Please enter following information.

Permit #     Permit Number *    
Project Description:    Project Description    
Permit Address:    Street Address *
Contractor Name:    Name             
Contractor Address:    Street Address        City     State      Zip Code    
      
Phone Number:    Phone Number *             
Email:    Email *    

Self Inspection Waiver of Liability

I am responsible for my own safety during the Self Inspection.

I allow the complete use of the photos of the Self Inspection by the Village.

I am responsible for compliance with all codes and standards applicable to the project.

I acknowledge that participation in the Self Inspection is voluntary.

I acknowledge that the decision to perform a Self Inspection is at the sole discretion of the Village.

Required inspection records, including, but not limited to, correction notices, electronic media, recordings or photo documentation, shall be maintained in accordance with the Village’s policy, laws, regulations, and applicable codes, and may be subject to disclosure.

By checking this box confirms my consent to the Waiver *