HomeMy WebLinkAbout156596 3 CITY OF GLENDALE
i i:.. PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
`"` GLENDALE,AZ 85301
[1,s,i,,d al@ 623.930.2800 SPECIAL INSPECTION CERTIFICATE
ARIZONA www.GlendaleAZ.com - STRUCTURAL
OWNER'S NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by the Owner before a building permit is issued
In accordance with Sections 1704 and 1705 of the 2018 International Building Code which requires that certain construction work be placed under inspection
of a registered design professional.I,as owner/legal agent,do hereby certify that I have retained FJS Engineering to be
responsible for the special inspections on this project. (Registered Design Professional/Firm-please print)
Owners name: PEORIA UNIFIED SCHOOL DIST11 Owner's Signature: Date: Z—ZZ—Z3
PROJECT NAME: REGISTE E DESIGN PROFESSIONAL/FIRM NAME:
gCo ff er_vuood Elementary) FJS Engineering
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
PrI2349_36th':Ave;Glendale;AZ=M 4_ Tucson,AZ.
COG PROJECT NUMBER: COG PERMIT NUMBER: /5 5?CP
CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF COMPLIANCE
To be filled in and signed by the professional in charge of Special Inspections To be filled in and signed by the professional in charge of Special Inspections
before a building permit is issued, before a certificate of occupancy is issued.
As registered design professional in I certify that,to the best of my F �
charge of special inspections of the �O{ 2018 Inteknowledgrnational Building n Code the ' • a f 4.
above named project,I certify that I �n� / T 79�,
am familiar with the design of the Ts. ,6, and the approved plans and �< F2 �10^
project and hereby assume full .,� Q' 4. �0^ specifications have been complied r7 47808 O. �_
responsibility for carrying out the a� U 47808 n with,insofar as the portion of the +a V O•
required special inspections In JOHN E. < work requiring special inspection IY JOHN E. -
accordance with Sections 1704 and SKWIOT under Section 1704 and 1705 is \ SKWIoT
1705 of the 2018 International p j
concerned.A guarantee that the �NBuilding Code. �� contractor necessarily constructed �'the building in full accordance with 9�ed O
the plans and specifications is '94Q/20c�P', �R�20NATV
neither intended nor implied. NA U
(Seal,Signature,and Date) (Seal,Signature,and Date)
SPECIAL INSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER(1704.2.1): DATE:
WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM
❑ CONCRETE CONSTRUCTION/REINFORCING STEEL(1705.3)
❑ MASONRY CONSTRUCTION(1705.4)
❑ WOOD CONSTRUCTION(1705.5)
❑ STEEL CONSTRUCTION(1705.2&AISC 360)
® SOILS(1705.6) GeoTek/AZ Firm #11148
!XI FOUNDATIONS(1705.7,1705.8&1705.9) GeoTek/AZ Firm #11148
❑ SPECIAL CASES:POST-INSTALLED(EPDXY/E(PANSION)ANCHORS(1705.1.1)
❑ SEISMIC RESISTANCE(1705.12)
❑ SPRAYED FIRE-RESISTANT MATERIALS(1705.14)
❑ EXTERIOR INSULATION AND FINISH SYSTEMS(EIFS)(1705.16)
O STORAGE RACKS(1705.12.7)
❑ OTHER:
FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT