05-839-001i'
"IRST
GE
0 1" 77"�k tf
CITY OF SOUTH MIAMI
SPECIAL INSPECTOR FORM
South Miami
Ir 1 0 r i d a
tIM
I? W 411PT.1
I (W, e) have been retained by R - to perform. special inspector
lir,
senices under the Florida. B Code at the 4-!&D S( M project on the below listed
structures as of (date). I am a registered architect or professional eugmeff licensed in the
State of Florida.
pitOCESSNUAMERS:
E] SPECIAL INSPECTOR FOR PI1JNG, FBC 1S22-110
F1 SPECIAL INS•ECIOp, FOR MSSES OVER 35FT LONG Olt 6FT HIGH 2319.17.2.4.2
0 SPECIAL INSPECTOR Fop, pXmORCED MASONRY, FBC 2122.4
SPECIAL INSPECTOR FOR STEEL CONNECTIONS, FBC 221,91
SPECIAL INSPECTOR FOR solL COUPACMN, FBC 1920.3.1
SPECIAL INSPECTOR. FOR PRECAST UNITS & ATTAaM&'NTS PER FBC 1927-12
r-1 SPECIAL INSPECTOR FOR
Mote: On[
y the inarked boxes aPPI.V-
ized relm-menta;Cwtz to perfbrm
The following in&viftjj(r.) eMleyed by *is firm or me are authm
inspecfion
3. zod re dMv is qualified by
*Spodal InspVtm ufthml aRthanzEd Wmentahm shall MSM the aufixnl pment Shan mch1de
education or Ifeenn" fo PlIfOrm the &dfgy U'dZ"#' by fi"r SP"'Kl lnsf�r' 7he q=liftcaaons , - -
fion fmw an - S&Wation pro v= in CM1 or
ycensure as a profezional water or archiled, Zradua ensmeenng
structural en2insering, graduatim f1vm an a1Tj1jMcfurajedzjWtj0n pv:=W swctgful completion of the NCEES
spedor or d co"huctor.
Fimdamen n as building in . personnel
L (we) wLU notify Miann-Djde Coijmty lidding Depx=ent of MY changes regarding "Nth =d 1
performing inspection tervicel-
(we) undfzst=d that a Special inspector inspection log for each building must be disPIRYed, in a convenient
&e site for reference All datory
.f
location on erence by the Mmmi_Da& County 3tuldiijg Dep&,
ftV!ctionsa as required by the Florida Building Code, must be performed by the Cmmty. lie Cminty bmIding
inspections must be called for on all mandatory inspections. Inspections palbrmed by the S� wial Inspector hired
b are, in dd&Hon to the mandatory in.-UmtImspeformed by the DtparMent: Further, upon completion
y the Owner -& specti the
of the vjork under each Building Feadt I Will submit to ffie Building Inspector at 'he fin of &21 in on -
completed inspection log form; and a sealed atrtenvV indicating that, to die best of my kwwledge, belief and
professional judgment those portions of the project outlined above meet the intent of the Florida Building I Code and
are in substan621 accordince'With the OPPrOved pb=
. ......... ..........
Engineer mbitec
Name
(PRIIND
Al
e �, :, x Addres 4 143 '&U) 14 CT
I.-I.
U
40�
.14 Phone No.