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Home My WebLink About147204 y CITY OF GLENDALE PLANNING&DEVELOPMENT SERVICES k.7 5850 W.GLENDALE AVE.,2ND FLOOR GLENDALE,AZ 85301 SPECIAL INSPECTION/VERIFICATION CERTIFICATE Glendale 623.930.2800 ARIZONA www.GlendaleAZ.com ELECTRICAL ENERGY CODE COMPLIANCE OWNERS NOTIFICATION OF SPECIAL INSPECTION To be completed and signed by the Owner before a building permit is issued In accordance with the 2017 National Electric Code,I,as owner/legal agent,do hereby certify that the construction of the below described building project will receive Special Inspection or Third Party Verification for compliance with the City of Glendale's current adopted Energy Code. The Electrical Engineer may also certify this project for Energy Code compliance. Owner's name: f/`�l kiWar 5/704410 vt. Owner's Signature: Date: 0 342_ PROJECT NAME: REGISTE ED DESIGN PROFESSIONAL/FIRM NAME: Apex Heart and Vascular Center Woodward Engineering PROJECT ADDRESS: 21360 N 75th Avenue REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS: 203 S Smith Rd,Suite 101 Glendale,AZ 85308 Tempe,AZ 85281 COG PROJECT NUMBER: 220482 COG PERMIT NUMBER: 147204 SPECIAL INSPECTION/VERIFICATION RESPONSIBILITY CERTIFICATE CERTIFICATE OF COMPLIANCE&APPLICATION FOR CERTIFICATE OF OCCUPANCY To be filled in and signed by the Electrical Engineer,Special Inspector, To be filled in and signed by the Electrical Engineer,Special Inspector, Contractor or Third Party Responsible for verification before the permit can be Contractor or Third Party Responsible for verification when construction is issued. complete. I certify that I am familiar with the The construction of the above enernamed oject is lete and requirements of compliance above named _ -- nal Eng�^ meets orrexceeds the prequi requirements - �o��al En-we,project and energy conservation.I /• r. of the City of Glendale's currently hereby assume full responsibility to �� i \ adopted Ehergy-Code.Request is co carrying out the required special 28880 hereby made for issuance of the triti- irait„. � 28880 n. inspections and verifications. DOUGLAS C. 5• certificate of occupancy. m DOUGLAS C. WOODWARD m O1 WOODWARD nc'i 'S' o I certify that,to the best of my dee 05.27.22 knowledge,the requirements of the OpQ 02.01.24 '9,Q/ Srgned•••••• Q..• approved plans for which Special -T,,Q� s%gnea Q 20NA, U•5• Inspection or Third Party Verification BONA, U•5• is required have been met. (Engineer's Seal,Signature,Date-If (Engineer's Seal,Signature.Date-If applicable) applicable) 4ENGINEER QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER: DATE: 6/3/2022 Instruction/Information about this form: 1. The person signing in the area that states that project will conform to the currently adopted Energy Code in the left box,does not have to be the same person that verifies those requirements and Is signing the right box. 2. The City of Glendale,Arizona,only needs this form to be completed and returned;we do not need any supporting documentation in order to Issue a Certificate of Occupancy. FORM EFFECTIVE 10/30/2020 POST AT JOB SITE WITH PERMIT CITY OF GLENDALE c PLANNING&DEVELOPMENT SERVICES 5850 W.GLENDALE AVE.,2ND FLOOR GLENDALE,AZ 85301 SPECIAL INSPECTION CERTIFICATE Glendale 623,930.2800 ARIZONA www.GlendaleAZ.com ELECTRICAL OWNER'S NOTIFICATION OF SPECIAL INSPECTION To be completed and signed by the Owner before a building permit is Issued In accordance with the City of Glendale amendments to Article 90.2(A)(5)&90.2(A)(6)of the 2017 National Electrical Code,which requires that the execution of certain electrical Construction work be placed under the inspection of the Engineer,or Special Inspector.I,as owner/legal agent,do hereby certify that I have retained to be responsible for electrical portion of c a truction that require special inspections on this project. (Registered Design Professional/Firm-please print) Owner's name: Ra!k+M'7ur- �i yipi(narrikt Owner's Signature: Date: ,/Z 3�Z Z PROJECT NAME: JJ REGIST DESIGN PROFESSIONAL/FIRM NAME: Apex Heart and Vascular Center Woodward Engineering PROJECT ADDRESS: 21360 N 75th Avenue REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS: Glendale,AZ 85308 203 S Smith Rd,Suite 101 Tempe,AZ 85281 COG PROJECT NUMBER: 220482 COG PERMIT NUMBER: 147204 CERTIFICATE OF RESPONSIBILITY CERTIFICATE OF COMPLIANCE To be filled in and signed by the professional in charge of Electrical Special To be filled in and signed by the professional in charge of Electrical Special Inspections before a building permit is issued. Inspections before a certificate of occupancy is issued. As registered design professional in I certify that,to the best of my charge of electrical special knowledge,the requirements of the inspections of the above named Aortal En9/ 2017 National Electric Code Article \crsal Eng1 project,I certify that I am familiar with / n @, 90.2(A)(5)&90.2(A)(6)and the fry e��--- -the electric design of the project and, //l �•- - -pproved plans and.specifications.— tip/ ^ _—___. in accordance with the Cityof co• have been complied with,insofar as o 14q 28880 o p 28880 Glendale amendments to Article _`w DOUGLAS C. the portion of the work requiring rn DOUGLAS C. 77• 90.2(A)(5)&90.2(A)(6)of the 2017 5• electrical special inspection is WOODWARD ni WOODWARD m National Electrical Code,I hereby . o c concerned.A guarantee that the op 02.01.24 .' assume full responsibility for carrying ��a 05.27.22 Contractor has necessarily fulfilled 9 P S snea out the required electrical special 9,Q Si9ned P• the obligations of this contract is '?, 5 P• inspections.Inspection reports will be �20NA, U.5• neither intended nor implied. ONA, U filed with the Building Safety Department,as required by the above referenced City amendments. (Seal,Signature,and Date) (Seal,Signature,and Date) SPECIAL INSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER[NEC 90.2(A)(5)]:_`e DATE: 6/7/2022 WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM ❑ GROUND FAULT PROTECTION ❑ EQUIPMENT 1000 AMPS OR MORE ® EMERGENCY AND STAND-BY SYSTEMS Doug Woodward,LC,PE ❑ NRTL ❑ COMMERCIAL PV INSTALLATION ® HEALTH CARE FACILITY Doug Woodward,LC,PE ❑ HIGH VOLTAGE(OVER 600 VOLTS) ❑ OTHER: FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT