APPROVED BLD2022-0392+SI FORM+6.7.2022_10.54.45_AM+2916817RECEIVED
Jun 07 2022 bld2022-0392
CITY OF EDMONDS
`fit. f:fy 7T DEVELOPMENT SERVICES
C' DEPARTMENT
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SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number: 2022-0392
Transform Weight Loss 21911 76th
Project: AVE. W. suite 100
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 Oxygen Medical Gas Services
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
❑ Structural Observation by design professional
❑ Grading/soils
❑ Retaining Wall Block Installation
® Medical Gas Installation
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 approved
plans, specifications and approved revisions or addenda. Any unresolved discrepancies must be detailed in
the final report.
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Contractor
The contractor shall provide the special inspector or agency adequate notification of work requiring inspection. The
City approved plan and specifications must be made available, at the jobsite for the use 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.
Buildinp, 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
l have read and agree to comply with the terms and conditions of this agreement.
S /'
Owner:
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Signature
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Date
Contractor:
Rod Ferris
Signature
Date 05/12/22
Arch/Engr:
Kent Gregory
Signature k`iV`r1_
Date 5111/22
Special lnsp:
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Signature ::� %( A,2
Date '33L,,�,r:2
Special Inspection Agency:nxvnPn
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Signature
Services
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ACCEPTED FOR THE CITY
OF EDMONDS BUILDING
DIVISION ,a, 1A1.h,0�1 Aa
R. kzdck Dr. NW p31
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By: Eri e� Ctiu^(•e r
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Date 08/01/2022C-1115 � 1
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