SIGNED - TOMIK- SIGNED SI AGREEMENT (2)-1 of CDM
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SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number: BLD2022-0582
Project: 1005 7' Ave S
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 SFA Design Group
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
® Pin Pile Installation
® Foundation Bracket Installation
® Stabilizer Base and Hardware Installation
❑ High Strength Bolting
❑ Spray applied Fireproofing
❑ Smoke Control Systems
❑ Lateral Wood
❑ Structural Observation by design professional
® Grading/soils
❑ Retaining Wall Block Installation
❑ Retaining Wall Footings
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 coveredby 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.
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 the terms and conditions of this agreement.
Owner: Michael Zach Peerand Signature
Contractor: Matvey Foundation Repair Signature
Arch/Engr: SFA Design Group, LLC Signature
Special Insp: SFA Design Group, LLC Signature
Special inspection Agency: SFA Design Group, LLC Signature
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ACCEPTEP FOR HE CITYAFDMONDS BUILDING DIVISION
By: � Date
Date 8/31 /22
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\\edmsvr-userfs\userprof$\kbloomfield\Desktop\TOMIK-FOUNDATIONSTABILIZATION SI Form (unsigned).docx 6/7/2022
Peerand SPECIAL INSPECTIONS FORM (1)
Final Audit Report 2022-08-31
Created: 2022-08-31
By: Permit Manager (permits@gomatvey.com)
Status: Signed
Transaction ID: CBJCHBCAABAAv2A13ah9drTS1gJ9du-yglGV-_bKNbyY
"Peerand SPECIAL INSPECTIONS FORM (1)" History
Document created by Permit Manager (permits@gomatvey.com)
2022-08-31 - 5:23:25 PM GMT- IP address: 98.194.188.206
Document emailed to zpeerand@gmail.com for signature
2022-08-31 - 5:23:35 PM GMT
Email viewed by zpeerand@gmail.com
2022-08-31 - 5:23:37 PM GMT- IP address: 66.249.87.185
Signer zpeerand@gmail.com entered name at signing as Micahel Zach Peerand
2022-08-31 - 5:24:41 PM GMT- IP address: 50.35.104.243
Micahel Zach Peerand (zpeerand@gmail.com) has explicitly agreed to the terms of use and to do business
electronically with Permit Manager (permits@gomatvey.com)
2022-08-31 - 5:24:43 PM GMT- IP address: 50.35.104.243
Document e-signed by Micahel Zach Peerand (zpeerand@gmail.com)
Signature Date: 2022-08-31 - 5:24:43 PM GMT - Time Source: server- IP address: 50.35.104.243
�i Agreement completed.
2022-08-31 - 5:24:43 PM GMT
a Adobe Acrobat Sign