City of Philadelphia Department of Licenses & InspectionsBuilding Services Unit, MSB Concourse 1401 John F. Kennedy Blvd. Philadelphia, PA 19102

SPECIAL INSPECTIONS PROGRAM - FINAL COMPLIANCE FORM

OFFICE USE ONLY Date Received: Application Number:

In accordance with the provisions of Section 1704.0 of the 2009 International Building Code, this form is used to list the Final Compliance of Special Inspections as required for the construction located at:

ADDRESS (Print):

Owner's Name: Owner's Phone #:

Owner's Address:Street City State ZIP

Owner's E-Mail Address Owner's Fax #:

The Design Professional In Responsible Charge of Special Inspections (DPRC-SI) named below verifies that the following Special Inspections, also listed on the submitted Statement of Special Inspections for the subject

building, have been completed in accordance with the special inspection requirements of the IBC. [Multiple Sheets may be used to demonstrate compliance. Affix professional seal to all sheets.]

SPECIAL INSPECTION ITEM CONTINUOUS PERIODIC COMPLETED

Professional Engineer Registered Architect

Name: Phone #:

Address: Street

City State ZIP

E-Mail Address: Fax #:

DESIGN PROFESSIONAL IN RESPONSIBLE CHARGE OF SPECIAL INSPECTIONS (DPRC-SI)

Affix Seal

Special Inspections Program Final Compliance Form (Rev. March 2014)

Application #:

C:\Documents and Settings\Tim.Ponti\My Documents\Philadelphia Seal New.GIF

City of Philadelphia

Department of Licenses & Inspections

Building Services Unit, MSB Concourse

1401 John F. Kennedy Blvd. Philadelphia, PA 19102

SPECIAL INSPECTIONS PROGRAM - FINAL COMPLIANCE FORM

OFFICE USE ONLY

 

Date Received:

 

 

Application Number:

In accordance with the provisions of Section 1704.0 of the 2009 International Building Code, this form is used to list the Final Compliance of Special Inspections as required for the construction located at:

Street

City

State

ZIP

The Design Professional In Responsible Charge of Special Inspections (DPRC-SI) named below verifies that the following Special Inspections, also listed on the submitted Statement of Special Inspections for the subject building, have been completed in accordance with the special inspection requirements of the IBC. [Multiple Sheets may be used to demonstrate compliance. Affix professional seal to all sheets.]

SPECIAL INSPECTION ITEM

CONTINUOUS

PERIODIC

COMPLETED

Street

City

State

ZIP

DESIGN PROFESSIONAL IN RESPONSIBLE CHARGE OF SPECIAL INSPECTIONS (DPRC-SI)

Affix Seal

Special Inspections Program Final Compliance Form (Rev. March 2014)

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