HomeMy WebLinkAbout1197162 _ • CITY OF GLENDALE, ARIZONA
dI l BUILDING SAFETY DEPARTMENT- COMMUNITY DEVELOPMENT GROUP
GLEN E SPECIAL INSPECTION CERTIFICATE
Pcµi<Nume Date
2_ -e3
Project A/ddrrcc /,, ^ //��' 6_ \,� /^J Q� Prrn it N th'�r/-/r/ nhrr
6,5 CERTIFICA 1'F, 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 Administrative Code of the City of Glendale. edition, which requires
that the execution of certain construction work be placed under the inspection of the architect,engineer, or special inspect::
employed by me, I certify that the construction of the above-described building project will receive special inspection.
A'ume aJ Architect/ Clint moor
L, , hl E-,n�c r. C n,A)s Rv(. 41 C'p
Name nJ Structural Engineer Signotur• wrier or Le Agent
FAX) P47-A E � /iP l .`
SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
(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
Section 306 of the Uniform Administrative Code of the City of Glendale, edition, I hereby assume full
responsibility for carrying out the required special inspection.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)
under my direct supervision and are to be on the job site to render full,complete and competent inspection.
of . ��,.
�. _. FF The special field inspector(s)are to be named below before work under their area of duty commences.
�?~ Architect or Engineer Responsible for Special Inspection (Type or Print)
35917
DELBERT A. t�eLr► �, Qnpier, S, E, P• r ,
RAPIE fR Name of Inspector(Structural Macon ) -'Name of Inspector(Steel)
3'4 'ne Z/f�d Name of Inspector(Concrete) Name of Inspector(Welding)
q�'�zONH S
Name of inspector(Specij Type) Name of Inspector(Spectf)Type)
Place Registration Seal and
Signature Date
SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(B)] ARE APPROVED.
Bui ut); tcitd c:r
CER 11l-ICATE OF COMPLIANCE AND APPLICATION FOR CERTIFIC. TE OF OCCUPANCY
(To be filled in and sealed before certificate of occupancy is issued.)
paof The construction of the above-named project is substantially complete and request is hereby made for
�\ issuance of the certificate of occupancy per Section 308 of the Uniform Administrative Code of the
l �/ r• 'e` 1p City of Glendale,_edition.
35917 1 certify that, to the best of my knowledge,the requirements of the approved plans for which special inspe:i or.
• DELBERT A. is required and Section 306 of the Uniform Administrative Code have been complied with. A guarantee the!
', RAPIER • the contractor has necessarily fulfilled the obligations of his contract is neigher intended nor implied.
•
�?= V_•P Architect or Engineer Responsible fur Special Inspection (Type or Print)
Place Rre • and A
SSignature-Dune .t.)e 1S12r I t I I2Vy1
RETURN TO BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
`l •BUILDING SAFETY DEPARTMENT
•BUILDING INSPECTOR
`1 •ARCHITECT OR ENGINEER
.JOB COPY(TO BE RETURNED TO THE BUILDING OFFICIAL WHEN YOUR INSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTS:
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