12-1372-027�K n
The City of South Miami
Building liepartment
6130 Sunset Drivcl, Second Floor
South Miami, FL 33143
305-663-6355
Fax 305-666-4591
NOTICE TO CITY OF SOUTH MIAMI BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL
INSPECTOR UNDER THE FLORIDA BUILDING CODE.
I (We) have been retained by ), , �t" to perform special
inspector services under the Florida Building Cole 20,10 at the :a o t o�C'�k 4�4� (.td
project on the below listed structure as of t" iw' 0 (date). I am a registered
architect/professional engineer licensed in the Sta e of horida,
Process Number:
Special Inspector for Pilin, FBC 1822.1.20 (R4404.6.1.20)
�-'Special Inspector for Trusses > 35 ft. long or 6 ft. high, FBC 2319.1.7.2.4.2 (R4409.6.17.2.4.2)
especial Inspector for Reinforced Masonry, FBC 2122.4 (84407.5.4)
Special Inspector for Steel Framing, FBC 2218.2 (R4408.5.2) "
(/Special Inspector for Soil Compaction, FBC 1820.3.1 (84404.4.3.1)
Special Inspector for Precast Attachments, FBC 1927.12.2 (R4405.9.12)
Special Inspector for Roofing Applications, Lt.Weight. Insul.Ccinc. FBC 191.7.2 (R4405.12.2)
_ Other
Note: Only the marked boxes apply.
The following individual(s) employed by this firm or me is authorized representative to perform
inspection*
3. -- �— ' 4. F
*Special inspectors utilizing authorized representatives shall insure the authorized representative is qualified by
education or licensure to perform the duties assign by Special Inspector. The qualifications shall include licensure as a
professional engineer or architect: graduation from an engineering education program in civil or structural engineering;
graduation from an architectural education program; successful completion of the NCEFS Fundamentals Examination;
or registration as building inspector or general contractor.
I (we) will notify the City of South Miami Building Department of any changes regarding
authorized personnel performing inspection services.
I (we), understand that a Special Inspector inspection log for each building must be displayed in a
convenient location on the site for reference by the City of South Miami Building Department
Inspector. All mandatory inspections, as required by the Florida Building Code, must be .
performed by the City of South Miami Building Department .Inspections performed by the
a% AMS
Specijk,f srpe� r�ktlr,�i by the owner are in addition to the mandatory inspections performed by
the d' art ent ..fu he#u on completion of work under each Building Permit, I will submit to
t i�� $ur bang Ins c, oo attime of the final inspection the completed inspection log form and a
1 e d t eme i " i tin t' t, to the best of my knowledge, belief and professional judgment
nth e rt ons of e ee"i dined above meet the intent of the Florida Building Code and are
t s J afk al c �� vv ` l the approval plans.
EyineerlArchitect
Name CII
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Address �� -fir? l I� ( K Dt
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