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Planning & Development PRIVATE PROVIDER

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Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
SUBMITTAL CHECKLIST
REV 01/29/20
PRIVATE PROVIDER
SUBMITTAL REQUIREMENTS CHECKLIST
Florida State Statute 553.791 (Alternative Plans Review and Inspection) authorizes a fee owner to elect the use
of a Private Provider for plans review and/or required building inspection services. It covers the rights and
responsibilities of the fee owner, the Private Provider, and the local Building Official/Building Code Enforcement
Agency.
PROJECT SUBMITTAL PACKET
Documentation required with building permit application submittal*
Notice to Building Official - Principal document required for the official election to use a Private
Provider and will specify if the Private Provider will perform the services of plan review and/or
inspections.
DAR Personnel Identification - Document identifies all of the Private Provider’s Duly Authorized
Representatives (DAR) who will be utilized on a specific project. It shall contain the numbers of
the current licenses that he/she holds to perform the specified type of work on the project, the
responsibility that the DAR will have for the specific project, along with contact phone number
and email address. This form is to be filled out for each DAR.
Plan Compliance Affidavit (required only if Private Provider is handling plan review) - Principal
document used to confirm that the Private Provider has performed the required plans reviews and
has approved those plans for code compliance under the allowable scope per FS 553.791. The
submission of an executed affidavit and a copy of the approved set of building plans is a pre-requisite
to the issuance of a permit. Note that this form is required for each submittal and if applicable, each
resubmittal (response to corrective comments), and revisions (changes to scope of work).
Contact Reference Form - Form identifies the primary contact information for the Private Provider to
which City staff can refer client inquiries regarding specific project details such as plan review and
inspection comments/interpretations.
FEMA Substantial Improvement Package (if applicable) – As a participant in the National Flood
Insurance Program’s (NFIP) Community Rating System (CRS), the City of Tampa will continue to
perform the Under Construction FEMA Elevation Certificate Check inspection and review the Final
FEMA Elevation Certificate on projects that are in a Special Flood Hazard Area (SFHA).
Construction documents being submitted as part of the private provider packet shall have a stamp or
notice of review of the private provider on the cover page of all submitted drawings.
IMPORTANT: The City of Tampa Construction Services Division is unique among its contemporaries in that the plans review and
inspection processes include not only the building and trade disciplines governed by the Florida Building Code, but also zoning,
site and fire components under other codes or local ordinances. As such, the City of Tampa will continue to conduct plans review
and inspections on all elements not regulated by the FBC.
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
SUBMITTAL CHECKLIST
REV 01/29/20
*Note: If the Private Provider will only be performing inspectional services, the Notice to Building Official and Personnel
Directory should ideally be submitted at permit application; however, FS 553.791(4) allows for submittal no less than two (2)
business days prior to the first scheduled inspection by the local Building Official or Building Code Enforcement Agency.
Documentation and steps required for inspections
Inspections Checklist - Prior to performing any required inspections, the Private Provider shall
serve notice to the Building Official by scheduling an inspection in the Accela system no later than
2:00 PM on the preceding day (FS 553.791(9).
Inspection Reports - The inspection reports must include specific criteria. Refer to
Inspection Report Checklist for specific information.
Documentation and steps required for Issuance of Certificate of Occupancy or Certificate of Completion
(applicable only if Private Provider performed inspections)
Certificate of Compliance must be submitted as outlined in FS 553.791(11). This document is notarized,
signed, and sealed by the professional in charge of the Duly Authorized Representative (DAR) to affirm
that all required inspections were performed as per Code and the approved construction drawings.
Submit summary document of all completed inspections performed by each Duly Authorized
Representative (DAR), organized by discipline (building, mechanical, electrical, plumbing, etc.) and
contain all inspection reports and results (approved, partially approved, or disapproved). A
comprehensive Final Inspection Report must be uploaded directly into the Accela permit record.
Important note:
• All applicable fire safety inspections must be performed by City staff and approved/final.
• All applicable site inspections must be performed by City staff and approved/final.
• All applicable fees must be paid.
• Any ancillary documents and/or government approvals applicable to the scope of work must be
uploaded into the Accela permit record and available on-site (i.e., Commercial Pool Operating Permit,
Termite Certificate, Blower Door Test).
FEES
Fees for qualified Private Provider projects will reflect a 30% reduction from the standard building permit fees
based upon the services performed by a Private Provider (plan review, inspections or both). The fee reduction
will be calculated after the application has been filed and accepted by the City as a Private Provider project.
Additional information can be found on the Private Provider webpage at Private Providers.
If you have any questions, please call (813) 274-3100.
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
REGISTRATION CHECKLIST
REV 01/31/20
PRIVATE PROVIDER REGISTRATION
Checklist
The City of Tampa requires registration for all Private Providers before commencing
work. Private Providers are responsible for keeping registration records current.
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 is used for both services pursuant
to Section 553.791(15) (b) Florida Statute.
Private Provider Registration Form
Employment Affidavit for Duly Authorized Representative(s) (DAR).
Copy of Florida license for the business entity. Screen print from DBPR website is
acceptable.
Copy of the Professional Licenses for each of the DAR personnel regulated by
Florida Statutes chapter 481 (Architects), chapter 471 (Engineers), and chapter
486, Part XII (Building Code Administrators and Inspectors).
Screen print from the
DBPR website is acceptable.
Copy of Occupational License
Certificates of Insurance for Workers’ Compensation and General Liability as
required by FS 440.02(8) and FS 553.791(16), respectively.
You can submit this in person or email: CSDHelp@tampagov.net
If you have any questions, please contact Construction Services:
MAIN #: (813) 274-3100
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
REGISTRATION FORM
REV 01/28/20
PRIVATE PROVIDER REGISTRATION
Registration Form
The City of Tampa requires registration for all Private Providers before commencing
work. Private Providers are responsible for keeping registration records current.
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 is used for both services pursuant
to Section 553.791(15) (b) Florida Statute.
Name of Firm: _______________________________________________________
Business Address:____________________________________________________
Office Phone: __________________________ Fax: _______________________
Email: _____________________________________________________________
Federal Employer Identification Number (FEIN): ___________________________
PRIVATE PROVIDER QUALIFIER
Name of Qualifier:___________________________________________________
Office Phone: _________________________ Cell Phone: ____________________
Email:_____________________________________________________________
You can submit this in person or email: CSDHelp@tampagov.net
If you have any questions, please contact Construction Services:
MAIN #: (813) 274-3100
Planning & Development
DAR EMPLOYMENT AFFIDAVIT
REV 01/21/20
DULY AUTHORIZED REPRESENTATIVE (DAR)
Employment Affidavit
This affidavit is required pursuant to the City of Tampa Private Provider Review and
Inspection Registration Program. F.S. 553.791 (8).
The authorization(s) for the listed individual(s) will remain in effect, unless cancelled in writing,
by the undersigned.
Private Provider Name (Printed): ___________________________________________________
Private Provider License No: __________________________________________________________________
I, , the Private Provider, do hereby affirm that the Duly
Authorized Representatives listed below are my employees, as required by Florida Statute
553.791 and are entitled to receive unemployment compensation benefits under Chapter 443.
Printed or Typed Name of Private Provider Signature of Private Provider
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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Planning & Development
DAR EMPLOYMENT AFFIDAVIT
REV 01/21/20
DULY AUTHORIZED REPRESENTATIVE (DAR)
Employment Affidavit
The law requires that all Duly Authorized Representatives (DAR) are employees of
the Private Provider firm and as such, entitled to receive unemployment benefits
under Chapter 443 of the Florida Statutes.
DULY AUTHORIZED REPRESENTATIVES
If more space is needed to list all DARs, please submit a supplementary
signed/sealed form with the information. You must also submit copies of license(s)
for each DAR listed (screen print from DBPR website is acceptable).
Name (Printed)
FL License
No(s)
Discipline
DAR Signature
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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Planning & Development
DAR IDENTIFICATION
REV 01/21/20
DULY AUTHORIZED REPRESENTATIVE (DAR)
Personnel Identification
DULY AUTHORIZED REPRESENTATIVE (DAR)
Please submit a separate page for each DAR.
