APPROVED BLD SI FORM BLD2021-1176RECEIVED
BLD2021-1176
Oct 19 2021
CITY OFEDMONEII�F EDAf
DEVELOPMENT 51R S
DEPART
G �
890
SPECIAL INSPECTION AND TESTING AGREEMENT
Permit #: BLD2021-1176
Project: Hedges, 9423 232 Street SW
Prior to issuance of a permit, this form must be completed in its entirety and returned to the Cityfor
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 Krazan 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 Epoxy
High Strength Bolting
Spray applied Fireproofing
Smoke Control Systems
Lateral Wood
Structural Observation by design professional
X Soils
X Installation and construction of helical piles
And brackets
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.
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: Ed Hedges
Contractor: R&R Foundation Specialsit
Signature Date 9/20/2021
Signature
Arch./Eng: Longitude One Twenty Signature
Special Insp. Krazan
Special Insp. Agency Krazan
Mans R Thurfjett
, zg&2�1 S/tlenz/-
S ignaturejeff�y S Mer er (Sep 21, 2021 13:23 PDT)
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
Un
W. W OfAa[t Date: 10/20/2021
Date: 9/21 /2021
Sep 30, 2021
Date:
Sep 21, 2021
Date:
\\edmsvr-userfs\userprof$\dakau\Desktop\Comments Letters and Special Inspection forms 2019\Special Inspection forms\SI 2021-1176
Hedges.doc9/14/2021
Signature: * LIW46WG
Mans Thurfjell (Sep 3 021 07:04 PDT)
Email: mthurfjell@1120engineering.com
BLD2021-1176_Required_Prior to_Issuance_9-
17-2021 UNSIGNED SPECIAL INSPECTION
AGREEMENT_SI_2021-1176_Hedges (1)
Final Audit Report 2021-09-30
Created: 2021-09-21
By: Barbara Stasiak (barbara@rrspecialist.net)
Status: Signed
Transaction ID: CBJCHBCAABAAguSznYMGSvylLbMF-ZsJQYj9HvsbHcoh
"BLD2021-1176_Required_Prior_to_Issuance_9-17-2021_UNSI
GNED SPECIAL INSPECTION AGREEMENT SI 2021-1176
Hedges (1)" History
') Document created by Barbara Stasiak (barbara@rrspecialist.net)
2021-09-21 - 6:26:34 PM GMT- IP address: 24.18.141.176
P Document emailed to Jeffrey S Mercer Qeffmercer@krazan.com) for signature
2021-09-21 - 6:27:24 PM GMT
Email viewed by Jeffrey S Mercer Qeffmercer@krazan.com)
2021-09-21 - 6:43:32 PM GMT- IP address: 107.77.213.152
Document e-signed by Jeffrey S Mercer (jeffmercer@krazan.com)
Signature Date: 2021-09-21 - 8:23:46 PM GMT - Time Source: server- IP address: 50.243.99.61
Document emailed to Mans Thurfjell(mthurfjell@1120engineering.com) for signature
2021-09-21 - 8:23:47 PM GMT
Email viewed by Mans Thurfjell (mthurfjell@1120engineering.com)
2021-09-30 - 2:03:32 PM GMT- IP address: 76.121.94.23
Document e-signed by Mans Thurfjell (mthurfjell@I120engineering.com)
Signature Date: 2021-09-30 - 2:04:35 PM GMT - Time Source: server- IP address: 76.121.94.23
(� Agreement completed.
2021-09-30 - 2:04:35 PM GMT
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