20140811105926667.pdfo1: F D A,/
SPECIAL INSPECTION AND TESTING AGREEMENT
(i 1P
1%//,,,
Permit #: BLD2014-0692
. . ..... . . ..... . . .........
Stern Deck
Prior to issuance of permit, thisfibrin must be coinjileted bi its entirety and returiied to Me Oty,for
al)1wovaL 'lie cowry pletedfoi,iiititusthai,esigiiattit-esoj'ackiio)a,ledtitieyitbj,cillp(ti°ties.
DUTIES AND RESPONSIBILITIES
!9,I)ecial I ection Firm and. q!q_kLnls
g L)!L(�
or.s.
The Special Inspection firm of
will perform special
inspection for the following types of work (separate forms must be submitted if more than one firm is to be
employed).
1. Pin Pile Installation
2. Grade Hearn Steel
All individual inspectors to be employed on this project will be WABO certified for the type of work they are to
inspect, If inspection is for work that is 'lot covered by the WABO categories, or tile inspector is not WABO
certified, a detailed resume of the inspector all(] firm must be Submitted. The resume must show that (Ile
inspector and the firm are qualified by education and experience to perform the work and testing required by (lie
project design and specifications.
The work shall be, inspected for conformance with the plans and specifications approved by tile City. Revisions
and addenda sheets will not be used for inspection, unless they have been approved by the City, inspection
records shall include:
A daily record to be maintained oil site, itemizing the inspections performed. Any nonconforming work
shall be brought to the immediate attention of the contractor for resolution.
A weekly report shall be submitted to the. City; detailing the inspections and testing performed, listing
any nonconforming work and resolution of nonconforming items.
A final report shall be submitted to the building department prior to the Certificate of Occupancy being
issued. This report will indicate that inspection and testing was completed in conformance with the
approved plans, specifications and approved revisions or addenda. Any unresolved discrepancies must
be detailed in the final report.
Contractor:
—F . . . . . .. . .............................. . . . . . ,
Fle collty,1001- shall provide the special inspector or agency adcquille notification cif' work requiring inspection,
The City approved plan and specifications must be made available, at the
jobsite for the use of the special
inspector and the City inspector. Tile contractor shall rilaintain all daily inspection reports, on site, for review by
all parties.
The special inspection functions are considered to be in addition to the normal inspections performed by the City
and the contractor is responsible for coulacting tile City to schedule, regular inspections. No concrete shall be
poured or other work covered until approval is given by the City inspector.
(.':\l-)SerSVjga halADoe tj 11) ell t skil 1119 illspc0ion forni.doc,7/25/2014
BiAildh1g, Dparfinent.
The building department shall review any revisions and addenda, The City inspector will monitor the special
inspection functions for compliance with the agreement and the approved plans, The City inspector shall be
responsible for approving various stages of construction to be covered and for work to proceed.
The architect and/or engineer will clearly indicate on the plans and specifications the specific types of special
inspection required and shall include a schedule for inspection all(] testing. The architect and/or engineer will
coordinate their revision and addenda process in such a way as to ensure that all required City approvals are
obtained, prior to work sbown oil the revisions being performed in the field.
The project owner, or the architect or engineer acting as the owners agent, shall employ [lie special inspector or
agency,
EA NFORCEMENT
A failure of the special inspector or firm to perform in keeping with the requirements of the IBC, the approved
plans and this document, may void (his agreement and the Building Official's approval of the special inspector,
In such a case a new special inspector and/or firm would need to be proposed for approval. A failure of the
design and/or construction parties to perform in accordance with this agreement may result in a STOP WORK
notice being posted Oil the project until nonconforming items have been resolved.
A CKNO WLEDGMENTS
I have read and agree to comply with the terms and conditions of this agreement.
Owner: L ----signature
Y
It
Contract 0r: t"/Yt
SrSignature"
I
�A c:
-.Signaturc
Date:
Special fiisp.,l!
Signatrire-1, I/-, I,1.—.
----Z,,
D,
ate:
Special Insp. Agency,-,
. . ..... ......... ... ....
ACCEPTED FOR TIE CITY OFJ.,,DMONDS BUTT,DfNG DEPT,
Tay: Date:
LI
H161-broOSpecial inspection foim.doO/25/2014