HomeMy WebLinkAboutASA - Crekkside Lot 11 signed.pdfg]UNIVERSAL°
ENGINEERING SCIENCES
Grounded in Excellence
Geotechnical Engineering
Construction Materials Testing & Inspection
Building Code Compliance
Occupational Health & Safety
Environmental
Building Envelope
Alternative Service Agreement
Project: DR Horton — Creekside — 9405 Potomac Drive, Fort Pierce, FL 34945 - Lot 11
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 — Building (1 and 2 Family), Mechanical
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
Dan Divan
BN# 4041
Inspector — Building Plumbing. Mechanical
Richard Schofield
BN# 2710
Inspector — Residential
Raymond Gendron
BN # 4950
Inspector - Building 1 and 2 famil , Electrical
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 change, or if any person listed above should discontinue
to quality as a duly authorizedAggnt, you will be nofed in writing immediately.
Representative Name:
( Signature
State of Florida, County of Palm Beach,
Sworn to (or affirmed) and subscribed before me this day of V 2021, by�
who is personally known to me.
rinted name of Notary Signature of Notary
Notary Public Stamp:
LINA MARIA SIFUENTES
Commission k GG 262173
Expires September25, 2022
Bvxled Thru Troy Fain Insurance BW3367019