RESUB 1-Signed SI Agreement4 OF ED,3,/0 SPECIAL INSPECTION AND TESTING AGREEMENT
'Cst. 1890
Permit: BLD 2022-0038
Project: 19209 OLYMPIC VIEW DRIVE
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
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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 Steel/Welding
_High Strength Bolting
_Spray applied Fireproofing
_Smoke Control Systems
_Lateral Wood
Structural Observation by design professional
_Grading/soils
Steel Floor and Roof Decks
_X_ Anchor Bolt poxy
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.
Desitsn 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.
ACIiNOWr r. Fk,(1A/rV'&T'VL1
I have read and agree to comply with the terms and conditi
Owner; Jesse Niebruegge Signature
Contractor: Bret Niebruegge (self performed) Signature
Date 4/14/22
Date: 4/14/22
Arch n PALO— A*6 '�`"5"i ature Date: 4112la?,?
Special Insp. Signature �►° Date: /f f
Special Insp. Agency '•� s% l� ; ��J
ACCEPTED FOR THE CITY OF EDMONDS WELDING DIVISION
By: ��1�/!� ,(�loom /�1G� Date: 03/05/2022
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