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CITY OF GLENDALE
< PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ85301 SPECIAL INSPECTION CERTIFICATE
lOndale 623.930.2800
A R I Z O N A www.GlendaleAZ.com STRUCTURAL
OWNERS 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 whiCti jequifes:lthat certain construction work be placed uttdeT'inspection
of a registered design professional.I,as owner/legal agent,do hereby certify that I have retained ,Spe6die &Associates 'LLC tb be
responsible for the special inspections on this project. 1.,!Vtcred Design Professional/Firm•please printl'
Owner's name: Trevor Colbert Owner's signature;:..-./4 t ?/Zt Date:11/7/2023
PROJECT NAME: REGISTERED DESIGN PROFESSIONAL/FIRM NAME:
Gopuff Wall Repair Speedie &Associates, LLC
PROJECT ADDRESS: REGISTERED DESIGN PROFESSIONAL/FIRM ADDRESS:
[9501N.-Glendale-Avenue,_Glendale,_AZ 3331 E. Wood St., Phoenix, AZ 85040
COG PROJECT NUMBER 232279 COG PERMIT NUMBER 163456 i:
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 bythe 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 �yto{eSSiprtpj
charge of special inspections of the Q,jotes51°40I, knowledge the requirements of the
above named project,I certify that I `' ,k' iC,`$' 2018 International Building Cade !1957.
�
` c specifications have been complied
project and hereby assume full it 7$95�
with,insofar as the portion of the ,Z`A0
responsibility for carrying out the i�ARY R4
required special inspections In2ACHARYM• _: _work requiring special inspection HERMAN _ ___ —
fiE
accordance with Sections 1704 and G under Section 1704 and 1705 Is yt,, *�
1705 of the 2018 International concerned.A guarantee that the 4'> ,
fc, contractor necessarily constructed 9 ONEO
Building Code. • 9. NEp R/�Q cam, '
44014-70,SI*1;'.Q the building in full accordance with A U. ' the plans and specifications is
neither intended nor implied.
•
cal,Signature,and Date) (Seal,signature.and Date)
SPECIAL INSPECTOR QUALIFICATIONS APPROVAL BY BUILDING OFFICIAL/PLANS EXAMINER(1704 21) ., ,. DATE:.11/07/2023
WORK WHICH REQUIRES SPECIAL INSPECTION QUALIFIED SPECIAL INSPECTOR INDIVIDUAL OR FIRM
❑ CONCRETE CONSTRUCTION/REINFORCING STEEL/POST-TENSION(1705.3)
® MASONRY CONSTRUCTION(1705.4) ' Speedie&Associates
, ❑ WOOD CONSTRUCTION(1705.5) - __. -.
0 STEEL CONSTRUCTION(1705.2&AISC 360)
❑ SOILS(1705.6)
• FOUNDATIONS(1705.7,1705.8&1705 9)
❑ SPECIAL CASES:POST INSTALLED(EPDXY/EXPANSION)ANCHORS(1705.1.1) '..Speedie &Associates
❑ SEISMIC RESISTANCE(1705.12)
❑ SPRAYED FIRE-RESISTANT MATERIALS(1705.14)
❑ EXTERIOR INSULATION AND FINISH SYSTEMS(EIFS)(1705.16)
❑ STORAGE RACKS(1705.12 7)
• OTHER:
FORM EFFECTIVE 04/26/2019 POST AT JOB SITE WITH PERMIT
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