1166 Main Street - COCLEGACY ENGINEERING, INC.
6415 Greenland Road
Jacksonville, FL 32258
INSPECTIONS CERTIFIED BY PRIVATE PROVIDER
OFFICIAL USE ONLY
Recieved Date:
Received By:
Route To Quality Assurance Office
PRIVATE PROVIDER INFORMATION
PROJECT INFORMATION
Name of Firm: Legacy Engineering
Permit Number: RERF23-0061
Primary Contact: John Ellis III
Address: 1166 Main Street
Phone #: 904-721-1100
Atlantic Beach, FL 32233
Interim Report ❑ Final Report: El
Owner:
Contractor: iLl.�j IZu' �r
All Interim and Final Reports Must Be Signed and Sealed"`
CERTIFICATION
In accordance with Florida Statute 553.791 and the requirements established by the City of Atlantic Beach, this is to certify that I or
my approved duly authorized representative performed all the inspections listed below, and certify that the work inspected was
according to the Florida Building Code. Further, I, including my employees, agents, and sub -consultants, shall hold harmless, and
indemnify the City, its directors, officers, employees, representatives, and agents against any claim, action, loss, damage, injury
liability, cost, and expense of whatsoever kind or nature (including, but not by way of imitation, attorney's fees and court
costs) arise out of injury (whether mental or corporeal) to persons, including death, or damage to property, arising out of or
incidental to me, my employees, agents, and /or sub -consultants for work performed hereunder including, but not limited to
all omissions or corrections to documents. This indemnification agreement is separate and apart from and in no way limited by, any
insurance provided in pursuant to this agreement or otherwise.
I also confirm that all monies have been paid to me in full for these professional services. Should additional inspections be
required of me by the City of Atlantic Beach because of errors or omissions on my part, there will be no additional charges for these
services to the City of Atlantic Beach.
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I further confirm that no individual, corporation, partnership,,,0ii�i�t i ur of -other legal entity, or any employee thereof that has
provided any part of this inspection service, has had any -CW I , pefmitting, or has any ownership interest of any kind in
the above referenced project. •�� �
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(Signature of Private Provider) '•�� Private Provider Seal
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LIST ALL INSPECTIONS PERFORMED - Attached additional pages if necessary
PERMIT TYPE
PERMIT NUMBER DATE
INSPECTION CODE AND SIGNATURE OF PERSON
PERFORMED
DESCRIPTION CERTYFYING INSPECTION
Roof
RERF23-0061 5/12/2023
Roof Dry In MICHAEL HOWARD
Roof
RERF23-0061 5/12/2023
Roof Sheathing and Nailing MICHAEL HOWARD
Roof
RERF23-0061 5/16/2023
Final Roof MICHAEL HOWARD
Revised 2/5/2018