20080806160054.pdfCITY OF EDMONDS
SPECIAL INSPECTi<ON AND TESTING AGREEMENT
PER9 •� 177 DATE.
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PROJECT SITE ADDRESS; _ 1,9 2M IQ `4+I _ - _ T,
rRoncT NAm>i.. E. -D WOODWAV 1>wZ
SPECIAL WSPECTIONAGENCY {jWk— 6L&,:r0SC— i pg%C&S
*One form must be completed by each Special IRspecdon Agency or ]Inspector.
SPECIAL INSPECTIONS REQUIRED: Special inspections are required for this project in accordance
with IBC Chapter 17 or in accordance with IRC R109.2 as applicable. IBC Section 1704.1 rcgetires the
owner or the roglstor ed de's'ign profmional In charge to employ an independent tesdngltuapectiou
ageneyfspecial inspector to perform required special inspections. The independent agency hired to
perform Me duties of special inspection is required to be a registered agency with WABO under the
Special Inapection Registration Program (SHIP), The special inspector shalt be a qualified person with
competence for inspection of the particular type of construction or operation requiring special Inspection
(SOQ may be required by the Building Official). The owner, registered professional, contractor and
special inspectorlagency shall complete the attacked form and submit directly to the Buildhig Division.
WORK RFQURING .SPIT{CIAI.. INSPECTION; Special inspections will be required for the following
categories of work in accordance with IBC Chapter 17 and IRC 8109.2: FOR SPECIFIC
INFORMATION REGARDING REQUIRED SPECIAL INSPECTIONS SEE THE STATEMENT OF
SPECIAL INSPECTION OATTACHED ❑APPROVED PLAN SHEET
C Faiuicatlon €704.2
and Constnxytioa 17E?4,
tee€ Caastmcdoa 1704.3
f[s 1704.
ncseite1704.4
a Salts i«sWlod in Concrete I704.13
C3 S Monnet RC$4dW Cvacrete Frames1704-4
a Reinforcing l?restrrssin 3teaf i ends 1701.4
-saal Welder 17043.1
a K h§ n BolHtt 1704.3. 3
a Mas
01vI 1704
a Rainforwd 2MMm C4=cto 1704.4
C 9lrt OX61 WOMY fur Soismic ftcsistancc 1748.1
a Shtumml Obseraflon 17019
C3 hmgLaft CWM to rift Q704.4
n SpMy A Ued Fite-itcaiAve Matedals €704.10
C Pii Drilled Pi and Caiv*g3 1704.8 1704.9
a Staotaestc 1704.4
ct Pier i?otutdutiocn 17{17.5
n Stradaral Steal 370172
Bene. Fit PmERoll n 3704.
a SnwkerContml s 1704.14
ct Sxtarior Fttsttlatioa cad Finish 3 stems (3744.12
n DSI cited Seistnin encs 17{1%9
o Mechanical gentle 1747.8
a Cold Farmed Steel F=Inz QZ9L4)
C Stogy t Racks (1707.q
a Armfttmoa ml neurs 1707.
Wand 3787.E
re. sp=kd Cascs 1704.13
n Sc#srtt3o 1solatiaa scant 1707.10
nMWCt ItImescecu Fire Reshtfutt Coagn a 1704.11
S
a
a Load Dia -_s(1704.6.€)
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BEFORE A PERMIT CAN BE ISSUED: The owner uad contractor and special hmpoetor shall
coneplete this agreement and the attached Special Inspection Information Foran, including the required
acknowledgements :and return to the Building Division for Approval prior to permit issuance.
W:1Bu1€din8lliMD0OP#' ECODEMORM WECIAL €NSPEMON AGREEMENT FOitM.doc7107 RECEIVED
A _ '21M�
DEPT.
5. TE`INAL CONSTRUCTION REPORT
The special inspector or inspection agency sitall submit a final signed report or Certificate of
Compliance to the City stating that all items requiring special luspe:c#ion and testing were fulfilled
and reported. And, to the best of hisllter knowledge the project is In conformance with the
approved plans and specifications, approved change orders and the applicable workmanship
provisions of the IBC. Items not in conformance, unresolved items or any discrepancies in
.inspection coverage (Lee., axissed inspections, periodic inspection when continuous inspections were
required, etc.) shall be speciftca ly addressed is this rgwrt.
D. Contractor Rgponsiibilitiees
I. NOTIFY TUX SPECIAL INSPECTOR OF ALL REQUIRED SPECIAL INSPECTIONS
It is fisc duty of the ton,tractor to notify the special Inspector when work is ready for special
inspection. Note, We items listed on the attached Special Inspection Inxforwatiou Form and as
noted on the approved pians and specifications are required to have special inspections. Adequate
notlee shaft be provided by the contractor so that the special inspector has time to become familiar
with tate project: All work requiring special Inspection must be approved prior to concealing or
covering said work.
2. PROVIDE ACCESS TO "PROVED PLANS
The contractor is responsible for providing the special inspector areas to approved plans at the
jobslte.
3. RETAIN SPECIAL INSPECTION RECORDS
The contractor is responsible to retain at the jobsito all speciad Juspectton recor& subatitted by the
Special inspector: These recor4h are to be provided to the City building inspector upon request.
