Fillable APPENDIX G (Brunswick County)

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APPENDIX G (Brunswick County)

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U.S.A. forms for Brunswick County

BROWSE BRUNSWICK COUNTY (NC) FORMS

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Project Information:
Responsible Licensed NC Architect or NC Engineer
APPLICABLE CODE:
2018 NCBC = 2018 NC Building Code; 2018 NCRC = 2018 NC Residential Code
Describe Element/Component/Type of Inspection: *
*(subgrade form/letter may also be required)
Attestation/Signature:
Licensed Architect or Engineer:
SEAL
Inspection Department disclaimer:
Firm Name:
Phone Numbers:
Office: Mobile:
Project Address:
Suite No:
Date Inspected:
Contractor Name:
Component Inspected:
DESIGN PROFESSIONAL INSPECTION FORM
RECORD OF THE INSPECTION OF A COMPONENT OR ELEMENT BY A NC LICENSED ARCHITECT OR ENGINEER
Name:
Residential Single-Family Project: Y N
Commercial Project: Y N
Code Enforcement Project No:
Permit No:
Project Name:
Owner:
APPENDIX G
By signing below, I certify that the component and/or element of the building as identified on this form has been inspected by me or
someone under my direct supervision per G.S. 160D-11-6 and is in compliance with the Code or other proposal of the architect or
engineer for the project. This inspection is in compliance with all of the requirements of the above referenced code. Attach any additional
documents if needed.
Upon the receipt of a signed written document as required by G.S. 160D-11-6, Code Enforcement shall be discharged and released from
any liabilities, duties and responsibilities imposed by this article or in common law from any claim arising out of or attributed to the
component or element in the construction of the building for which the signed written document was submitted. Be aware that this
inspection will be noted in all inspection records including the Certificate of Occupancy or Certificate of Compliance. This inpsection does
not address any local ordinances or zoning requirements. The delayed effective date of this Rule is January 1, 2021. The Statutory
authority for Rule-making is G.S. 143-136; 143-138.
Email Address:
Mailing Address:
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APPENDIX G (Brunswick County)

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Completed 1 April 2021

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