Form # 9b-3.053-2002-01 - Notice To Building Official Of Use Of Private Provider

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City of Pompano Beach
Department of Development Services
Building Inspections Division
Notice to Building Official of Use Private Provider
100 W. Atlantic Blvd Pompano Beach, FL 33060
Application Number: ________________________
Phone: 954.786.4670 Fax: 954.786.4677
Folio #: _____________________________________
Project Name:
_________________________________________________________________________
Plans Review: ______________
Inspections: ______________
Services to be Provided:
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: ___________________________________ Fax: _____________________________________
Email Address : ___________________________________________________________________________
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 or structure that is the subject of the enclosed permit application, as authorized by s.
553.791. Florida Statues. 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 ade4quately 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 or structure 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 Statues.
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
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Modified: 10.22.2012
G:\Zoning 2009\Forms and Sample documents\Website Documents\Building\Forms \ noticetobuildingofficial.pdf
Form # 9B-3.053-2002-01
Effective: January 20, 2003
Revised Florida Statue 553.791

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