SIGNED SPECIAL INSPECTION AGREEMENT.pdftit' EDAI
SPECIAL INSPECTION AND TESTING AGREEMENT
Permit #: 3W 10 1,V
Project;
Prior to issuance of a permit, this form must be completed in its entirety and returned to the Cityfor
approval. The completed form must have signatures of acknowledgment by all parties.
DUTIES AND RESPONSIBILITIES
Succinl Insvectiritlt I«i ° trl ° t e itt# 4ttsttcctrrus
r
The Special Inspection firm of _ �� �� ,m a.����",..�... _ . _ will perform special
inspection for the following types of work (separate forms must be submitted If more than one firm is to be
employed):
• Grading 0 Structural Fill
• MSE Baektill 4 Rockery
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 not covered by the WABO categories, or the inspector is not WABO
certified, a detailed resume of the inspector and firm must be submitted, The resume rnust shrew that tite
inspector and the firm are qualified by education and experience to perform the work and testing rcgtrrred by the
project design and specifications.
The work shall be inspected for conformance with the plans and specifications approved by the City. Revisions
anti 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 on 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 depatt.ment 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.
CWt-It rA L
The contractor shall provide the special inspector or agency adeqowe notification of work requiring inspection.
The City approved plan and specifications roust be made available, at the jobslte for the use of the special
inspector and the City inspector. "I fie contractor shall Inaintain all daily inspection reports„ on site, for review by
all parties.
\IEDMSVR•DEPTfStinuildinglHandouls Infonmalion Ay ChuckVnspcctionslspecial inspection and testing egreetnenl COF,doc5/1312016
The special inspectinn, functions are considered to be in addition to the non-nal inspections performed by the City
and the contractor is responsible for contacting the City to schedule regular inspections No concrete. AWI be
poured or other work covered until appioval is given by the City inspector
Hie huilding dtporlissent shall review any revisions and addenda, The City inspector will womlor the special
inspection functions lbr compliance with the agivenicill and dsc oppiovrd plims. I'liv, (,,,jty 111%pvctor Ofill be
responsible for approving variuus stages Of'croistruciiiin 1(a lit, covvi-cd wid (m work to proccud
Desig,11. L1114gAmmW '& I
'nic architect ond/ot vnjJ 11 cul vy vw $y nid Icale t m the plans and stivc i ficin i W i s the SPU6 (4 IYP" k1l slr$L'c-
icispCefloo w(liumd mind shall ji,ichitic is schudole l'ot and lesting 'I he architect aildli" will
coordinatc Ilicir wvj"iou and at dendo process ii, MICh It vvay, ijs to enstire that all re ciiiirc(t are
obtained, prior to work shown On the revisions being performed in the field,
Owner:
ffic protect owner, or the architect or engineer acting as the owners agent, shall employ the special insproor or
agency,
ENFORCEMENT
A Isidore of the special inspector its, (ijnj to liciAnin in keeping wittl the rcquirenictits of the IFIC, 11W filiprov(A
pirisis and tjsj,, docutriew, critsy void this nip-coincril And the 111jildisig Official's appro"d $)('tile spacial illsimclor.
In stench 1% cose a liew $pccisil inspuclos and/or Kirin would need to tic plup')Ned 1b, liplitovH1, A itillure rat thia
do r4hwith this agrucIncill noty rcsids iti a WORK
ign 111ttirs)l colistroction parlics to perform in occoince
Ooticc living posted on time project until nonconroroliNt items have been resolved.
ACKNOWLFDG k 414-
I hive read and agree to comply vith the terms and conditions
jr its ligs' :lyclit
OwvV Olt V Signalure_
Contractor: 2)ptj
Arch.11:11g: Dsitc�
Special lisp..
Special Insp. AguncY, A TE L<",,
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OHM) wno Umv.
The bullding depedonent shall reAvy ninny reNisimt ard Akan VW CAY wqxcloii wIli rnoniItor 0hc spIC6,111
Inspection funmions for comphance wNh Ow ayumw" and the approved plans I hr Cly inspedor shaH In,
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coordhMe duh reylJoin ard adderide Imncess in such a way as w einsure, lhau 0 required Oy approvsk are
chlairmd, pnrmv to mot ohms on the revo sions I. perforrned in the fivId
Q!tner.,
ow yqVm omwq or the archincl or enginerx achng as be owners ngcW, sJoh employ We span eNt insputor or
agency,
ENFORCENIEN1
A fadure of the speeml nlspector or firmi tar perVai in keeping vdlh the requiernanis of Ac IBC, Te appromad
Fdons and ilk docunwrd, may vWd this alpecmm and die BAWQ OftkiO's approvaIl uf the speclal hnspectc)ir
in such as cut a new spedal insparlor andMr An =Ad need to Law proposed fm appr-OVO. A faiiure of Hit
design and/or consmcAbn PWks W perfoiirn hi accordainec with thh; agremnent mmy resuh At a STOP %YORK
,woe ky pmad on Ar piqjo unfil nonconforn)Iing IOnrini have bev rv�solvcd
ACXNOWLEDGNIEN',,S
I have rud MW agme 10 aimpy; %00; Me terms and cnrriWwrs of 116 B
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I )V.SVR-D� ) C L MM, %K Ed Nw"w""Mn" to ITFOOM, ,
The special inspection functions are considered to be in addition to the normal inspections performed by the City
and the contractor is responsible: for contacting the City to schedule regular inspections. No concrete shall be,
pouted or- other work covered until approval is given by the City inspector,
the building department shall review &try revisions and addenda. 'rhe City -inspector willmonitorthe special
inspection functions for compliance with the agreement and the approved plans. nic City inspector shall be
responsible for approving various stages oll"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 orspecial
inspection required and shall include a schedule for inspection and 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 shown on the revisions being performed in the field,
Owner.
The project owner, or the architect or engineer acting as the owners agent, shall cnrploy the special inspector or
agency,
ENFORCEMENT
A 6,111jj'j ji Iii gecial ins,,-,�cctor or irin w ierform in keeoml willi the rejuirements of the IBC, the 116�rovcd
In such a case a new special inspector and/or firm would need to be proposed for approval, A failure Of the
design arid/or construction panles to perforin in accordance with this agreement inay result in a s,rop WORK
notice being posted on the project until nonconfor-ming items have been resolved
ACKNOWLEDGMENTS
Signature
Contractor: _1> signaluin
Arch,/Fng: 4,7-> _Sigirartttr
Special Insp.. H, r a I rJ I tA I i no I C3 C I Signaturt
Special Insp. Agency,, C uo�3s 2 De gn
A( I V I " PIT (F)r �THE CITY 0 F N S BUILDTNG DEPT. 16� leDate: ?y
Date e_1
Date:
Date: (0
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lT.DMS4'RADEPTFS113uildpngql6odotiis Informoinr. by ChLWin5pelions\ypecial nspedion and iesling agmenicni CO dmVi3/2016
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