439 Irex Road RESA23-0008 - 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: RESA23-0008
Primary Contact: John Ellis Ill
Phone#: 904-721-1100
Interim Report □Final Report: 0
All Interim and Final Reports Must Be Signed and Sealed
CERTIFICATION
Address: 439 lrex Road
Atlantic Beach FL 32233
Owner:
Contractor: On e Eleven Construction
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 inspe cted 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 indemnif ication 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 bythe City of Atlantic Beach because of errors or omissions on my part, there will be no addition al charges for these
services to the City of Atlan tic Beach.
I further confirm that no individu al, corporation, partnership, joint venture or other legal entity, or any employee thereof that has
provided any part of this inspection service, has had any p�r,t,in: 1:'he d��ift,n, permitting, or has any ownership interest of any kind in
the above referenced project. ,,,,,, 5·. � Or:; 11;
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LIST ALL INSPECTIONS PERFORMED -Attached additional pages if necessary
DATE PERMIT TYPE PERFORMED
Building 8/24/2023
Building 9/20/2023
Mechanical 9/20/2023
Electrical 9/20/2023
Building
PERMIT NUMBER
RESA23-0008
RESA23-0008
RESA23-0008
RESA23-0008
RESA23-0008 9/25/2023
INSPECTION CODE AND
DESCRIPTION
Window/Door
Framing
Rough Mechanical
Rough Electrical
Insulation
Revised 2/5/2018
(Private Provider Seal}
SIGNATURE OF PERSON
CERTYFYING INSPECTION
Byron Crawford
John Ellis Ill
John Ellis Ill
John Ellis Ill
Byron Crawford
PERMIT PERMIT NUMBER DATE
TYPE PERFORMED
Building RESA23-0008 10/21/2023
RESA23-0008 10/21/2023 Mech
RESA23-0008 10/21/2023 Electrical
INSPECTION CODE AND DESCRIPTION
Building Final
Mechanical Final
Electrical Final
SIGNATURE OF THE
PERSON
CERTIFYING
INSPECTION
John Ellis Ill
John Ellis 111
John Ellis Ill