Special inspection form-vault-pln20070021-ESNW.pdf
SPECIAL INSPECTION AND TESTING AGREEMENT
Permit #: _pln20070021___________________________________
Project: __Stonebridge Court 10-lot Plat_____________________
Prior tocommencing vault construction, this form must be completed in itsentiretyand returned to
the City for approval. The completed form must have signatures of acknowledgment byall parties.
DUTIES AND RESPONSIBILITIES
Special Inspection Firm and Special Inspectors:
The Special Inspection firm of __Earth Solutions NW, LLC_____________ 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 ConcreteSpray applied Fireproofing
Bolting in ConcreteSmoke Control Systems
Prestressed ConcreteLateral Wood
ShotcreteStructural Observationby design professional
Structural MasonryGrading/soils
Structural Steel/WeldingOther _______________________________
High Strength BoltingOther _______________________________
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
recordsshall include:
A daily record tobe 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
approved plans, specifications and approved revisions or addenda. Any unresolved discrepancies must
be detailed in the final report.
F:\\Projects\\Stonebridge Court\\Plans-Civils\\Land\\Final Engineering\\Approved\\pln20070021-Special inspection form-vault.doc8/9/2012