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ENGINEERING SCIENCES
Grounded in Excellence
Geo nical Engineering
Con ction Materials Testing & Inspection
Building Code Compliance
occupational Health & Safety
Environmental
Building Envelope
Alternative Service Agreement
Project: DR Horton-Creekside — 9612 Potomac Drive, Fort Pierce, FL 34945-Lot 124
Private Provider Firm: Universal Engineering Sciences
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:
Matthew Chaney
BN# 7342
Inspector — Building
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 -Electrical, Plumbing Mechanical
Dan Divan
BN#4041
Inspector -Building, Plumbing, Mechanical
Richard Schofield
BN#2710
Inspector -Residential
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 the inspection personnel should ch ge, or if any person listed above should discontinue
to quality as a duly authorized agent, you will be notified in writing WWdiatql� „/J
Representative Name:
re
State of Florida, County of Palm Beach,
Sworn, to (or affirmed) and subscribed before me this day of 2021, by J Qhh Patrsor
who is personally known to me.
Printed name of Ndtary Signature of Nota
Notary Public Stamp:
;,p F Notary PuAde ,104 eY f115.8 ,
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