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Alternative Service Agreement
Project: Triton Roofing & Restoration-6748 Dickenson Terrace, Port St. Lucie, FL 34952
Private Provider Firm: Universal Engineering Sciences, Inc.
Private Provider Name: John Carl Peterson
Address: 607 Commodity Cove, Port St. Lucie, FL 34986
Phone: (772) 924-3575 Fax: (772) 924-3580
Names, License/Certificate Numbers, and License description of provider and duly authorized agents who will be
providing services for this project.
Name:
License/Certificate No.:
License/Certificate Type:
Kevin Hempel
BN#2335, RPX#1507
Inspector — Building, Mechanical, Electrical,
Plumbing
Don Determan
BN# 4688
Inspector — Building (1 and 2 family), Plumbing
Josean Duprey
BN# 7330
Inspector - Building
Carl Peterson
BN# 5555 RPX# 243
Inspector — MEP, Building
Michael Benton
BN# 8067
Inspector- Inspector -Building (1 and 2 family),
Mechanical, Plumbing
Donald Green
BN#7301
Inspector -Electrical
Vincent Burdo
BN#5337
Inspector -Mechanical, Electrical, Plumbing
As the private inspection services provider for this project, I have read and agree to be bound to the provisions of State
Statute 553.791. 1 further agree and understand that only the above listed personnel may perform inspections on this
project and that if for any reason a inspection persopel should change, or if any person listed above should discontinue
to quality as a duly authorize44ent, y9p will t)e 06cl in w�mediately.
Representative Name:
State of Florida, County of Palm Beach,
Sworn to (or affirmed) and subscribed before me this day of 4 Pr 11 2021, by j • r ie-�e rscr
who is personally known to me.
r L. j('33Zdif0
Printed name of Notary
Notary Public Stamp:
J ., BN TTAMY mm Jo7Amf
Nma Publk - Sate d FWJ
j` Cammhfkn3 NN i06.5.
. w °;% My COmm. Expires Mar tf. 3"Ok @I WO Nocnai Nctary A
Signature of NotaV