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SPECIAL INSPECTOR REQUEST
__________________________ (Date)
Mr. Danny Ezzeddine,
Building Department, Director
th
401 NW 70
Terrace
Plantation, FL 33317
Re:
___________________________________ (Project Name)
___________________________________ (Job Address)
Plantation, FL
Permit No. _________________________
Dear Mr. Ezzeddine:
I/We, the undersigned, ______________________________ am certified by the State of
Florida to perform special inspection services in accordance with the Florida Building Code,
Broward County 2010 Edition, Administrative Section 110.10.1
I/We will be performing the inspections for referenced Project/Address/Permit filed under
______________________________________________________ (Contractor of Record).
List of Special Inspections to be performed: ______________________________________
_________________________________________________________________________
The following items have been attached to this letter:
1. A copy of liability insurance for inspection services (the City of Plantation must be
listed as Certificate Holder).
2. A synopsis of experience and background, showing qualifications for all named
inspectors to make said inspections.
3. Copies of State Department of Business and Professional Regulation Licenses for all
named inspectors.
4. Hold Harmless Letter.
5. Broward County Board of Rules and Appeals Form for Special Building Inspector.
Sincerely,
__________________________________
City of Plantation
Special Inspector Request
Rev. 06/06/2016