Form Wmo 9-8-15 - Request For Final Inspection (Rfi) Page 2
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2CERTIFICATE BY GENERAL CONTRACTOR:
NAME /COMPANY: __________________________________ TELEPHONE NO. _________________________________________
ADDRESS: __________________________________________ CITY / ZIP: ______________________________________________
I hereby certify that the above project has been constructed of approved materials and that the project has been completed in conformance
with the intent of the plans and specifications and is hereby warranted to be free from defects. I further certify that I have read the WMO
permit covering the project and that I have not violated any of the terms and conditions.
BY: _________________________________________________________________________ DATE: _________________________
(Print name and title of authorized official)
BY: ______________________________________________________ TELEPHONE NO. ____________________________________
(Signature of authorized official)
***************************
CERTIFICATE BY OWNER (CO-PERMITTEE):
NAME /COMPANY: __________________________________ TELEPHONE NO. _________________________________________
ADDRESS: __________________________________________ CITY / ZIP: ______________________________________________
As to the WMO permit portion of the project only, I hereby certify that the project work has been completed to my satisfaction and is
acceptable to me. I assume full responsibility for any defects or malfunctions in the completed project. I further certify that I have not
violated any of the terms and conditions of the WMO permit.
BY: _________________________________________________________________________ DATE: _________________________
(Print name and title of authorized official)
□
□
BY: _________________________________________________
Schedule R Recordation Required?
Yes
No
I
(Signature of authorized official)
f Yes: Per WMO §1003, if recordation documents are not submitted, the
District will record the documents and the $500 recordation
deposit will be forfeit by the Co-Permittee.
Please submit
recorded documents within 90 days of the above date.
***************************
PARTIAL TEST: If only a portion of the system covered by the permit is to be tested and approved, describe below:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
***************************
□
□
APPROVAL BY:
METROPOLITAN WATER RECLAMATION DISTRICT
AUTHORIZED MUNICIPALITY
The work covered by this permit has been tested and inspected and is hereby approved. The Permittee may grant
occupancy at its option. This approval does not constitute a release from other obligations under the permit.
P.E.
SEAL
INSPECTOR
ENGINEER
_________________________________________
___________________________________________________
(Print name and title)
(Print name and title)
_________________________________________
____________________________________________________
(Signature)
(Date)
(Signature)
(Date)
WMO 9-8-15
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