HomeMy WebLinkAbout027320 CITY OF GLENDALE, ARIZONA
--, BUILDING SAFETY DEPARTMENT- COMMUNITY DEVELOPMENT GROUP
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SPECIAL INSPECTION CERTIFICATE
Projectje Name f7 G' -- Date /
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Project Address , 4; f, Permit No. DSC No
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CER III-ICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit isissued.) ''"'' ::::»:,,......
In accordance with Section 306 of the Uniform Administrative Code of tie 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 inspection
Name of Architect Ctxnractor
Name of Structural F�giaeet .;: Stg att re of Dicier or t egal Agent
1 [,.4,42.rSa /ud:=c'� coT ,-..2icf \\ �_' ' w vy.�—
',,e SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
(To befilled m and sealed`before building permit is•.ssued) ,•
I certify chill ant familiar with the structural design of the above Warned projecand,in accordance with Section
306 of the.Uniforrn Administ•rative Code of the City'of Glendale,_edition,Ihereby assume full responsi-
bl3ity for carrying out Erie required special inspection. Inspection reports will.be filed with the Building Safety
Department,'as required by Section 306(c).:The fofowingindividual(s)will:be special field inspectors)under
,.my direct supervision and are to be on the job site to render full,complete and competent inspection.
f°r31"'.:A The special field inspector(s)•are to be named below before work under their area of duty commences.
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j�t`% 1� t �i �;rdttitce or Engineer Responsible.rot Special Inspection(Type or Print)
t - .o D. h f =tiaras of£ts;i star(Strik;i:*l),1, �r} Name oC Irsgecioe f{Sreeti:
IuRLE-1' +
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'0 Y / 1 Nameaf for Cnrxrete `�tame:a£ ai>F _
e S.igne
Plac Name•of ins (S 'rameof or if T
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Signs te.
P� �x n'P�): tSP�`Y Ype)
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SPECIAL INSPECTOR QUALIFICATIONS[UAC SEC306(B)] ARE APPROVE /a Z /g?
CERTIFICATE OF COMPLIANCE AND APPLICATION.FOR CERTIFICATE OF OCCUPANCY
(To be edinin and sealed before certificate of occupancy is issued.)
;��1Pi1f ICA ,f ,_ The construction of the above-named project is substantially compkte and request is hereby made for issuance
V k'�a .f the certificate of occupancy per Section 308 of the Uniform Administrative Code of the City of Glendale,
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TUR.LEY
de ei 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 4*, S/,no
0�.• eq p guarantee that the
contractor has necessarily fulfilled the obligations of his contract is neither intended nor implied.
QNA. U.S.A.
Architect gineer Responsible for Special Inspection(Type or Print)
Place Si Registration Date.
Seal and V.
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Signutae IC14 4/417 !:tY E-1/
RETURN TO BL•ILDL'G SAFTY DEFT.FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWL`
0-BUTL.DNG SAFETY DEPARTMENT
0-BUILDNG NSPECTOR
0.ARCHITECT OR ENGNEER
0.JOB COPY(TO BE RETURNED TO THE BUILDING OFFICIAL WHEN YOUR NSPECTION IS COMPLETE AND BEFORE A CERTIFICATE OF OCCUPANCY IS REQUESTED.)