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HomeMy WebLinkAbout23008 4,, at, 45-8 ( D c a 7 6 8........c_ 7KTI CITY OF GLENDALE.ARIZONA ' BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP GIE I\11 DtE SPECIAL INSPECTION CERTIFICATE • Project Name Date ' Glendale Sauare • 11/23/05 Pro/ectAddruss Permit Number © DSC Number NWC 51st Avenue & Peoria Avenue J 23 00 8 ❑ CERTIFICATE OF SPECIAL INSPECTION BY OWNER • (To be filled in and signed by owner before permit is issued) In accordance with Section 306 of the Uniform Adminisbetive Code of the City of Glendale 1997 edition,which requires that the execution of certain • construction work be placed under the inspection or the architect,engineer,or special inspector employed by me,I certify that the construction of the above-described building proed will'octave special inspection. Name of Arctdfeat �, > Contractor Su.tttO POP&tic4Cr.( tltxae W&.- Name of SMJcb.nlEngJneer SignaNreorO ,/,errorL alA ant r• — 3. Cc•res t • / 0 SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE • (To be filled in and sealed before building permit is issued.) I certify that I am fanlike with the souctuial design of the above-named project and,in accordance with Section 306 of the Uniform Administrative Code of the City of Glendale 1997 edition,I hereby assume full responsibility for carrying out the required special inspections. Inspection reports will be filed with the Building Safety Department,as required by Section 306(c). The following individual(s)will be special field inspectors(s) . under my direct supervision and are to bean the Job site to render full,complete and competent inspection. \e�od i-^T C q T a / ' The special field lapdogs)are to be named below before work under their area of duty commences. a SPS r Architect or EnglnesrResponsible far Special Inspecaon(type Gratin!) I a fir, :2115 Anthony Pawloski v Ar FAIINY K1 Name of inspector(Structural Mason. - Nameoflnspedor(Sreel) 14�A " Ki ' Tim Pachak Tim Pachak (tic\ Name of Inspector(Concrete) Name of Inspector(Welding) \\ DN A U-�. Tim Pachak Canyon State Welding Neil Short or Brent Couch • Name oflaspeclor(Specify Type) Name ofInspector(Specify Type) t SPECIAL INSPECTOR QUALIFICATIONS[UAC SEC 30S(B)]ARE APPROVED. J� / IZ.O/D� uutMrr a h tiara ❑ CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANCY(/ l • • (To be filled in and sealed before certificate of occupancy is issued.) The construction of the above named project Is substantially complete and request is hereby made for Issuance of the certificate of occupancy per Section 309 Of the Uniform Administrative Code of the City of Glendale 1997 edition. • I certify that,to the best of my knowldegesihe requirements of the approved plans for which special inspection is required and Section 306 of the Unifonri Administrative Code have been complied with. A guarantee that the contactor has necessarily fulfilled thebbllgationa of his contract is neither Intended or implied. • Architect of En ginner Responsible for Spatial lnspec(on(type orPdn° RETURN TO THE BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING: 0 BUILOING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 0 JOB COPY