HomeMy WebLinkAbout000000 (2) P CITY OF GLENDALE,ARIZONA
BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
�IT�i SPECIAL INSPECTION CERTIFICATE
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Project Name n Lf �1 uC.- L Y OLI�/ t JS Date e—24_ '
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Project Address Permit Number DSC Number
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❑ 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 A hitect n Contractor
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Name of Structural Engineer Signature of Owner or Legal Agent
Se_14 fay $r a-v cru f2a L.
n 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 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 required 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 he job site to render full,complete and competent inspection.
The special field inspector(s)are to be named below before work under their area of duty commences.
Cq' o‘,› Architect or Engineer Responsible for Special Inspection(type or print)
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735 O � o f A� t-10125 — Jo IK fl¢i c l� ��
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r(Specify Type) Name of inspector(Specify Type)
+.O•�r ONA U.S P Name of inspector(Specify Type) Name of Inspector(Specify Type)
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SPECIAL INSPECTOR QUALIFICATIONS[IBC 1703]ARE APPROVED.
Building Official Date
CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANCY
no be illed 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
f. Issuance of the certificate of occupancy per the 2006 International Building Codes.
v, G O
�' 27350 I certify that,to the best of my knowldege,the requirements of the approved plans for which special inspection
JOHN C is required and the 2006 International Building Codes have been complied with. A guarantee that
CHNEIDER m the contractor has necessarily fulfilled the obligations of his contract is neither intended or implied.
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S:n e0�. Architect or Engineer Responsible for Special Inspection(Type or Pont)
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expires 0 9I301�`i 11 ec r (cc/1416'tA6A ST12uc_rcl -"9 -)
RETURN TO THE BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
❑ BUILDING SAFETY DEPT. ❑ BUILDING INSPECTOR Cl ARCHITECT OR ENGiNEER ❑ JOB COPY
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