SPECIAL INSPECTION FORMof EI)�
SPECIAL INSPECTION AND TESTING AGREEMENT
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Permit #: BLD2020-0876
Project: Morino. 958 Walnut Street
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
5 [tiiA- l Inspection F"rrm and Special Inspectors:
The Special Inspection firm of se�'y e _ I I 1 1�._ will perform special
inspection for the following types of work (separate forms must be submitted it more than one firm is to be
employed)_
X Concrete/Grouting
Bolting in Concrete
Prestressed Concrete
_ Shotcrete
Structural Masonry
X Structural Epoxy
_ High Strength Bolting
Spray applied Fireproofing
Smoke Control Systems
Lateral Wood
Structural Observation by design professional
X Soils
,Expansion Bolts/Threaded Expansion Inserts
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 sbow 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.
s A weekly report shall be submitted to the City, detailing the inspections and testing performed, listing any
nonconforming work and resolution of nonconforring items.
• A final report sball be submitted to the building departnient prior to the Certificate of Occupancy being
issued_ This reportwiii indicate tht inspection and testing was completed in conformance with the
approved plum, spec,-ifcatious and approval revisions or addenda. Any uru'rsolved discrepancies must be
detailed in the final report.
Contractor:
1\ednisvr-deptfs4ADDRESS_FILESW1pha1WALNUT 5TWWBLD2020-0876 REMODEL AND DECKISUBMIT 811.201SI 202"876
MorinoAlocW 2020
The contwor shall provide the special inspector or agency adcqu.ne notification of work requiring inspection.
The City approved plan and specifications must be made availablc. at the jobsite for the ILse of the special
inspector and the City inspector. The contractor shall maintain 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 contacting the City to schedule regular inspections. No concrete shall be
poured or other work covered until approval is given by the City inspector.
Building Dgpartment:
The building department shall review any revisions and addenda. The City inspector will monitor the specia!
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 Profess'
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 regWrements of the IBC, the approved
plans and this docu lent, may void this agreement and the Building Offieial's approval of the special inspector.
In such a case a new special imTwctor 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 the terms and conditions o 9
Owner: Si
ale
Contractor-T- , uC',Q 1, i� Date: oZ LciO
�`•t'�v/S � C��.L 'tom
Arch./Eng: GeY(U1 G Signa Date: ZsI2U ZD
Special insp. Kevin Richardson / GeoTest
Signature
`t 1 �� Date: 9-2-2020
Special Insp. Agency GeoTest Services, Inc.
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
Date:
1,adms„F-0,ptis%&DDRESS_FQ.ESWpba1WALNUT SP958ML132020 0976 RUAODL•L AND DEWSURNOT 911.20M 2020-U76
Morino.doc9l112020