BLD2022-1221+SIGNED_SPECIAL_INSP_AGREE+11.10.2022_4.46.00_PM+3215047SPECIAL INSPECTION AND TESTING AGREEMENT
Permit #:
Project:
_BLD2022-1221
21601 76th AVE W. MRI SUITE
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
will perform special inspection for the following types of work (separate forms must be submitted if more than
one firm is to be employed):
X Reinforced Concrete
X High Strength Bolting
X Welding
_Shotcrete
Structural Masonry
High Strength Bolting
Spray applied Fireproofing
_Smoke Control Systems
Lateral Wood
_Structural Observation by design professional
X Soils
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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