APPLICATION FOR BUILDING DEPARTMENTS/CODE ENFORCEMENT AGENCIES ACCREDITATION For IAS Internal Use Listing No.

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1 APPLICATION FOR BUILDING DEPARTMENTS/CODE ENFORCEMENT AGENCIES ACCREDITATION For IAS Internal Use Listing No. New accreditation Accreditation Criteria: Number of Employees AC251 (United States) Renewal Department Name Change AC475 (Canada) 101 and Above 1. NAME OF BUILDING DEPARTMENT 2. NAME OF THE JURISDICTION (Exactly as it should appear on IAS listing) 3. NAME OF COUNTY 4. DESIRED SCOPE OF ACCREDITATION Complete table on page 3 5 SIX-DIGIT NATIONAL FLOOD INSURANCE PROGRAM (NFIP) NUMBER (if applicable) 6. YEAR JURISDICTION WAS ESTABLISHED YEAR BUILDING DEPARTMENT WAS ESTABLISHED 7. JURISDICTION SIZE (in square miles) 8. JURISDICTIONS SERVED BY BUILDING DEPARTMENT (List name, county, NFIP number and population. Use additional sheet if necessary) 9. CHIEF ADMINISTRATIVE OFFICER AND TITLE (such as: Mayor, City Manager) 10. CONTACT ADDRESS Address (exactly as it should appear on listing) Name City State/Province Zip/Postal Code Country (if other than U.S.A.) 11. PHYSICAL ADDRESS OF BUILDING DEPARTMENT Address City State/Province Zip/Postal Code Country (if other than U.S.A.) 12. MAILING ADDRESS Address City State/Province Zip/Postal Code Country (if other than U.S.A.) 13. TELEPHONE NO. FAX NO ADDRESS WEB ADDRESS 15. Name and title of applicant s representative (Building Official) Address (if different from address noted above) Name Phone number Fax number Mobile number 16. Within the past five years have any of your accreditations been revoked, withdrawn, placed on suspension, and/or removed from listing? If yes please explain on a separate page. No Yes 17. If this is a renewal, please answer the three questions below. If you answer yes to any of the questions, please explain on a separate sheet and/or include appropriate supporting documentation. a. Since the last time your jurisdiction applied for IAS accreditation, have there been any changes in key management, technical, or inspection personnel? No Yes b. Since the last time your jurisdiction applied for IAS accreditation, have there been any changes in the department operations? No Yes c. Are you aware of any unresolved complaints about the services covered by this application? No Yes Authorized Signature for Applicant Page 1 of 5 Date

2 By signing, the applicant agrees that all the information presented on page 1 of the application is true and correct, and to abide by the CONDITIONS FOR APPLICATION listed below. CONDITIONS FOR APPLICATION a. As a condition of the accreditation, the applicant acknowledges that the International Accreditation Service, Inc. (IAS), staff or authorized representative(s) may conduct assessments of the facilities of the applicant, or other facilities where the applicant jurisdiction provides services under this application, to verify compliance with the listing and applicable rules of procedure. b. Within 30 days of mailing of written demand by IAS, applicant shall reimburse IAS for all expenses related to accreditation. Reimbursable expenses include, but are not limited to, travel expenses and staff time. c. Accreditation by IAS does not imply any guarantee or warranty, express or implied and including but not limited to any warranty of merchantability or fitness for any particular purpose, of any services provided by the applicant, or any guarantee or warranty of any nature by IAS concerning any services provided by the applicant. Applicant agrees that it shall have no cause of action or claim against IAS, International Code Council (ICC), or any of their affiliates, parent, or brother or sister corporations or their Successors-in-Interest or assigns, or the officers, directors, members and employees thereof (collectively, the Indemnitees ), arising in any manner from any denial of this application or from any accreditation given pursuant to this application, whether or not such accreditation is or is not subject to any conditions. Applicant agrees to hold the Indemnitees harmless, and to protect, defend and indemnify them, with respect to any claim, liability, demand, action, judgment, proceeding, costs, damages and expenses (including attorneys' fees) whether for personal injury, wrongful death, property damage, or any type of injury or damage whatsoever, arising from: (i) the application and accreditation; (ii) any services of any nature provided by the applicant; (iii) the use of any service of any nature offered by the applicant, whether related to the matters set forth in the first sentence of this paragraph or otherwise; or (iv) the reference to or reliance upon, actual or asserted, any approval given by the applicant or any services rendered by the applicant. California law shall apply to the interpretation hereof. If any part or portion of this paragraph, or any application thereof to particular facts, should be determined invalid, the provisions hereof shall be severable so as to achieve for the Indemnitees the maximum legal application. If this application relates to a renewal of an existing accreditation, the provisions of this paragraph shall apply from the date of the first granting of accreditation, whether upon application or without application by applicant or a predecessor and regardless of: (i) intervening modifications of said accreditation or modifications pursuant to any application for renewal; (ii) any prior change in the number assigned to the accreditation; (iii) any prior change in ownership rights in or rights to said accreditation since the granting of said first accreditation listing. d. In consideration of the processing of this application, the applicant agrees to abide and be bound by any conditions attached to any listing or renewal thereof issued pursuant to this application, or any later amendment of said listing or renewal, the Rules of Procedure for Building Department Accreditation, which by this reference are made a part hereof, the applicable Accreditation Criteria for Building Departments, which by this reference is made a part hereof, and any additions, deletions, or changes to such Rules or Accreditation Criteria hereafter adopted. In agreeing to abide and be bound by the applicable Rules of Procedure and the Accreditation Criteria for Building Departments applicant understands that the failure to do so may result in the revocation, suspension or modification of accreditation issued pursuant thereto in accordance with the terms of the Rules of Procedure. Authorized Signature for Applicant Name of Signer (type or print) Date Page 2 of 5

