RC-16-1778 (2)Miami Shores Village
Building Department
.-Cl
10050 NE 2nd Ave.
R.
Miami.Sho-res', FL 33138
305-795-2204 / Fax 305-756-8972
NOTICE TO MIAMI SHORES BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL
INSPECTOR UNDER THE FLORIDA BUILDING CODE.
I (We) have been retained by dZ15oa✓ A,4r M to perform special inspector services under the Florida
Building Code 511 Edition (2014) and Miami Da0e County Administrative Code`at the All-ke leegtoef1M .Ta✓
project on the below listed structure as of 8'// )1!G (date). I am a registered
arch itect/professional�engineer licensed in the State of Florida.
'Process Number:
Special Inspector for Reinforced Masonry, Section 2122.4 of the FBC 5th Edition (2014)
_ Miami Dade County Administrative Code, Article 11 Section 8-22 Special Inspector for
— Trusses > 35 ft. long or 6 ft. high
— Steel framing and Connections welded or bolted
oil Compaction
_ Precast Attachments
_Roofing Applications, Lt. Weight. Insul.Conc.
Other
Note: Only the marked boxes apply.
The following individual(s) employed by this firm or me is authorized representative to perform
inspection*
I. A44NyeC A,6r, Ices _ 2. PeDI'0 /1/� 24typ .
3. }�RM/G To•/ orAleS 4. FerA1,1,11,0a CArr4s-Co
*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 NCEES Fundamentals Examination:.
or registration as building inspector or general contractor.
I (we) twill notify the Miami Shores Building Department of any changes regarding authorized personnel
performing inspection services.
I (eve), understand that a Special Inspector inspection log for each building must be displayed in a
convenient location on the site for reference by the Miami Shores Building Department Inspector. All
mandatory inspections, as required by the Florida Building Code, must be performed by the Miami Shores
Building Department .Inspections performed by the Special Inspector hired by the owner are in addition to
the mandatory inspections performed by the department. Further, upon completion of work under each
Buildin. Permit, I will submit to the Building Inspector at the time of the final inspection the completed
inspection log form and a sealed statement indicating that. to the best of my knowledge. belief and "
professional ment those portions of the project outlined above meet the intent of the Florida Building
d fnitCode ccordance with the approval plans.
• • • • h'n�neer/Architect i
�` • •' I�r;e. ' LC.�7( hs : n/r/¢ 6y/9T• L-
igned.a�r!/� Print
Date: ft ' li, Address GIBS Az& I/b ht/ • McOt e-1 t't 3.31)8"
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