NTBONotice to Building Official of
Use of Private Provider
Project Name
Parcel Tax ID
(check applicable) Inspections Services to be provided Plans Review
Ai Gas Electrical Mechanical Structural Plumbing
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
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 Fax
Email Address (Optional)
Florida License, Registration or Certificate #
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
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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 th
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, enyironmental or other codes
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The following attachments are provide as required
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
Partnership Individual Corporation
Print Partnership Name Print Corporation
By
(signature) (signature) ,(ignatu
Print Print
Name Name Name
Its Address Its
(Address Addres
Telephone
No
Telephone Telephone
No No.
Please use appropriate notary block
STATE OF
COUNTY OF
Partnership Corporation Individual
day Before me, this day of day of Before me, this Before me, this
the 20 of the 20
foregoing instrument was the foree oing instrument was foregoing instrument was
acknowledged before me by means of acknowledge before me by means of acknowledged before me by means of
0 physical presence ord online physical presence ord online 0 physical presence or online
notarization and acknowledged before notarization notz arization
partner/agent on behalf of me that same was executed for the
purposes therein expressed a
a
partnership, who executed the
foregoing instrument and acknowledged corporation, on behalf of the state
before me that same was executed for corporation, who executed the
the purposes therein expressed foregoing instrument and
acknowledged before me that same
was executed for the purposes therein
expressed
Type of Identification Produced or Produced Identification Personally known
Print Name Signature TERESA SCHNEIDER
Notary Public - State of Florida
Notary Pul
My Comm. Expires Jut 10, 2026 CF F
3ondec through National Notary Assn
My commij
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