HomeMy WebLinkAboutB4-996 SUMMER CAMP INSP.PDFDCD-0304 Identification h
Rev, 9/02 County
Date of Inspection
BUILDING +DTI FORM
NAME OF OPERATION
ADDRESS TELEPHONE:
CITY STATE ZIP
BUILDING INSPECTORS CERTIFICATE
1, The areas in the building that are designated as the licensed space are required by the licensing agency
to meet the Building Code in effect when an application for licensure is submitted to the regulating agency,
Does the building Iis above, to the extent observable, meet the current North
CarolinaBuilding Code? Yes No
2. If no, list question numbers which do not comply, explain the violation and whether equivalent protection
for the safety of the children is provided:
I)
2)
4}
Are any of the above violations of a life safety concern? Yes No
If yes, please list question numbers
4. In your opinion based on the violations listed above, do you recommend that the
Division of Child Development issue a provisional license to allow time for
correction of the violations? Yes No
If yes, how long (3 - 90 days) and for which violations?
(Note: Ali violations t be corrected before a license can be issued unless a provisional time period is
recommended or equivalent protection is documented.)
. Number of rooms approved for occupancy by children?
(Attach sketch of building with rooms identified)
. Specify any local zoni restriction:
4
Signature of Inspector ' !Date
- L
Jurisdiction !Phone:
e Inspectors Certificate and wilding Inspection Form are required to be completed in its entirety before the Division of Child
Development can consider the document complete, All questions must beanswered; any NO answers must have a written
explanation.
This form was developed through the cooperation of the Division of Child Development and the Engineering Division of the Departinent of
Insurance. Please note that the inspection forms do not cover all areas f the Code, but are intended to be used as a guide for thc'local inspector.
If additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on, the back of this
_form
Prepare in triplicate: Original to Division of Child Development, I copy retained by inspector, 1 copy ret I ained by o ., rator.