Special Inspection Agreement Form.pdfF ED;I, SPECIAL INSPECTION AND TESTING AGREEMENT
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Permit #: BLD2018-0417 au��.oING DEPARTMENT
Project: Foundation Underpinning -ln' OF EDMONDS
Prior to issuance of a permit, this form must be completed in its entirety and returned to the City for
approval. The completed form must have signatures of acknowledgment by all parties.
DUTIES AND RESPONSIBILITIES
Special Inspection Firm and Special Inspectors:
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):
Reinforced Concrete
Bolting in Concrete
_Prestressed Concrete
_Shotcrete
Structural Masonry
_Structural Steel/Welding
High Strength Bolting
Spray applied Fireproofing
Smoke Control Systems
_Lateral Wood
_X_Structural Observation by design professional
_X_Grading/soils
_Other
_Other
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 must show that the
inspector and the firm are qualified by education and experience to perform the work and testing required by the
project design and specifications.
The work shall be inspected for conformance with the plans and specifications approved by the 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 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 department prior to the Certificate of Occupancy being
issued. This report will indicate that inspection and testing was completed in conformance with the
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Building Department:
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.
Design Professionals:
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 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 employ the special inspector or
agency.
ENFORCEMENT
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 this 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 on the project until nonconforming items have been resolved.
ACKNOWLEDGMENTS
I have read and agree to comply with file terms and conditions of this agreement.
Owner: Iguchi Sign:►turn Date Mar 22,2018
Contractor: AI ' / 1-) 7—It it l7 / Signature ~ Date:
<;�YA
Arch./Eng. F f q4: ?,"57 Signature
Special Insp. � EE Ezc ffe Signature �/ / s' � Date: � �//
Special' Insp. Agency SFA Design Group, LLC.
ACCEPTED Tl ; CITY OF EDMONDS BUILDING DEPT. /
By: Date: [� /D /''J� _
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