HomeMy WebLinkAboutAlternative Service AgreementG' ® eot' ,.,,3 cal ftigineering
1
U N .1 V E .S.A L Construction Material's Testing & Inspection
ENGINEERING SCIENCES
BuildingCode Compliance
• ..Occupational Health �& Safety
Environmental ,
..Groundod in Excellence.. Build ng.Envelope.,
Alternative Service Ag'.reernen.
Project: 'DR Horton-Creekside = 9405 Potomac Drive, FortPierce. FL 34945-Lot 1.1.
Private Provider Firm: Universal Engineering Sciences-..
Private Provider Name:. John Carl Peterson
Address:.607 Commodity. Cove, PortSt:.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:. :. : -
LicensWCertificateNo::.
License/Certificate
Maftheiw Chaney
BN#:7342 ...
Inspector— Building.
Don Determan __ :. `,
`BN# 4688 :,
lnspe6tor.=:Buildin'g..(l and 2 family), Plumbing`:
Josean Duprey _.
.BN#:7330 ' - '
Inspector -Building ,.
Carl Peterson `.
BN# 5555 RPX#.243
Inspedtor.= MEP,'Bgilding: : .
u
Michael Benton
BN# 8067
:.. ..
i Inspector- Inspector -Building (1 and 2 family);
calPlumbing.. .. _
Mechani,
Donald_ Green
BN#7301. ,
Inspector -Electrical
Vincent Burdo :. .
BN#5337 :. :.
'- Inspector-Electrical,::Plumbing Mechanical.
As the private inspection services provider for this project, f have:read-and agree to be-bound�to the provisions �of State
Statute.:553. 791. I further agree and understand that only the.above listed personnel may perform inspections on this
project. and that if for any'reason the inspection personnel should change, or -if any person listed above -should .discontinue-
toquality as a:daly authorized agent, will be tifiedin ti immediately. .
Representative Name: .
Signature
State of Florida, County of Palm. Beach,
nn `
Sworn to (or affirm ed).and.subscribed before me this"! day of I .. 2021, by cJ., P(;,!
who is personally known to me.
Anted: ram
i a of N ary'- Signature of Nota :.
Notary Public.Stamp:
w" BRITrANVLYNNJOLUTIS
a�!sr Notary t+ahiio - State of Ficrida
Commipfion r NI. 106ASS .
l My Comm; Expiros Mar 2.1. 2025
Berm arauQr racera, rotary Aitr.