HomeMy WebLinkAbout101200 CITY OF GLENDALE,ARIZONA
• BUILDING SA Ft t f QEPAR'RYE T-COf3RNlUNITY DEVELOPMI=NT GROUP
G JE E MV" SPECIAL INSPECTION CERTIFICATE
PI*ctName Date
TANNER TERRACE ARTS GAME ROOM 10121/20/6 )
[Permit Number Project Number
7135 N 45TH AVE I Io12oo 161641 F
(3 CERTIFICATE OF SPECIAL INSPECTION BY OWNER
LL-1 (To be-fatedin and signed by owner before permits issued) :
In accordance with the 2012 International Building Codes, which requires that the execution cf certain construction work be placed under the•
inspecion"ctthe architect,engineer,or special inspector ern^lryed by me,I certify that the construction of the eldiave-deci-ehr.d building project wIl
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receive special inspeciiuit. k
Nana of&Mira Contractor - j
NI yy) ..0.._.1S. )i)3 L
Name Of SbUdEligagiffeVf Sir aful a of Owner or Leggy '"T
.043.c.0 61- 8,thi FRIR4105
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SPECIAL INSPECTION RESPONSIBILITY CER7IFICATE
• (To be filled In and sealed'before building permit is issued)
• I certitr that I am farrrar with the structural design of the above-named project and,in accordance with the 2012 International Building Codes,I hereby .
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assume full responsibility for carrying out tee required special insQec'fio:n_ tnspectron roports will be filed with the Building Safety Department,as repulred
by the 2012 International Building Codes. The following indlvidual(s)will be special field inspector(s)under my direct superlrsion and are to be on the job
Ij site to render fun,complete and competent inspection.
Thespeciat field inspector(s)err It be named below before warkunder their area of duty commences.
i �� -.,�. .••-cnaect or EngineerRespinsinfe theSpeciat tnspeCJcn(type orurnf)
-�/. �` r:,br..m+g saw�fr t Pei 4, c.G•. Epcley +��t Ancndtors:r. .,..a.
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i SP" 17 .,`:f . QUALIFICATIONS[IBC 1703].'NRE APPROVED. Q, C:72 17
QCERTIFICATE OF COMPLIANCE AND APPLICiTTON FOR CERTIFICATE OF OCCUPANCY
(To be tamed in and sealed before certificate of occup<ray is issued)
The Cort3truction of the above-owned project is substantially com'ietr and request is hereby made for issuance of
the-certificate of occupancy per he 2012 International Building Codes.
1 I codify that to the best of my alowledge.the requirements of the approved ptens for winch speciat inspection is
required and the 2e12 Ntternaticnel Building Codes have been complied with. A Guarantee that the contractor has
necessarily futfiled the obligations of OS cOntratals.neiliter intended nor implied.
a
-weal.orEngirreer Responsil a for Special lnspeclion(type or print)
RETURN TO THE BUILDING SAPETY'OEPARTMENT FOR APPROVAL AND CISTRIBUTION TO THE FOELOWING'
Q BUILDING SAFETY DEPT. 0 BUILDING INSPECTOR 0 ARCHITECT OR ENGINEER 01 JOB COPY
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