HomeMy WebLinkAbout2110-0385 C Notice to Building OfficialPlanning and Development Services
Building and Code Regulations
2300 Virginia Avenue
Fort Pierce, FL 34982-5652
NOTICE TO BUILDING OFFICIAL OF SPECIAL INSPECTOR
I (we) have been retained by VQi��I�O 11� Sh")K? S Owner,
to perform special inspector services in accordance with the Florida Statutes 471 & 553 and the
Florida BuildingCode- 6th Edition 2017.
Project Name: VO./, � (DyJ iG[� ed, C Permit # a % 10 -p (3ES-
s-� r L van
Address.-) `7�-(j �. .P � be City _ „I-) —zip L1rt -7
NOTE: ONLY THE MARKED BOXES APPLY
SPECIAL INSPECTOR FOR PILINGS
SPECIAL INSPECTOR FOR SOIL COMPACTION AND FOUNDATIONS
SPECIAL INSPECTOR FOR SHORING
SPECIAL INSPECTOR FOR REINFORCING MASONRY AND ALL CONCRETE ELEMENTS
SPECIAL INSPECTOR FOR POST -TENSION CABLES AND ACCESSORIES
SPECIAL INSPECTOR FOR STEEL AND/OR WELDED CONNECTIONS
SPECIAL INSPECTOR FOR FLOOR AND ROOF TRUSSES
SPECIAL INSPECTOR FOR PRECAST UNITS. TILT WALL ATTACHMENTS & REBAR PLACEMENT
SPECIAL INSPECTOR FOR CURTAIN WALL AND/OR STRUCTURAL GLAZING
SPECIAL INSPECTOR FOR PLYWOOD DECK AND/OR METAL DECK AND ATTACHMENTS
SPECIAL INSPECTOR FOR THE FOLLOWING (if not identified above)
" The following individual(s) employed by this firm are authorized representatives to perform
inspections on the project named herein and are authorized by the signature and seal below
1.
3.
4
4.
a Authorized Representatives of an Engineer or an Engineer performing threshold inspections shall
conform to Rule 61G15-30.004 of the F.A.0 & FL Statute Section 553 79(5)(a),(b) and (c). Sections 110 7 & 110.8 of
the Florida Building Code (FBC)
b. Special inspectors performing building department required inspections shall conform to the 6th
Edition (2017) Florida Building Code. comply with Section 110.8 and be licensed under FS 468 Part XII Permission
to perform these inspections may only be performed under specific authorization of the Building Official
c the special inspector niaN not serve as a surrogate in carrying out the responsibilities oflhe
huilding otiicial. the architect, or the en�.zineer ot' record
d. A list of all individuals performing actual inspections with their qualifications. resumes and license
information shall be furnished to the Building Department for approval with this document. Only persons listed on this
document and authorized by the Building Official or his/her representative will be accepted
I, (we) will notify the St. Lucie County Building Department of any changes regarding authorized
personnel performing inspection services.
I, (we) understand that a Special Inspection Log for each building must be displayed in a
convenient location on the site for reference by the St. Lucie County Building Inspector. All
Page 1 of 2
Special Inspector Form 2/17/2020
NO
mandatory inspections, as required by the Florida Building Code. must be performed by the
County. The St. Lucie County Building Inspector must be called for all mandatory inspections.
Inspections performed by the Special Inspector hired by the Owner are in addition to the
mandatory inspections performed by the Building Department. Upon completion of the work
under each Building Permit, I (we) will submit to the St. Lucie County Building Inspector at the
time of final inspection the completed inspection log form and a signed and sealed statement
indicating that. to the best of my knowledge, belief and professional judgment. those portions of
the project approved for special inspections and permits outlined above and are in substantial
accordance with the approved plans. I (we) hereby certify that if shoring is needed to be
installed on an emergency basis. it will be in compliance with the provisions of the Florida
Building Code and in conformance with generally accepted engineering standards.
Engineer Printed Name: J b AJrJ Q, 1 1LE1T15N G Ac%A
Engineer Signature: _
Company Name:
Address:
City:
PE # SI #
I N2 5/8" labels l o h� h
Breitenbach Eng
4853 SE Pilot ineepy�ge I
Stuart,Way
BREITfye,,, This item has been digitally signed
` Florida 34997 �,p;. �sCENSF :;✓ny and sealed by Johnt Breitenbach, PE
No 59770 using a digital signature and date.
Signed & Sealed:
gREI
.y
No. 59770 "
STATE OF
�0.,
��: ••., OR to .• G��
OwneffA&/ ,�i Rt&\Gme.
Owner/Agent Signature:
For St Lucie County Office Use Only
2 V L L .U?Printed copies of this document are
STATE or +�� _= not considered signed and sealed and
,F�0R
w,P-'��".� the signature must be verified on any
electronic copies.
C.1%yE
* • No. 59770 • * "
STATE OF
.�-
- S/QNA�� ,,\��,.
Date document received: / / By.
Permit #
Page 2 of 2
Special Inspector Form 2/17/2020
Authorization:
Date: /