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SPECIAL INSPECTION AND TESTING AGREEMENT
Permit #: BLD2020-0412
Fae. 184C
Project: Binder, 8912 192"a Street SW
Prior to issuance of a permit, this form must be completed in its entirety and returned to the City for
approval. Tile completed form must have signatures of acknowledgment kv all parties.
DUTIES AND RESPONSIBILITIES
Special Inspection Firm and S ecizall Iin,s- ectors:
The Special Inspection firm of 1Ve�.s tl _ 1
perfo
inspection for the following types of work {separate forms must be submitted if more s nelf firm is to beecial
employed):
_ Reinforced Concrete
Spray applied Fireproofing
_ Bolting in Concrete
` Smoke Control Systems
— Prestressed Concrete
Lateral Wood
— Shoterete
Structural Observation b design
-- Y professional
Structural Masonry
X Soils! Subgrade conditions, Temporary cut
conditions, fill compaction and drainage
system
Installation
_ _Structural Epoxy
^ Expansion Bolts/Threaded Expansion Inserts
High Strength Bolting
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 cotrorcd 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 shalt 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 shalt be submitted to the City; detailing the inspections and testing performed- listing
any nonconforming work and resolution of nonconforming itetns.
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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ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
sy:Dommir zx W. X ofkau Date: 7/20/2020
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