HomeMy WebLinkAbout17943 Pig& CITY OF GLENDALE,ARIZONA
BUILDING SAFETY DEPARTMENT-COMMUNITY DEVELOPMENT GROUP
III
• GLEN E SPECIAL INSPECTION CERTIFICATE
Project Name j 1 Date
Age-etvizAc ds Ce-e")?A- 5 g/go 5
Project Address Permit Number DSCNumber
63 'w ,• UMiChly 111 L.L-5. -, 17 9'q3 e y:= z9L
LiCERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued.)
In accordance with Section 306 of the Uniform Administrative Code of the City of Glendale,,•_edition,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 ins ection.
•
Name ofArchitect Contractor/. ��y�"�f�7, a
(. r , ►/ ' 5 17g.vm s J.
Name of Structural Engineer , 'Signature o net or Legal AO
SPECIAL INSPECTION RESPONSIBILITY CER'1'iFICATE ,
(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
Section 306 of the Uniform Administrative Code of the City of Glendale, edition,I hereby assume full
responsibility for carrying out the required special inspection.Inspection reports will be filed with the Building
Safety Department,as required by Section 306(c),The following individual(s)will be special field inspector(s)
under my direct supervision and are to be on the job site to render full,complete and competent inspection.
s;essi0Rj�
... . .... , Fe0 9i The special field inspector(s)are to be named below before work under their area of duty commences. •
`c am c- ` �jF�?.•.,,\ Architect or Engineer Responsible for Special Inspection (Type or Prim)
,0 258.71 . t
fit!;r TIMcCAUSLAND JAMES I. ,I.- ��o 1�/(�Esc v�„u.uc�
, ,I...','
'r Name of Inspector(Structural Masonry) Name of Inspector(Stee)
tas �( p �l
• 4 s? Name of Inspector(Concrete) Name oflncpector(Welding)
Name of Inspector(Sped type) Name of Inspector(Specify Type)
Place Registration Sealant]
Signature Date • . . - -
-SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306(B)] ARE APPROVED.
-Buildin'-Offi.ia Dare _
CERT1HCATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANCY -
(To be filled 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
issuance of the certificate of occupancy per Section 308 of the Uniform Administrative Code of the
City of Glendale,—edition.
I certify that,to the best of my knowledge,the requirements of the approved plans for which special inspection
is required and Section 306 of the Uniform Administrative Code have been complied with.A guarantee that
the contractor has necessarily fulfilled the obligations of his contract is neigher intended nor implied.
. Architect or Engineer Responsible far Special Inspection(Type or Print)
Place Registration Seal and
Signature Date
:---i!' RETURN TO BUILDING SAFETY DEPT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
[l -BUILDING SAFETY DEPARTMENT
CI-BUILDING INSPECTOR
CI•ARCHITECT OR ENGINEER
(]-JOB COPY(TO BE RETURNED TOM BUTLLDING OFFICIAL WHEN YOUR INSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTED.)
111.07/95 .