SPECIAL INSPECTION SITE Check-in/Check-out REPORT

Notice: Use of this specific form is mandatory, and information contained on this page will be kept as part of the inspection report record.

Applicant Address 24 west 12th road Report Date:11/02/2017

Applicant ID # 003894 Construction Company: CAC-BHL

Construction Management Firm: Tishman Representative on Site:None

CM Rep on Site and Contact Phone: Contact Number:

Describe if access was provided and Name of the person providing the access and his/her relation to the site:

Inspection Date: (mm/dd/yy):__11/02/2017 _______________

Start/Arrived on Site: 12:00pm am/pm
Inspection Type:
Left Site (Temporary): _____________am/pm
Other (specify) __Masonry/grout______ Name(s) of
Returned to Site (Temporary): __________am/pm individual(s) performing inspection
Omar Elshahat
Final Departure from Site: 3:00 pm am/pm

Weather Details/Photo: Clear, 64 degrees 1:00 pm.

BILLABLE CANCELLATION

Description of current phase: No work here today

Inspection Agency: _________MTL_________________________ Construction Company Name: _ CAC-BHL ____

SIA Inspector Name: _______Omar Elshahat ____ Representative Name: _________ _________________
(Print) (Print)

Signature: ____Omar Elshahat_________________________ Signature: ______________________________________________

This form must be fully executed to be valid, if construction company representative is not present please ensure that IBTS is notified, as
well as if access was denied and by whom
SITE PHOTO CATALOGUE: