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♦ r r6 • Form#9113.053-2002-01 Notice to Building Official of Use of Private Provider Effective January 20,2003 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 used for both services pursuant to nS.�ec,,tio'n 553.191(!}Florida Statute. I (�Ytq jt & rwl ej ,the fec owner,affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: Universal Engineering Sciences,Inc. Mark K Hardy J Private Provider: 9802 Palm River Road,Tampa,FL 33619 Address:Telephone; ---- 813-740-8506 Fax: 813-740-8606 Email Address(Optional): TarnpaB1DScheduling@UniversalEngineering.com Florida License,Registration or Certificate#: 57233 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 requiremeats 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 barmless the local government,the local building official,and their building code enforcement personnel from any and all claims arising firom 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. 1 understand the Building Official retains authority to review plans,make requiredinspections,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 shalt, within I 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. Page 1 of 2