Fillable Notification of Special Inspection By Owner (City of Chandler)

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Notification of Special Inspection By Owner (City of Chandler)

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BROWSE CITY OF CHANDLER (AZ) FORMS

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Mailing Address:
P.O. Box 4008, MS 406
Chandler, Arizona 85244
-4008
Development Services Department
Building Safety Division
215 E. Buffalo Street
Chandler, Arizona 85225
Telephone: (480) 782-
3000
Fax: (480) 782-
3009
www.chandleraz.gov
Form No: UDM-096
/Building
Rev: 12/20/19
Special Inspection Certificate
Project
Date
Address
Permit No.
Notification of Special Inspection By Owner
In compliance with the 2018 International Building Code as adopted, which requires the owner or agent to employ a
Special Inspector, I here
by designate the following Architect/Engineer to be in responsible charge of the special
inspection on the above project.
Designated Architect/Engineer
Owner/Agent Signature
Special Inspection Responsibility Certificate
I certify that I am familiar with the above-named project, and in accordance with the 2018 International Building Code as
adopted, hereby assume full responsibility for the special inspection of the following type(s) of construction:
Work Requiring Special Inspection
Insulating concrete fill
Sprayed-on fireproofing
Piling, drilled piers, caissons
Special grading excavation and filling
Smoke-control system
Shotcrete
Service entrance section over 1,000 amps-HI-POT-test
(UL-891)
Special cases
Date
Architect/Engineer Signature
Az. Registration No.
Registrant’s Seal
Complete to this point before applying for permit
Note to registrant: Please retain a copy for use as the Certificate of Compliance
Certificate of Compliance
I certify that, to the best of my knowledge, the special inspection requirements of the 2015 International Building Code
and the approved plans and specifications have been met.
Date
Architect/Engineer Signature
Az. Registration No.
Registrant’s Seal
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Notification of Special Inspection By Owner (City of Chandler)

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Completed 2 August 2020

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