Job Site Inspection Request

Job Site Inspection Request
Date of Request
Project Name
Project Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Project Team
Architectural Firm
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Engineering Firm
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
General Contractor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Jobsite Phone

Area Code Phone Number
Email
example@example.com
Masonry Team
List the various types of masonry materials (Brick/CMU/Stone) specified for this project
Brick Manufacturer/Distributor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
CMU Manufacturer/Distributor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Stone Manufacturer/Distributor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Architectural Precast Manufacturer/Distributor
Company
Contact
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Mortar Manufacturer/Distributor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Masonry Contractor
Company
Contact

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone

Area Code Phone Number
Email
example@example.com
Project Start Date

Month Day Year
Date
Present Stage of Construction
Applicable Model Building Code
Does masonry & mortar contain Integral Water Repellent?

Yes No
If yes, please provide the name of Integral Water Repellent used
Does mortar contain Integral Water Repellent?

Yes No
If yes, please provide the name of Integral Water Repellent used
Was a Post-Applied Sealer applied?

Yes No
If yes, please provide the name of the Post-Applied sealer used
Reason for Job Site Inspection Request (Please provide as many details as possible on the issue to be addressed)
Is there a sample wall of the masonry work on the job site?

Yes No
Additional information to be submitted:

1. A complete set of the project specifications.
2. A complete plan set for the project including details for flashing, weeps, vents, etc.
3. If available, pictures of areas in question.
Provide links to your submitted information
As a condition of requesting a job site inspection, you hereby agree to save harmless and indemnify the AMC Technical Committee, the Job Site Inspection Team and its members, as well as the Arizona Masonry Council and their respective members, from any and all claims, damages, attorney’s fees or other expenses resulting from the performance of the aforementioned inspection and evaluation.

Agreed by electronic signature:
Company
Contact

First Name Last Name
Title
Phone

Area Code Phone Number
Email
example@example.com
Enter the message as it's shown *
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Job Site Inspection Request

Project Team

Masonry Team