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CITY OF GLENDALE,ARIZONA
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BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
GLENDtE SPECIAL INSPECTION CERTIFICATE
Project Name G- Date
.43RD AVE MINI MART CORRECTIONS .07/23/2010
Project Address Penni(Number __,.. Number
6520 N 43RD AVE 513125 100468
Z CERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued)
In accordance with the 2006 international Building Codes, which requires that the execution of certain construction work be placed under the •
inspection of the architect,engineer,or special inspector employed by me,I certify that the construction of the above-described building project will
receive special inspection.
Name of Architect Contractor ,
Jori-c Q✓O aCO g'e itt.a . __ d/"Xl� .,,,ieei
Name f Structural Engineer Signature of Owner or egal A fl _
I .X SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE ,/
LJ (To be filled in and sealed before building permit is issued)
•
I certify that I am familiar with the structural design of the above-named project and,in accordance with the 2006 International Building Codes,I hereby •
assume full responsibility for carrying out the required special inspections. Inspection reports will be filed with the Building Safety Department,as require I
by the 2006 International Building Codes. The following individual(s)will be special field inspector(s)under my direct supervision and are to be on the job
site to render full,complete and competent inspection.
special field inspector(s)are to be named below before work under their area of duty commences.
v .--ir - ' • : Engineer Responsible for Special Inspection(type or print)
•� A `
/i�! � - 410,4„, H. E,e,o� PE-
dr
'0 , t:' F,p P\ Structural Masonry Inspector
0) C' ' 35476 m 1
rn .JOHN H. ,),
d ER!ON,JR.
if p .
e
9�<-0.A,0• . -
£*P,/cs /i.-/3,//z,
SPECIAL INSPECTOR QUALIFICATIONS [IBC 1703]ARE APPROVED. ���� G
❑ CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICAT •F OCCUPANCY
(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 o
the certificate of occupancy per the 2006 International Building Codes.
I certify than,to the best of my knowledge,the requirements of the approved plans for which special inspection it
required and the 2006 International Building Codes have been complied•with. A guarantee that the contractor has
necessarily fulfilled the obligations of this contract is neither intended nor implied.
Architect or Engineer Responsible for Special Inspection(type or print)
RETURN TO THE BUILDING SAFETY DEPARTMENT FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
❑ BUILDING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 0 JOB COPY