HomeMy WebLinkAboutRW030956_form 00-01SPECIAL INSPECTION PROGRAM
And Desigwdon Of
_ SPECIAL {NSPECTOR
SPECtAlINSPE Ti Ns
(Only cheeped items an renatred)
Firm or individual to be responsible for all Special inspections:
Name- Pbone: ( ) County Registration:
If different Fhms or individuals are responsible for different items, List names, phortes and
rezistrations below,
Concrete
Batts installed in ConcreW
Concrete Frame
Steel and Prestreseiwe Seel Tendons
ligh--sftmEh Bolting
Structural Mawnry _
Reinforced Gypsum Co
Emulating Comm* Fill
and
SPECIAL INSPECTORS
1. OF
DECLARATION 13Y OWNER OR ARCHTfEM1ENGINEER RECORD /
I, the D Own= ❑ Eaginor ❑ ArcWtea ofrrcord, declare at the above listed Special lnspcctu{s) ;afire
hired by nw. II
Signature
Form No. 0"]
Date