Special Inspections Page 1 of 1 Revision Date: 1-Dec-15
Certificate of Special Inspection
For:
(Type of Inspection)
Project Name: Date:
Address: Plan Check No.:
OWNER’S NOTIFICATION OF SPECIAL INSPECTION
To be completed and signed by Owner before a building permit is issued.
In accordance with Sections 1704 & 1705 of the International Building Code, which requires that certain construction work be
placed under the inspection of a registered design professional. I, as owner/legal agent, do hereby certify that I have retained
to be responsible for the special inspection.
(registered design professional/firm)– please print
Owner’s Name: ___________________ Owner’s Signature: Date:
CERTIFICATE OF RESPONSIBILITY
To be filled in and signed by the professional in charge of
special inspections before a building permit is issued.
CERTIFICATE OF COMPLIANCE
To be signed by the professional in charge of special
inspections before a certificate of occupancy is issued
As registered design
professional in charge of
special inspections of the
above named project, I
certify that I am familiar with
the design of the project and
hereby assume full
responsibility for carrying out
the required special
inspections in accordance
with Sections 1704 & 1705 of
the International Building
Code.
Seal, Signature & Date
I certify that, to the best of my
knowledge, the requirements of
the Building Code and the
approved plans and specifications
have been complied with, insofar
as the portion of the work requiring
special inspection under Section
1704 and 1705 is concerned,
except for those deviations
previously reported. A guarantee
that the contractor necessarily
constructed the building in full
accordance with the plans and
specifications is neither intended
nor implied.
Seal, Signature & Date
LIST OF INSPECTIONS
Structural steel construction (1705.2.1 & AISC 360)
Steel construction other than structural steel (1705.2.2)
Concrete construction (1705.3)
Masonry construction (1705.4)
Wood construction (1705.5)
Special cases (1705.1.1)
Processed by:
Plans Reviewer
Soils (1705.6)
Foundations (1705.7 to 1705.9)
Spray applied fire-proofing materials (1705.13)
Mastic and Intumescent fire-resistant coating
(1705.14)
Exterior insulation and finish system (EIFS)
(1705.15)
Other:
Original - to be retained by the professional in charge of special inspection until the Certificate of Compliance is signed; then returned to the Building Inspections
Supervisor.
Copy - to be scanned and saved to CDS plan folder by the plans reviewer after the Certificates of Special Inspection and Responsibility are signed.
Planning and Development Services Department
7447 E Indian School Road, Suite 125, Scottsdale, AZ 85251 Phone: 480-312-7080 Fax: 480-312-7781
click to sign
signature
click to edit
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