3 CODES ENFORCED The information below will be used when reviewing your submitted documentation, conducting on-site evaluations, and granting accreditation. For examples of how to complete this table, please review the scopes of currently-accredited building departments posted on the IAS website at: Please list the fields of code enforcement the department is responsible for under Fields of Code Enforcement. For each of these fields, please identify if the department conducts plan review, permitting, and/or inspection under Type and Range of Accredited Services. Identify which version of which code the department currently enforces. Please list any applicable state laws, local ordinances, or reference standards under Referenced Codes. FIELDS OF CODE ENFORCEMENT [e.g., Structural and Life Safety, Plumbing, Mechanical, Electrical] TYPE AND RANGE OF ACCREDITED SERVICES [Plan Review, Permitting and Inspection] REFERENCED CODES [e.g International Building Code] Page 3 of 5

4 JURISDICTIONAL PROFILE Please answer the following questions and have evidentiary documentation (where requested) available for examination by the team during the on-site evaluation. Historical and Political Information 1. Local charter meets all constitutional requirements of the state and federal government. Charter describes power of elected officials, processes for enacting zoning laws and raising funds (taxation). A copy of the charter is available for inspection by IAS during the on-site evaluation. 2. Enabling legislation provides authority to adopt and enforce construction codes. A copy of our enabling legislation is available for inspection by IAS during the on-site evaluation. 3. Please list the name and title of each individual that indicates the line of authority within the jurisdiction, beginning with the name of applicant department/division leader and indicate to whom he or she reports, and ending with the highest authority within the jurisdiction. 4. A map showing the boundaries of the jurisdictional area is available for viewing by IAS during the on-site evaluation. Environmental and Topographical Information 1. Please describe, in a short summary, the main geographical and topographical features of the jurisdiction served by the applicant. 2. High wind speeds are a special concern for construction within the jurisdiction. YES NO Provide wind zone 3. Flooding is of particular concern for areas within the jurisdiction*. YES NO (*Please have a flood hazard areas map available for review by IAS during the on-site visit) Page 4 of 5

5 4. Seismic activity is a risk within the jurisdiction. YES NO Provide seismic zone 5. Other risks to environmental health and/or safety are present within the jurisdiction as described below: Economic and Demographic Information 1. At present, data indicates that this jurisdiction s population, in the next few years, is expected to Grow Decline Remain steady 2. If the residential population is expected to grow, is the applicant division/department actively creating future needs projections in line with the predictions of the jurisdiction? 3. Please provide current median housing cost within the jurisdiction: $ 4. Please provide current property tax rate(s) within the jurisdiction: $ 5. Please list major contributors to and major employers within the local economy (e.g., tourism, manufacturing, education, etc.). Signature Name/ (type or print) Date Page 5 of 5