APPROVED RESUB1 BLD2022-0955+SI FORM.8.16.2022_9.20.57_AM+3052886SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number:
Project:
BLD2022-0955
Haase,18603 811t Avenue West
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).
❑
Reinforced Concrete
®
Epoxy 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
❑ 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 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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8/4/2022
C'tint!'tnefor
`i11i eotimit►-ior shalt prov idc the special 111%pec1or or azeno adequate notif►ratton tit work requiring insivcti ?n, The
- City approved plat and p"iiicatiom, mast he made awailahie. A the •johsite for lire ttSe of die ipial itttipecttrT and
the City insplc cter. Tttr contractorshall maintain all d:liiy inspection reports. tan site,. tin ro iew by all parties,
Fhe special. inspection functions are con'�id ted to be in addition to the nurrnal inspection-, performcd by the City and
tine contractor is respx►risihle tur contacting, the City to schedule ri:itular inspcetions: No concrete shall be pouted or
ether ►vork cowered until approval is given by the City, Inspector.
Building Department
Vie hailding department shall review any revislons and addenda. The. City illspector will monitor the special
t ipcction i4petion t-or comphati x with the agreement and the appto�ed plans. The City inspector shall be
`' - rG'.S C311Ctllti" t'17r :TpparC«'in_' wart{)'try Jt;1QC'� tat Ct�114trttction to tie covered ;and or work to proceed.
Design Professionals
l lie architect arid. Of en. -sneer w ill clearly indicate on the plain and specifications the specific tvpcs of special
tnNpectio►1 rcquucd and shall include a sc-heduie for inspe:;lion and testing. The architect andltrr engineer will
courdinatt_ their re,. ision and addkmda proems in such a kvay as to ensure that all required City approvals are obtained,
prior to %Fork shop \ n on lice revisions being pc6ormed in tine firlcl.
,Owner
The pro'
co m nm or the architect or engineer acting, as the Lmner�s agent, sxxtor or
tlizencV
ENFORCEMENT
A ihiture ol'tllc special insiketttr or troll to Pertiar►n ill keeping with the requu•cmems of the I13C. the approved plans
and this d"utn nt. inay void `this a_rrcctnent and the Building Otiicial•<approval of the special insptetor, in such a
case a nc«• special inspector and or firm �tiouid need to be proposed tier approval. A iitilure o the desi�_n and'or
rcrlt•truc Linn panics to pttfonu in accordance with this agreement may result in a STOP NVORK notice lit Illp: pxaxtril
sin the prole:ct until nonconfarning, items have been'reml ved. -
ACKi\OWLEDGME TS
1 have lc:at] and wirer to Comply Willi the tmmi and Conditions cif this agr;ee-timll.
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