City of Tampa Permit No.: ______________________________________________________________
Project Address: ______________________________Project Folio No.: ____________________
Private Provider Firm (Printed): ____________________________________________________
DAR Name (Printed):_____________________________________________________________
Office Phone: ______________________________ Cell Phone: _________________________
Email: _________________________________________________________________________
Florida Professional Licenses:
Type of service(s) to be performed by named DAR (check all that apply):
Plan Review Service Inspection Service
Building Building
Mechanical Mechanical
Electrical Electrical
Plumbing/Gas Plumbing/Gas
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
COMPLIANCE AFFIDAVIT
REV 01/22/20
PRIVATE PROVIDER
Compliance Affidavit
City of Tampa Permit No.: _____________________________________________________________________________
Project Address: ____________________________________________________Project Folio No.:__________________
Private Provider Firm:_______________________________________________ License No.:_______________________
Office Phone: _____________________________________________Cell Phone: ________________________________
Email: ____________________________________________________________________________________________
Select all that apply:
Construction Plans Resubmittals (Response to deficiencies) Revisions (changes to original scope)
I HEREBY CERTIFY that to the best of my knowledge and belief, the documents submitted for the above referenced project
were reviewed according to, and are in compliance with, the Florida Building Code and all local amendments thereto,
either by myself or by the affiant identified below, who is duly authorized to perform plans review pursuant to Section
553.791, Florida Statutes, and holds the appropriate license or certificate:
________________________________________ _______________________________________
Printed or Typed Name of Private Provider Signature of Private Provider
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
Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
Contact Reference Form
Contact
Information
Instructions: Please utilize this form to identify the primary contact information for the Private
Provider to which City staff can refer client inquiries regarding specific project details such as, but
not limited to, plan review and inspection comments and interpretations, Private Provider inspection
reports, inspection results by a Private Provider, etc.
Point of Contact Name
Organization Name
Email
Phone
Planning & Development
Inspections Checklist
Rev 1-28-20
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
HOW TO UPLOAD IN ACCELA:
1. Log into Accela record
2. Go to the Record Info Tab - Attachments. Click ADD
3. Hit ADD and choose your document to upload. In the title box you
will name it “Electrical Power Release”
4. Click Continue. It will prompt you with a dropdown box, choose
other document and click ADD. Follow the prompts.
HOW TO UPLOAD IN ACCELA:
1. Log into Accela record
2. Go to the Record Info Tab – Attachments, click ADD
3. Hit ADD and choose your document to upload. In the title box you
will name it “Under Construction Elevation Check”
4. Click Continue. It will prompt you with a dropdown box, choose the
document that is called “Under Construction Elevation Check” and
click ADD. Follow the prompts.
HOW TO UPLOAD IN ACCELA:
1. Log into Accela record
2. Go to the Record Info Tab – Attachments, click ADD
3. Hit ADD and choose your document to upload. In the title box you
will name it “Private Provider Final Certificate”
4. Click Continue. It will prompt you with a dropdown box, choose
Private Provider Final Certificate and click ADD. Follow the prompts.
INSPECTIONS
Checklist
The
following Inspections must be scheduled and completed:
□ Pre-Construction Inspection - When silt fence, tree barricades, sanitary facilities and approved plans
are installed. No work should begin until City of Tampa Inspectors approve.
□ All required Florida Building Code inspections through the Accela System.
□ All site, driveway/sidewalk and Stormwater drainage/retention “In Progress” inspections before
concealment. City of Tampa Inspectors will perform inspections.
□ “Electrical Power Release” and
upload the document indicating
that Private Provider has
inspected the electrical system
and approved the release.
□ FEMA Properties: Schedule an
“Under Construction Elevation
Check” inspection once the
under construction elevation
certificate has been uploaded to
the Accela Record.
□ All site and building finals once
the project is complete. Upload
the Private Provider Final
Certificate of Compliance
document to the Accela Record.
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
INSPECTIONS REPORT CHECKLIST
REV 01/23/20
INSPECTIONS REPORT
Checklist
The DAR inspection reports must provide, at a minimum, space for the following
information, and when completed will state:
City of Tampa permit number
Job address (including suite/unit number if applicable)
Date inspection was performed
Private Provider’s company contact information
Inspector’s name, license number, and signature
Inspection comments (what the inspection result was based on, and the
location/area that the inspection was for), the inspection results
(Approved, Partial Approval, or Disapproved), the corrections required (if
corrections or further action is required).
A copy of all periodic inspection reports must be uploaded directly into the
Accela permit record and available on-site.
