ROSE RIDGE SPECIAL INSPECTION FORM SIGNEDSPECIAL ECT N AND TESTING AGREEMENT
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Permit # _ , - ' ?
Project- RetainW
Mar to issuance of apermft, t ' form must be completed in its a t% eta, and returned to the atyfor
approvat. The completecompletedform must have signatures o; ' acknowledgment by ari pa .
l:�.t AND �'l�Il�;l'l'�
Special l lrttt art W j ter
The Special 1uspection firm of r'
will perforni special inspection for the following types of work (separate forms must be submitted if thore than
one firm is to be employed),
Reinforced "Onc ete __ p y applied Fireproofing
.—Bolting in Concrete Smoke Control Systenis
dPr str s ed Concrete —Lateral d
h ter ke _Structural ser ation by desist profes +—Structural Masonry Grading/soils
Stmetural StcelMeldi —Pin Pile Installation
lilt StrengthBolting,eWnin Wall hags
r l individual inspectors to lie employed on this project vm Ill be WA130 certified for the of workthey are t
inspect. If inspection is for work that is not covered by the WASO eategories, or the inspector is not ` 'AB
certi ed, a detailed resume of the inspector and firm, must be submitted, Ibc 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 cork- sliall bo inspected for confot nance with the plaits and specifications approved b the City. Revisions
and addenda sheets will not be used for insspection, witless they have been approved by the City. Inspection
records shall inclu&
daily- record to be maintained on site, itcini7irig the inspections performed. Any rronconforsrttng work —
shall be brought to the immediate attention of the contractor for resolution.
weekly report shall be submitted to the City, detailing the inspections and testing performed, listing any
nonconforming Mork- and resolution of noncouf6 items.
final Te rt shall be submitted to the building dcpartment pfior to the Certificate of Occupancy being
issued. This report will indicate tl;at inspection and testing was completed in conformance with the
approved plans, specifications and approved revisions or addenda, mar unresolved discrepancies mist be
detailed in the final report.
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Co&Lract
The eontraetor shall provide the special inspector Or agency adequatenoti ication of 1 orl�: requiring inspection,
The City approved plan and specifications st be madeavailable, at the jobsite for the use of the special
nspcetor axid the City inspector, The contractor shall maintain alt daily inspection reports, on site, for review b
all parties. ;
The special inspection functions arc considered to be in addition to the no al inspections -performed by The City
d the coAtractor is responsible for contacting the City to schedule regular inspections. concrete shall b
oared or other work covered until approval is given by the City inspector,
Boazdens e►t
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The l to ldirtg department shall review any revisions ns and addenda, The pitinspector mill' monitor the special
inspection ft actions for compliance with the agrecment and the approved plans, he Cit inspector shall
resp osibl for approving var ouus stages od'construction to use covered and for work to proceed.
rnfessattist
The architect and/or en iriccr will clearly indicate can -he plans and specifications the specific lypes o:fspecial'
inspection icquired and shall include a schedule for i spectin and tasting. The architect andtor engineer will
coordinate their € ;<sion and addenda process in such a way as to ensure that all, required Cagy approvals are
obtained, prior to work shown on the revisions being performed in the field.
QyvnSr;
The pmJect owner, or the architect or,engineer acting as the aumers Win, still employ the special inspector or
aen.
ENTORCEMENT
. failure of the special inspector or Ermto perfbrm in keeping th the requirements of the IBC, the approved
plans and his document, may void this agreement and the Building Official's approval of the special inspector,
In such a case a new special inspector andlor fit. would need, to he posed for approval. A fair of
dcsign andJor construction partite to lserform in accordance with this agreement may result in a STOP WORK
notice being posted on the project until nonconforming items have been resolved.
I have road and arse to comply -14th, the terms and conditions of this agreement.
Owner: Signature ��� �-�.... � _ Date -7
I ate;
Special la
_5�7"e5;�
special Imp. gcnc°
ACCEPTED TED FOR THE CITY OF DMIO BUILDING DIVISION
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