DNS RESUB 1-Signed SI Agmnt+9.22.2022_12.14.55_PM+3124008SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number:
Project:
BLD2022-0877
Jewel, 946 Maple Street
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
❑
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.
\\edmsvr-userfs\userprofS\dakau\Desktop\Comments Letters and Special Inspection forms 2019\Special Inspection forms\SI 2022-0877 JEWEL.docx
8/4/2022
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: Ruth Jewell
Contractor: Karl J Dropping
Arch/Engr: Albert H Cohen
Special Ins1GE0 Group Northwest, Inc
Special Ins j gD#W.g
Signature: W"'. (A Ia..dA
Rut Jewell (SVp 15, 2022 11:34 PDT)
Signature: AK"Fa�lwz�
Karl J Dropping (S�1022 14M4 PDT)
Signature: A4AJ M rskhome.com
Albert H Cohen (Sep 15, 202215:04 PDT)
Signature: al ende " all com
Signature: MflraaLO!g gmai1.com
William Chang (Sep 22, 02211:03 PDT)
Email: wsmchang@aol.com
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
In
Date
Sep 15, 20 2
Sep 15, 2022
Sep 1r; ?022
Sep?? 2.022
Sep 22, 2022
\\edmsvr-userfs\userprofS\dakau\Desktop\Comments Letters and Special Inspection forms 2019\Special Inspection forms\SI 2022-0877 JEWEL.docx
8/4/2022
Jewell Inspection Agreement 09.15.2022
Final Audit Report
Created:
2022-09-15
By:
Kelly Johnson (kelly.johnson@norskhome.com)
Status:
Signed
Transaction ID:
CBJCHBCAABAAKOdQwgFOJuitGxKnTSotkbBHg_AMB1 DC
2022-09-22
"Jewell Inspection Agreement 09.15.2022" History
Document created by Kelly Johnson (kelly.johnson@norskhome.com)
2022-09-15 - 5:32:26 PM GMT- IP address: 24.19.200.72
Document emailed to Ruth Jewell (jewellra916@live.com) for signature
2022-09-15 - 5:35:23 PM GMT
Email viewed by Ruth Jewell (jewellra916@live.com)
2022-09-15 - 6:34:01 PM GMT- IP address: 104.47.66.126
dp Document e-signed by Ruth Jewell Qewellra916@live.com)
Signature Date: 2022-09-15 - 6:34:20 PM GMT - Time Source: server- IP address: 71.231.152.11
Document emailed to Karl Dropping (karl.dropping@norskhome.com) for signature
2022-09-15 - 6:34:23 PM GMT
Email viewed by Karl Dropping (karl.dropping@norskhome.com)
2022-09-15 - 9:44:08 PM GMT- IP address: 24.22.165.0
d Signer Karl Dropping (karl.dropping@norskhome.com) entered name at signing as Karl J Dropping
2022-09-15 - 9:44:34 PM GMT- IP address: 24.22.165.0
&Q Document e-signed by Karl J Dropping (karl.dropping@norskhome.com)
Signature Date: 2022-09-15 - 9:44:35 PM GMT - Time Source: server- IP address: 24.22.165.0
Document emailed to alcohendesign@gmail.com for signature
2022-09-15 - 9:44:37 PM GMT
Email viewed by alcohendesign@gmail.com
2022-09-15 - 10:03:49 PM GMT- IP address: 50.125.80.164
Signer alcohendesign@gmail.com entered name at signing as Albert H Cohen
2022-09-15 - 10:04:41 PM GMT- IP address: 50.125.80.164
a Adobe Acrobat Sign
650 Document e-signed by Albert H Cohen (alcohendesign@gmail.com)
Signature Date: 2022-09-15 - 10:04:43 PM GMT - Time Source: server- IP address: 50.125.80.164
Document emailed to garrett.f.dean@gmail.com for signature
2022-09-15 - 10:04:45 PM GMT
Email viewed by garrett.f.dean@gmail.com
2022-09-22 - 5:58:50 PM GMT- IP address: 71.212.168.196
Signer garrett.f.dean@gmail.com entered name at signing as GEO Group Northwest, Inc.
2022-09-22 - 6:00:09 PM GMT- IP address: 71.212.168.196
&9 Document e-signed by GEO Group Northwest, Inc. (garrett.f.dean@gmail.com)
Signature Date: 2022-09-22 - 6:00:10 PM GMT - Time Source: server- IP address: 71.212.168.196
Icy Document emailed to wsmchang@aol.com for signature
2022-09-22 - 6:00:12 PM GMT
Email viewed by wsmchang@aol.com
2022-09-22 - 6:02:42 PM GMT- IP address: 71.212.168.196
Signer wsmchang@aol.com entered name at signing as William Chang
2022-09-22 - 6:03:26 PM GMT- IP address: 71.212.168.196
Document e-signed by William Chang (wsmchang@aol.com)
Signature Date: 2022-09-22 - 6:03:27 PM GMT - Time Source: server- IP address: 71.212.168.196
Agreement completed.
2022-09-22 - 6:03:27 PM GMT
a Adobe Acrobat Sign