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Home My WebLink AboutPlan Compliance Affidavitg]UNIVERSAL®. ENGINEERING SCIENCES Ocean Glass Townhomes Building 2 1.0101 S Ocean Dr. J each, FL 34957 . . Jensen B , Private Provider.. . Plan Compliance Affidavit Private Provider Firm:-.:. Uniyersal.Engineering.Sciences ..: Private Provider: : John Carl Peterson Address: 607:NW.Commodity.Cove, Port St:-Lucie;Florida34986 . Phone: - 772-924-3.575 Fax : 772-924-3580 .: Email.. gfascheduling(a,universalengineenng:com I hereby .' certify 4hat to the: best .of in 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 .553,791, Florida Statute and holds the appropriate license or .certificate: Name: John Carl Peterson : Plan- Sheets: AO-00, AO-01, AO-07, AO-08, A0-09, A040A, A0=10B, A0-10C,'AO-11, A042, A043; AO-14, AO-15, AO-18, A1-.10; Al-11, Al-20, Al-.AIAl-22, Al-23, Al-. 24, A1-25;,A1'-26; A1-30,.A1-31, Al-32-, A140; Al-41; A1-42,.A1=50; Al-5.1; A1-52; Al=53, Al-60; A1- 61, A1-62,'A1=63; Al=64, Al-65' EO-01; El-01; -E1=02,.E1-03; E1-04, MO-01-MI-01;-M1=02; M1-03; M1- 04, M2.00, M3.06, M3:01,.P0-01, P1-00, P1-61, P1-02, P1-03; P1-04; PS-01, P5-02; P5-03; P5-04;.,P6-01;. P6. 02, P7-00, SB4-01,'SB4.02, SB4-03,'SB4-04, SB4105, SB4-06, SB4-07, SB4-08,: SB.4-9, SB4-10, SB4- 11, SB4-12, SB4-13; 04-1.4; SB4715, SB4-16, SB447, SB4-18, SB4-19 Florida License/Registration/Certifrcation #(s) and: description Kyle Sawchuk yCrray.Vigrass Mike 1VI4'ya11. AR96356 PX3589 PX1700: Signature of.Reviewen SWORN AND SUBS BED before:me by. John Carl Peterson, BU#1721 being personally known to me • or having produced as,'ideiitification and. who.being fully sworn,and:cautioned; state that1Nrt the. foregoing is true. and correct to. the best of his/her knowledge or belief ure of NotPrint Name Public: NOTARY STAMP BELOW .My commission expires:. oIX Y ° JENESSA FVETfE FUNEfr Notary Public •,State of Florida F` Commission # HH 130136 My Comm. EzRl es May 16, 2025 Banded through National Notary Assn. I Geotechni,cal EngineeringURIVERSALConstructionMaterialsTesting & Inspection ENGINEERING SMEN.CES Building code compliance occupational Health. & Safety Environmental Grounded in Excellence Building Envelope Alternative Service Agreement Project: -Ocean Glass Residence Bldg:-2: 10101.South Ocean. Dr. Jensen Beach, FL 34957` Private Provider. Firm: Universal- Engineering Sciences - Private Provider Name: John Carl Peterson Address: 607 Commoditv 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:a License/Certificate Type:. Kevin Hempel BN#:2335, RPX#1507 Inspector — Building, Mechanical, Electrical, Plumbing Don Determan. BN#:4688 . InspectorBuilding (1-and.2 family);:Plumbirig Josean Duprey BN#•7330. Inspector _ Building : :. Carl Peterson BN# '5555- RPX# 243 . Inspector—, MEP, Building . Michael Banton BN# 8067 Inspector = Building (1 and 2 family), Mechanical; Plumbing Donald Green BN#7301• Inspector . Electrical p — Vincent Burdo . BN# 5.337.Ins ector =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. I further agree and understand that only the above listed personnel may perform inspections on this project and that if for any reason the ins ectio • ersonnel should change; or if any person fisted above should discontinue, to quality as a duly authorize' t; wi a Y iting immediately. - Representative Name: Signature State of Florida, County of Palm Beach, Sworn to (or affirmed) and subscribed before me this . 4 day of , 2021, b O)* U `I, 1n who is personally, known to me: 4L Printed name of -Notary Ignature of No Notary. Public Stamp: EFuNES da Yvplody r'r . ! ppbll NH t30 01g - - • MY WA. ExParYhlia eaAehr«a Notice of Building Official of Use of Private Provider Project Name: Ocean Glass Residence -Building 2,10101 South Ocean Dr. Jensen Beach, FL 34957 Parcel Tax ID: Services to be provided: Plan Review X Inspections X Note: If the notice applies to either private review or private inspection services, the Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute. I. as the fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: Universal Engineering Sciences Private Provider: John Carl Peterson Address: 607 NW COMMODITY COVE, PORT ST. LUCIE FL 34986 Telephone: (772) 924-3575 Fax: (772) 924-3580 Email Address (optional): gfascheduling (aD-universalengineering.com Florida License Registration or Certificate #:BU1721 I have elected to use one or more private providers to provide building code plans review and or inspection services on the building that is the subject of the enclosed permit application, as authorized by_s. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable code, except to the extent specified in said law. Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law required minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I make any changes to the listed private providers or the services to be provided by those private providers, I shall, within 1 business day after any change, update this notice to reflect such changes. The.building plans review and/ or inspection services provided by the private provider is limited to building code compliance and does not include review for fire code, land use, environmental or other codes. T he following attachments are provided as required: 1 Oualification statements andior resumes of the private provider and all duly authorized representatives Proof of insurance for professional and comprehensive liability per Florida Statutes s.533.79 i (16). Individual Corporation Print Corporation Nanre Print Name By. By. signature) (signature) Print name Print name Address: Address. Phone #: Phone #: Please use appropriate notary block. STATE OF Florida COUNTYOF Individual Partnership Pint Partnership Name By. signature) Print narne Olen p <Zxq Address. 1 SE Ocat., 3IVC4 FZ- 3 L(sVy Phone # 2 3 31 `' °t ) -7Am V Before me. this day of 20 __, personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed Corporation Before me, this _-_-._.__..______. dayof____._,__ _. _.....__.__..20, personallyappeared_—_,_-_ ^ of 4 ............._ _-, corporation. on behalf of the state corporation, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed Partnership Before me, this-,,-2 .__..day of '__ +, ?_ _ , personally appeared.•U P c Fes. k> ' partner/agent on behalf of Aa pa nershi ,who execut he foregoing instrumentandacknowledgedbeforemethatsamasexecutedforthepurposedthereinexpressed Personally known _-; or produced identification _ t! h_ _ type of identification producea;gl Li 2 c hl/(Ia t Sig natu o ary RYAN SCHNELLNotaryPublic: NOTARY STAMP r+F • „ `Fj Notary PubNc State of Florida j A' Commission a HH 054841 orxy- My Comm. Expires Oct 19, 2024 a.D. . _...... Print Name My commission expires: