 01/22/20
NOTICE TO BUILDING OFFICAL
OF USE OF PRIVATE PROVIDER
City of Tampa Permit No: ________________________________________________________
Project Address: _______________________________________________________________
Project Folio No: _______________________________________________________________
Fee Owner Name (Printed): ______________________________________________________
Services to be provided (select all that apply):
Plan Review Only Inspections Only Plan Review and Inspections
PRIVATE PROVIDER FIRM
Name of Firm: _______________________________________________________________
Business Address: ____________________________________________________________
Office Phone: __________________________ Fax: _________________________________
PRIVATE PROVIDER QUALIFIER
Name of Qualifier: ____________________________________________________________
Office Phone: _________________________ Cell Phone: ______________________________
Email: _______________________________________________________________________
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
NOTICE TO BUILDING OFFICAL
REV 01/22/20
NOTICE TO BUILDING OFFICAL
OF USE OF PRIVATE PROVIDER
ACKNOWLEDGMENT
I, , have elected to use one or more Private Providers to
provide building
code plans review and/or inspection services for the building or structure that is the subject of the enclosed permit application, as
authorized by Section 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 the building code enforcement personnel from any and all claims
arising from my use of these licensed or certified personnel to perform building code plan review and/or inspection services
with respect to the building or structure that is the subject of the enclosed permit application.
I understand that 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 Section 553.791, Florida Statutes. If I make any changes to the
listed Private Providers, I shall, within one 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 are limited to compliance with the Florida Building Code
and do not include review for compliance with fire safety, land use, environmental or other codes.
______________________________________________ ___________________________________________
Printed or Typed Name of Fee Owner of Property Signature of Fee Owner of Property
NOTARY
STATE OF FLORIDA
COUNTY OF
SWORN TO (OR AFFIRMED) AND SUBSCRIBED before me this day of __________________ ,
20 , by (name of person making statement).
Signature of Notary Public State of Florida
(NOTARY SEAL)
Printed or Typed Name of Notary Public
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signature
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