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Report of Special Inspection
Project Name,& Address
Permit Number —
InspectionType(s) _—._-
Inspection Date(s)
Describe Inspection Made, including Locations:
List Tests Made:
Total Inspection Time Each Day:
[ ] Periodic [
Date
Hours
List Items Requiring Correction, include uncorrected items previously listed
Comments:
Continuous
To the best of my knowledge, the work inspected was in accordance with the Building Department approved
design drawings, specifications and applicable workmanship provisions of the U.B.C. except as noted above. All
inspections based on four hour minimum. Inspections exceeding four hours will be billed at eight hours. Any
inspections beginning before 12:00 noon and end after 12:00 noon will be billed as eight hours
Date
Print Full Name:
Registration No.
FORM SI.02,01