HomeMy WebLinkAbout147205 CITY OF GIENDALE
C PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR '
Glendale 6239302800�301 SPECIAL INSPECTION/VERIFICATION CERTIFICATE
!,t,• z o r+ ° www.GlendaleALcem PLUMBING/MECHANICAL ENERGY CODE COMPLIANCE
OWNERS NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by the Owner before a building permits issued
In accordance with the Glendale City Code.Chapter 9.1,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 Plumbing/Mechanical Engineer may also certify this project for Energy Code compliano
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Owner's name:44 j Kollar rV�{Vn iorLn 1 Owner's Slnature: ' Date: �Z?/Z a
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PROJECT NAME: REGISTERED N PROFESSIONAL/FIRM NAME:
Apex Heart and Vascular Associated Mechanical Engineers,PLLC
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
21360 N.75th Avenue Glendale 85308 1121 W.Warner Road,Suite 107 Tempe 85284
COG PROJECT NUMBER: 220482 COG PERMIT NUMBER: 147205
SPECIAL INSPECTION/VERIFICATION RESPONSIBILITY CERTIFICATE CERTIFICATE OF COMPUANCE&APPUCATION,FOR CERTIFICATE OF OCCUPANCY
To be filled in and signed by the Engineer:Special Inspector.Contractor of Third To be filled In and signed by the Engineer,Special Inspector,Contractor or Third
Party Responsible for verification before the permit can be issued. Party Responsible for verification when construction is complete.
I certify that I am familiar with the The construction of the above
energy code compliance named project s complete and /
requirements of the above named d, j meets or exceeds the requirements ',/,'
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project arid energy conservation.I i I' of the City of Glendale's currently --
hereby assume full responsibility to 'Y' Gpr adopted Energy Code.Request Is I i i E^alq�^
carrying out the required specral / 1!� GtE�^ hereby made for issuance of the /S'e0- CATt
inspections and verifications. (C certificate of occupancy: r, �ti
32566 \I I certify that,to the best o1 my 32366
GEORGE J. n- ` knowledge,the requirements of the ; GEORGE J.
JOSEPHS .JOSEPHS
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• approved plans for which Special ; o
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Inspection or Third Party Verification dq:s/25-2.'
\`ri ! is required have been met. ,p, ie•� P'
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ENGINEER QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER: �'tiy'''-: DATE:
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