Application to Inspect Existing Structure

APPLICATION FOR INSPECTION OF EXISTING STRUCTURE
Name of Establishment
I, First Name* Last Name* am applying for an inspection of a building/structure for in accordance with the following information and as shown on the accompanying drawings.
1. Legal Description (street address or similar description that will readily identify,
and definitively locate the proposed building or work.)
Parcel No.:
Block No.:
Lot No.:
Address

Building No. and Street Name

Street Address Line 2

City / Town / VillageDistrict

Postal / Zip Code
2. Legal owner of property:

First NameLast Name
3. Name of Building Owner:

First NameLast Name
4. Number of EXISTING building(s) on lot:
i. Number of buildings on lot to be inspected:
ii. Number of independent UNITS within each building to be inspected:
iii. Estimated number of occupants (per building):
a) Guest
b) Staff
c) Total Occupant Loading
5. Building Description:

i. Dimensions of building(s):
Length:
Width:
ii. Number of floors:
iii. Approx. height of building(s):
6. Building Category

Other
7. Date of Construction (if available):

MonthDayYear
Date
8. Building construction type (Construction Materials): if information is available
i. Foundation
ii. Structural framework

Other
iii. Exterior walls & openings

Other
iv. Floors

Other
v. Stairways

Other
vi. Roofs

Other
9. The sewage is disposed by

Waste Water Treatment (Specify Type)
10. Method of waste water discharge

Waste Water Treatment (Specify Type)
11. Electricity supply is provided by
12. Back-up electricity supply will be provided by
13. The building has been fitted with the following type and quantity of air conditioning fixtures.
i. Central air conditioning (insert quantity):
ii. Split units (insert quantity):
iii. Window units (insert quantity):
I, First Name* Last Name* accept responsibility with consent of the owner for applying to the Director of Building Control Unit of the CBA for the following inspections: BTB Clearance EPZ Clearance* GAMING Clearance
Name of permittee or his authorized agent

First NameLast Name
Address of permittee or his authorized agent

No. of Building and Street Name

Street Address Line 2

City / Town / VillageDistrict

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Signature of permittee or his authorized agent
OR Upload a Digital Signature

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Date Submitted

DayMonthYear
Date
Upload Documents

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Proof of Payment

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Should be Empty:

APPLICATION FOR INSPECTION OF EXISTING STRUCTURE