5
ROY CLARK
Fax (813) 974-2465
Email: BCA-FPC@usf.edu
WEBSITE: usf.edu/fpc
EDITION: NOVEMBER 5, 2015
FACILITIES MANAGEMENT
BUILDING CODE ADMINISTRATION PROGRAM
4202 E. FOWLER AVENUE, FPC110
TAMPA, FLORIDA 33620-7550
BUILDING CODE ADMINISTRATOR (813) 974-0893
TN-000000
BCA TRACKING NUMBER
INSPECTION REQUEST & REPORT FORM
THE INSPECTION REQUEST/REPORT FORM MUST SUBMITTED BY 3:00 PM IN ORDER FOR THE INSPECTION TO OCCUR WITHIN THE NEXT FIVE BUSINESS DAYS.
PROJECT:
PERMIT NO:
INSPECTION LOCATION:
REQUEST DATE/TIME:
OTHER INSPECTION TYPE:
SFM FILE NO:*
IRR NO:**
REQUESTOR NAME:
PHONE NO:
NOTE: *INCLUDE SFM FILE NUMBER WHEN ISSUED AND THEREAFTER ON ALL CONSTRUCTION PHASE COMMUNICATIONS.
NOTE: **CM/GC TO ASSIGN NON-REPEATING SEQUENTIAL ID/NUMBER FOR EACH INSPECTION REQUEST FOR TRACKING PURPOSES.
INSPECTION TYPE AND DATE (BY REQUESTOR)
BUILDING/STRUCTURE
FOOTING
SLAB
MASONRY
WALL/CEILING
FRAMING
STRUCTURAL
SHEETROCK
ROOFING
RE-INSPECTION
FINAL BUILDING
DATE
ELECTRICAL
UNDERGROUND
FLOOR ROUGH-IN
WALL ROUGH-IN
CEILING ROUGH-IN
PANEL/FEEDER
SERVICE/GROUND
APPLIANCE/EQUIPMENT
LIGHTNING PROTECTION
RE-INSPECTION
FINAL ELECTRICAL
1200000
 SFM SITE INSPECTION REQUEST
DATE
PLUMBING
UNDERGROUND
ROUGH-IN
STACK PIPING & TEST
WATER PIPING & TEST
GAS PIPING & TEST
STORM PIPING & TEST
FIXTURES
EQUIPMENT
RE-INSPECTION
FINAL PLUMBING
DATE
MECHANICAL
DUCT ROUGH-IN
STEAM PIPING & TEST
HW PIPING & TEST
CHW PIPING & TEST
COND. PIPING & TEST
INSULATION
WALL & CEILING
EQUIPMENT
RE-INSPECTION
FINAL MECHANICAL
DATE
INSPECTION RESULTS (BY INSPECTOR)
PASSED
1
DATE
2
DATE
3
DATE
CONDITIONAL*
PARTIAL
FAILED
NOT READY
SIGNATURE
SIGNATURE
 FAILED OR NOT READY ON THIRD TRY REQUIRE A NEW
INSPECTION REQUEST AND RE-INSPECTION FEE MAY APPLY.
SIGNATURE
1
2
3
4
5
6
7
QA
DATE
CODE
CONDITIONS/COMMENTS (BY INSPECTOR)














COMMENT*
 *SEE ADDITIONAL CONDITIONAL COMMENTS ON REVERSE SIDE OF THIS FORM.
FILE:
BCA-Form 05 Inspection Request-BCA.docx
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