C Ci of Edmonds Building Divisi . ResgWihilittes
L APPROVE SPECIAL INSPECTION
The BuitdingDivision shalt approve sillspecial Inspectors sand special inspection ruquiroments.
Z. MONITOR SPECIAL INSPECTIONS AND APPROVE WEEKLY REPORTS
Work requiring special inspection and the performance of special inspectors shall be monitored
by the City Building Inspector. Ruilding Inspector approval mast he obtained prior to placement
of concrete or other situllar activities in addition to that of the special €aspector.
3. ISSUE CERTIFICATE OF OCCUPANCY
The Building Official may isetuc a C"ficate of Occupancy after all wee ldy special iospeetion
reports including the final report have been submitted and accepted by Hee City.
D. Owner Re$oonsibilities
I. The project owner or the engineer or architect of record acting as the owner's agent sliall fund
special inspection services.
E. P-ggigeer or Architect offtffA Rcs onsibilities
I. Pr*Pare 5tatessteat of Special Inspections in accordance witit 1HC Section 1705.
2. Review the special inspection reports and provide corrective action for work that may not
conform to tine approved pines.
W:1Beaildit'OMNCO(T XCOVESWORMMPECIAL IN3PWFf0N AGR13EMENT FOPM.doo7/07
APPROVAL OF SPECIAL INSPECTORS; Each apecial inspector shall be approved by tite liuilding
Officitsl prier to performing any ditties or inspections. The compasty performing inspections must be
WAHO cortified as well as the ludividuaf completing impections. When required by the Building
OffirlA, eack special inspector shall submit Statement of Qualifications to the City for review. Special
inspectors shall display Identification when performing special inspections on the project site. Special
inspections and testing shall meet the minimum requirements of IBC Chapter 17 and the following.
A. Butt god ties ousibilitfes of the seta Ins ector
1. OBSERVE WORK
The special Inspector shall observe the site work for conforenanco with the approved (stamped)
plana and specifications and applicable workmanship provisions of tate 18C. A,rchitoet or
Engineer reviewed shop drawings may be used only as an aid to inspection. Special inspections
are to be performed on a continuous basis—meaning that the special ices
pec#or is on site at all
times observing the work requiring special inspection. keriodic inspections are permitted only as
spec fically noted in the approved project plans in accordance with IBC Chapter 17, and as
approved by the Building OffiicW.
CoAtinucus Inspection means the same inspector is on site day to day to observe the work
rewiring special inspection.
Periodic,trupect€on means some inspections may be performed on a periodic basis to satisfy the
requirements of continuous inspection, provided these periodic inspections are performer) as
outlined in the project )dans and specifications, and approved by the Building OfficlaL
Z. REPORT NONCONFORMING ITEMS
The special inspector shalt bring non-conf'orwing items to the itamediate attention of the
contractor and note all such Items in the daily field report. Any item not resolved in a timely
manner shall be immediate cause of the special inspector to notify the Building Official by
telephone at (425-771-022€1) or in persons at City Hall, of the pian deviation, error, change or
omission. It shall also be the dotty of the special inspector to promptly notify the engineer or
architect of record.
3. DAILY REPORTS 10EIrr ON SITE WITHCONTRACTOR
Each special inspector shall complete and sign a doily report for each day's inspections. Tim daily
reports shall remains at the jobsite with the contractor for review by the City Building Inspector.
't. WEEKLY REPORTS TO CITY
The special inspector or inspection agency shall furnislb the City with weekly reports of tests and
inVediwns. The project engineer or Architect, and others as designated shall also be copied on
reports. Weekly reports must Includo the following;
a Description and date of daily inspections and te=sts vandc with applicable locations
A List of all non -conforming Item and locations
r Report on status ofnon-conforming items (holy each was resolved or unresolved)
0 Field chaseges authorized by the Architect, Engineer or City Inspector if not included In
"on -conformance items.
W:lBnitdt"OANVOUt' ICODE51F0RMSLSPP-CiAr. WSPUMON AGREUMNC FORM.doc7lo7
ACKNOWLEDGEMENTS
• f haul read and egree to cvmpiy wl& the tenw and conditions of dth agn m a4
Owner nanxe
(please print or type)
Signatn Date ` r%
General Contractor Company/Owner nama f"Q.�^^ "', •`' "` `� �, e r�' �-
(please print or type) r� C
Signatu Date v LD O
Special i A e napri��i`tFLOI _t?,�C�Lic�:' %,tlC°
print or type)
Date
-• -- - - - -- - -- - fr----- - -- . .
AmbitectMagineerofRecord name_ MACLtZ :>
(P16'astprint or type)
Signitare % L
Date
Roca
eturn
Return the ariginai signed agmement to the Building D"iion
City of Edmomds Building D"Ien
121 S' Avenue Nordt, City Hall Second Floor
F monds, WA 98020
ACCEPTED 13Y CITY OF
City Official Signiture ,,,
DIVISION:
W %uitdirWRM00UT 1C01DMV0RMSISPECiAi.INSPj3cn0N AOREgMEN'T FORM.doc7/07