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�:•'` CITY OF GLEN®ALE, ARIZ®hlA
BUILDING SAFETY DEPARTMENT —COMMUNITY DEVELOPMENT GROUP
SPECIAL INSPECTION/VERIFICATION CERTIFICATE
ARCHITE iI. ENERGY C®®� ®t i�LIA6�CE
Project Name r � Date .
Project Address I Proj ct Nuniber
o Q, 67 .18 / I
CERTIFICATE OF SPECIAL INSPECTION/VERIFICATION BY OWNER
(To be filled in and signed by owner before pennit is issued)
in accordance with the 2012 City of Glendale Policy, I certif e that -the construction of: the above described building project will receive
Special Inspection or Third PaKU Verification for compliance with the City of Glendale's currently adopted Energy Code.
The Architect may also certify this project for Energy Code compliance.
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SPECIAL INSPECTION/VERIFICATION RESPONSIBILITY CERTIFICATE
(To be filled in before permit is issuedl
I certify that I am familiar with the energy code compliance requirements of the above named project and energy conservation. I hereby
I assume full responsibility for carrying out the required special inspections/verifications.
Archiitect, Spe al insrector, Contractor or Third Party Reso®risible for Verification
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(type or print) - ' ,
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AmhiteLt, Sneclal Inspector, Contractor or Third Party ResRansible for Verification
-
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Signature
Architect Seal, sign, date
if aoble
J"� CERTIFICATE OF COMPLIANCE AND APPLICATION FOR CERTIFICATE OF OCCUPANY -
-(To completed before certificatre of a ccripanca is issuedl- -- -
The construction of the above named project is complete and meets or exceeds the
requirements of the City of Glendale°s currently adopted Energy Code. Request is hereby
made for issuance of the cerilficate of occupancy.
I certify that, to the best of my knowledge, the requirements of the approved plans for
which Special inspection or Third Party Verification is required have been met.
Architect Seal, sign, date I eor print)
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If applicable
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Instructions3information 2bout th!5 form: A Sper_ial inspectm is r:et "Reg.wred" a £hird party, or architectlen ineer is allowed
The person signing in the area that states that E0!` f0,1TY^. tG the currently adopiec Enern Code does not have to bF. the same gc)ersort
that ve- ies those recuirernernts -
The City of Glendale. Arizona only needs this forma comoletcd and returnee; WE do not needs Gnx Lugkordw, do; urnentation ir, order to issue a L of 0