Signed Spec Inspec Agreement Form 2010-0376.pdfO,C EDAI
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/' DDIVISION
SPECIAL INSPECTION AND TESTING AGRE EMENT
PERMIT # j .,t. j) (+%� (! ., 1:� '7 �_G` DATE:
PROJECT SITE ADDRESS:' ?
PROJECT NAME:
' SPECIAL INSPECTION AGENCY
*One form must be completed by each Special I
tion Agency or Inspector.
SPECIAL INSPECTIONS REQUIRED: Special inspections are required for this project, as applicable, in
accordance with Title 18 Edmonds Community Development Code (ECDC). When required, the project must
be installed/constructed per approved plans and specifications. The special inspector shall be a qualified person
with competence for inspecting the specific type of construction or operation requiring special inspection. The
owner, registered professional, contractor and special inspector/agency shall provide a special inspection report
detailing compliance with approved plans and specifications directly to the Engineering Division.
WORK REOURING SPECIAL INSPECTION: Special inspections will be required for the following
categories of work: FOR SPECIFIC INFORMATION REGARDING REQUIRED SPECIAL INSPECTIONS
SEE THE STATEMENT OF SPECIAL INSPECTION NOTED AS A CONDITION ON THE BUILDING
PERMIT AND/OR ON THE APPROVED PLANS.
Permeable Pavement (asphalt, concrete, paving blocks, "grass -trete" and others)
Il Raingarden (Bioretention Cells)
�( Vegetated Roofs
Other: �'r. l (�'t_.;�t.%�'_� I 'Cl'l!t' t�'7{'1'1 �� `-"La l -'+r"
Other:
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor and special inspector shall complete this
agreement and return to a Permit Coordinator prior to permit issuance.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the Engineering
Division prior to performing any duties or inspections. The credentials of the specific person performing the
inspection shall be submitted. When applicable, the company performing inspections must be accredited by the
American Association of State Highway and Transportation Officials (AASHTO) R18.
A. Duties and Responsibilities of the Special Inspector
1. OBSERVE WORD
The special inspector shall observe the site work. for conformance with the approved (stamped) plans
and specifications. Special inspections are to be performed as needed, to confirm that the work being
completed meets specifications and approved plans.
S:\ENGRTORMS-Form Letters\Permits\SpecialInspectionAgreement-ENG.doc Revised 07.23.10
2. REPORT NONCONFORMING ITEMS
The special inspector shall bring non -conforming items to the immediate attention of the contractor and
engineer of record. The special inspector shall provide a report to the Engineering Division notifying of
any items not resolved and/or not installed per the approved plans and specifications.
Items not constructed per the approved plans and specifications will result in a review of the plans to
determine what requirements will be needed for the project to meet the necessary stormwater
requirements; such as removal and reconstruction, re -design of the stormwater management system(s),
etc.
Final approval for the project will not occur until installation of all required improvements is complete
and accepted by the Special Inspector and the City.
3. FINAL CONSTRUCTION REPORT
The special inspector or inspection agency shall submit a final signed report or Certificate of
Compliance to the City stating that all items requiring special inspection and testing were fulfilled and
reported. The report shall also include a statement from the inspector stating to the best of his/her
knowledge the project is in conformance with the approved plans, specifications, and approved plan
revisions, if any. Items not in conformance, unresolved items or any discrepancies in inspection
coverage (i.e., missed inspections, periodic inspection when continuous inspections were required, etc.)
shall be specifically addressed in this report.
B. Contractor Responsibilities
1. NOTIFY THE SPECIAL INSPECTOR OF ALL REQUIRED SPECIAL INSPECTIONS
It is the duty of the contractor to notify the special inspector when work is ready for special inspection.
Note, the items listed under the statement of special inspection on the building permit and as noted on
the approved plans and specifications are required to have special inspections. Adequate notice shall be
provided by the contractor so that the special inspector has time to become familiar with the project. All
work requiring special inspection must be approved prior to concealing or covering said work.
2. PROVIDE ACCESS TO APPROVED PLANS
The contractor is responsible for providing the special inspector access to approved plans at the jobsite.
3. RETAIN SPECIAL INSPECTION RECORDS
The contractor is responsible to retain at the jobsite all special inspection records submitted by the
special inspector. These records are to be provided to the City Engineering inspector upon request and
upon completion of work.
C. City of Edmonds Engineering Division Responsibilities
1. APPROVE SPECIAL INSPECTION
The Engineering Division shall approve all Special Inspectors and special inspection requirements.
SA\ENGRTORMS-Form Letters\Permits\SpecialInspectionAgreement-ENG.doc Revised 07.23.10
2. MONITOR SPECIAL INSPECTIONS, AND APPROVE REPORTS
Work requiring special inspection and performance of special inspectors shall be monitored by the
Engineering Division Inspector. Engineering Inspector approval must be obtained prior to placement of
concrete or other similar activities in addition to that of the special inspector.
3. FINAL APPROVAL
The Engineering Division may provide final inspection approval after the special inspection report(s)
have been submitted and accepted by the City.
D. Owner Responsibilities
1. The project owner or the engineer or architect of record acting as the owner's agent shall fund special
inspection services.
E. Engineer or Architect of Record Responsibilities
1. Prepare Statement of Special Inspections.
2. Review the special inspection reports and provide corrective action for work that may not conform to the
approved plans.
ACKNOWLEDGEMENTS
I have read and agree to comply with the terms and conditions of this agreement.
Owner name L
A (please print or type)
Sign
Date 14 v f
General Contractor ompany/Owner name
(please print or type)
Signature .W- Date
....
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Special Inspector/Agency name ree� "� � t� .' �••
W, .._
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Signature �� Date '
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Architect/Engineer of Ree d �R name �.....e ..° .W �,��., p..
(please print or type)
Signature M .., �� . Date ..,�
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Return the original signed agreement to:
City of Edmonds Development Services Department
121 5thAvenue North, City Hall Second Floor
Edmonds, WA 98020
am
City 1
Title:
S AENC
17.23.10