CITY OF PORTAGE
BUILDING DEPARTMENT
CITY HALL
6070 CENTRAL AVENUE
PORTAGE, INDIANA 46368
TELEPHONE 762-4204 / FAX 764-5749
ARCHITECT OR ENGINEER’S CERTIFICATE OF COMPLETION AND COMPLIANCE
Address of Construction Activity __________________________________________________
__________________________________________________
State Permit Number: ___________________
The undersigned architect or engineer hereby states under the penalties for perjury that:
1. I have made reasonable and periodic observation of the above mentioned construction project
to determine whether the work accomplished is in accordance with the plans and specifications for
this project as released by the Fire Prevention and Building Safety Commission and whether the
work accomplished is in compliance with building standards promulgated by the Fire Prevention
and Building Safety Commission and provisions of the regulations of the City of Portage, Indiana,
with the following exceptions hereafter noted:
___________________________________________________________________________
___________________________________________________________________________
2. I am familiar with such building standards of the City of Portage applicable to the work
accomplished, and
3. To the best of my knowledge, information and belief such work has been accomplished in
conformity with such building standards promulgated by the Fire Prevention and Building
Safety Commission and the City of Portage.
Date: ____________________ Signature: _________________________________
Place seal here:
Print Name: _______________________________
Architect ______________Engineer ____________
Indiana Registration Number: _________________
Address: __________________________________
__________________________________
Phone: ____________________________________
The City of Portage and Porter County requests that an Architect or Engineer’s Certificate of
Completion and Compliance be filed with the City of Portage Building Department by the
architect or engineer who observed the construction of the project, within (10) days after the
completion of construction activity for which review and monitoring by an architect or engineer is
required by the Fire Prevention and Building Safety Commission.
Detailed comments and explanations that cannot fit on the face of this sheet may be attached or
placed on the back of this form.
Revised 04-14