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
REQUEST FOR CO
REV 01/22/20
PRIVATE PROVIDER CERTIFICATE OF COMPLIANCE
REQUEST FOR CERTIFICATE OF OCCUPANCY OR CERTIFICATE OF COMPLETION
City of Tampa Permit No.: ______________________________________________________________
Project Address: ________________________________________________________________
Private Provider Firm: ________________________ Qualifier Name: ______________________
Phone: ____________________________ Email: __________________________________
I HEREBY ATTEST that to the best of my knowledge, belief and professional judgment, the building components
and site improvements captioned above have been inspected under my authority, as indicated in the inspections
report, and have been completed in substantial compliance with the approved documents, plans, revisions,
and applicable codes; and, I FURTHER ATTEST that to the best of my knowledge, belief and professional
judgment, there are no known issues relating to life safety which would preclude the issuance of the following:
Certificate of Occupancy Temporary Certificate of Occupancy (TCO)
Certificate of Completion Partial Certificate of Occupancy (PCO)
Printed Name of Private Provider Qualifier License No. Signature of Private Provider Qualifier
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
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
CHANGE PRIVATE PROVIDER
REV 01/23/20
CHANGE PRIVATE PROVIDER
Checklist
Changes to the originally approved Private Provider Firm or services shall be noticed to the
Building Official within one business day after any change. Note that the new Private Provider
firm and its DAR’s must be duly registered with the City of Tampa in order for the change to be
authorized. 553.791(4)
Change of Private Provider Firm and/or Services to Alternate Private Providers Firm/Services
Submit Notice to Building Official Change of Private Provider Firm and/or Services. Must be
submitted within one business day.
Change from Private Provider to City of Tampa
In the event that the Fee Owner of Property intends to revert from a Private Provider to the City
of Tampa for any services including plan review and inspections the following documents shall
be required:
Notice to Building Official Change of Private Provider Firm and/or Services.
Official log of all completed inspections performed by each DAR of existing provider,
organized by discipline, containing all inspection reports and results.
A Certificate of Compliance must be submitted as outlined in FS 553.791(11). This affidavit is
notarized, signed, and sealed by the professional in charge of the DAR (of existing provider)
to affirm that all inspections performed by existing provider are as per Code and the approved
construction drawings. It will include the following statement, as outlined in FS 553.791(11):
“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.”
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
CHANGE OF PRIVATE PROVIDER
REV 01/21/20
NOTICE TO BUILDING OFFICAL
CHANGE OF PRIVATE PROVIDER FIRM AND/OR SERVICES
Changes to the originally approved Private Provider Firm or services shall be noticed to the Building Official
within one business day after any change. Note that the new Private Provider firm and its DAR’s must be duly
registered with the City of Tampa in order for the change to be authorized.
City of Tampa Permit No.:____________________________________________________________________
Project Address:_________________________________________________ Project Folio No.: ___________
Fee Owner Name (Printed): __________________________________________________________________
CHANGE REQUESTED (check all that apply)
Change of Private Provider Firm to Alternate Private Provider Firm Change of Services
Change from Private Provider Firm to City of Tampa
EXISTING PRIVATE PROVIDER FIRM / QUALIFIER
Name of Firm:_____________________________________________________________________________
Qualifier: ___ License No.:______________________________
Business Address:___________________________________________________________________________
Office Phone: Fax:_____________________________________
NEW PRIVATE PROVIDER FIRM / QUALIFIER No Change
Name of Firm:______________________________________________________________________________
Qualifier: ___ License No.:_______________________________
Business Address:____________________________________________________________________________
Office Phone: Fax:________________________________
Planning & Development
1400 North Boulevard Tampa, FL 33607
(813) 274-3100
CHANGE OF PRIVATE PROVIDER
REV 01/21/20
CHANGE OF SERVICES
Original Services provided: (select all that apply):
Plan Review Only Inspections Only Plan Review and Inspections
New Services to be provided: (select all that apply):
No Change Plan Review Only Inspections Only Plan Review and Inspections
I, ____________________________________, the fee owner of the property referenced above, hereby affirm
that I request the change of Private Provider and/or services as indicated above effective on
___________________________________ ____________.
_________________________________________ ________________________________________
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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Planning & Development PRIVATE PROVIDER

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Completed 5 August 2020

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