CITY OF GLENDALE, ARIZONA
BUILDING SAFETY DEPARTMENT - COMMUNITY DEVELOPMENT GROUP
SPECIAL ELECTRICAL INSPECTION CERTIFICATE
Project Name Date
Project Address Permit Number DSC Number
CERTIFICATE OF SPECIAL INSPECTION BY OWNER
(To be filled in and signed by owner before permit is issued)
In accordance with the City of Glendale amendments to Section 306 of the Uniform Administrative Code of the City of Glendale 1997 edition, which requires that the
execution of certain electrical construction work be placed under the inspection of the engineer, or special inspector employed by me, I certify that the electrical portion of
construction of the above-described building project will receive special inspection.
Name of Architect of record Contractor
Name of Electrical Engineer Signature of Owner or Legal Agent
SPECIAL INSPECTION RESPONSIBILITY CERTIFICATE
(To be filled in and sealed before building permit is issued.)
I certify that I am familiar with the electrical design of the above-named project and, in accordance with the City of Glendale
amendments to Section 306 of the Uniform Administrative Code of the City of Glendale 1997 edition, I hereby assume full
responsibility for carrying out the required special inspections. Inspection reports will be filed with the Building
Safety Department, as required by Section 306.3. The following individual(s) will be special field inspectors
under my direct supervision and are to be on the job site to render full, complete and competent inspection.
The special field inspector(s) are to be named below before work under their area of duty commences.
Engineer Responsible for Special Inspection (type or print)
Name of Inspector (Ground Fault Protection) Name of Inspector (Other, Specify)
Name of Inspector (Equipment 1000 amps or more)
Name of Inspector (Emergency and Stand-by Systems)
SPECIAL INSPECTOR QUALIFICATIONS [UAC SEC 306.2] ARE APPROVED.
Building Official Date
CERTIFICATE OF COMPLIANCE
(To be filled in and sealed before certificate of occupancy is issued.)
The construction of the above named project is substantially complete.
I certify that, to the best of my knowledge, the requirements of the approved plans for which special inspection
is required and Section 306 of the Uniform Administrative Code have been complied with. A guarantee that
the contractor has necessarily fulfilled the obligations of his contract is neither intended or implied.
Engineer Responsible for Special Inspection (Type or Print)
RETURN TO THE BUILDING SAFETY DEPT. FOR APPROVAL AND DISTRIBUTION TO THE FOLLOWING:
BUILDING SAFETY DEPT. BUILDING INSPECTOR ARCHITECT OR ENGINEER JOB COPY