HomeMy WebLinkAboutAlternative Service Agreement1 ' Geote-hnical'Engineering
U: N 1 V E ai S.A L :® construction Materials Testing & Inspxection
ENGINEERING SCIENCES'-'s
.. .. oedupagional Healthll& S fety..
En vironrrlental
Grounded in Exeell@race.. Bui{ding:Envelope..
Alfiernative Service Agreement
Project: DR Horton-Creekside = 3335 Homestead .Drive, Fort Pierce; FL 34945-Lot.4 '
Private Provider Firm: Universal En-gineering Sciences..
Private Provider Name:. John'Carl Peterson
Address:. 607 Comrriodity. 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, :.
Matthew Chaney _
BN#:7342
..Inspector;=Building `: .: • ' ,
Don Determari ,. '.
'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 -(I and 2 family),'
Mechanical., Plumbing.
Donald: -Green
BN#7301' :
Inspector -Electrical .
Vincent Burdo ;.
BN#5337 ..• • '.
. Inspector -Electrical,, Plumbing Mechanical
As the private inspection services.provider for this project, Ihave-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. pgdorm 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 authorized agent, you'will.be notinwriti f iimmedi I
Representative Name:
Signature ,
State of Florida, County of Palm Beach;
Sworn to (or affirmed) and subscribed before me this day 2021; by �.1.. Pe 1 on.-
who is personally known to me..'
•
ri �U . Jc�2cll�s
Printed'name of N tary:. Signature of Notfr"
Notary Public Stamp:
,r��jtt +''•. BRrrmmv LYNN JOZAIT15 -
(P;� Notary Public • State o1 Florida
Ids' . Commission d NN 106455
\\, .n,:• My Comm, Expires Mar 21,4025
3creee -nrogr Nadcnal Notary Assn.
- 93U - NIVE4 `SALEE
ENINRING SCIENCES
DR Horton-Creekside
California Model -Lot 4 -
3335 Homestead Drive
Fort Pierce; FL
Private Provider
Plan Compliance Affidavit
California Mode13335 Homestead Drive
Private Provider Firm: : ,Universal Engineering Sciences
Private Provider: John Carl Peterson
Address::.: - 607 NW Commodity: Cove, Port St.. Lucie; Florida 34986
Phone: 772=924-3575 .. Fax:. .7727924=3580 . "
Email:.. teeterson(oDuruversal6agineering.com
I hereby certify that to. the .best of my knowledge and belief the plans submitted .were .
reviewed .:for . and are- in compliance, with'. the ' Florida. Building Code 'and :all local
amendments . to the Florida Building Code by the . following affiant, who is duly,
authorized to perform plans .review pursuant: to Section 553301, Florida Statute and
holds the appropriate license or certificate:
Name: -John Carl Peterson Revised Plan She( ts:.C-1, GN,-A1; A2.C; El,.P1; M1',.D'1,.D2, .
WAl, WA2; WA3,:WA6; S1,-S11A,-SL2, S1.2A, S2,-S2.lA, SIM, S3, SIM SIM
SMC, SN1..
Florida License/Registration/Certification #(s) and description:
John Carl Peterson
RPX 243
Signature of Reviewer:
SWORN AND SUBSC ED.before me by ohri Carl Peterson, BU 17.21
being personally known to me _ or having produced as identification
and.who being fully swornand cautioned,.state'
that the foregoing is -true and correct to the best of his/he'r.knowledge or belief.
r �f�.l. (rj Z • �.O ZCt I . l
Signature of N Print Name
1` RY TAMP BELOW :
Notary' C. Pub rIN S
My commission expires:,
MY
O( /
� $�`�} Notary P;lbdt • State Cf; PiCrida,
Commissicn 0 Hh 1064!5'
My Comm; Expires Mar 21. 2025
3cncee :nroup 4arcoai Ncsari.assr.-