Inspector Availability

	Monday	Tuesday	Wednesday	Thursday	Friday
Plumbing / Mechanical	Terry Thatcher (Afternoon Only)	Gary Heckman	Terry Thatcher (Afternoon Only)	Gary Heckman	Terry Thatcher (Afternoon Only)
Electrical	Artie Wilcox	Artie Wilcox	Artie Wilcox	Artie Wilcox	Artie Wilcox
Building	Garrett Reitenour	Garrett Reitenour	Garrett Reitenour	Garrett Reitenour	Garrett Reitenour

Inspection Request Form

Requester Information:
Requested By: Name / Company*
Requester Email*
Requester Phone*

Permit Information:
Permit Number*
Jobsite Street Address*
City/Township/Village*

Health & Safety:
Has anyone at the property indicated above been sick or in contact with someone sick in the last two weeks?* YesNo

Inspection Information:
Date Ready for Inspection*
Permit Type*

Building Inspection: Select Inspection Type:

Electrical Inspection: Select Inspection Type:

Mechanical Inspection: Select Inspection Type:

Plumbing Inspection: Select Inspection Type:

Other Inspection Type: Describe

Notes: Include any access instructions.

Site Contact Information:
Information is Same as Requester Information?* YesNo

Site Contact Name*
Site Contact Phone*

Affidavit:

I hereby certify that I am authorized to make this request on behalf of the permit applicant. I certify that all information is true and complete to the best of my knowledge. I understand that this form is used only to request an inspection, and does not mean that an inspection has actually been scheduled. I understand that if I do not receive a confirmation it is my responsibility to follow up and confirm that an inspection has been scheduled.

I have read, understood, and agree with the above statement.