APPROVED BLD BLD2020-0581+SIGNED SPECIAL INSP FORM+8.3.2020_6.45.26_PMRESUB
Aug 04 2020
CITY OF EDMONDS
Mo DEPARTMENT
DEVELOPMENTSERVICES
OF ED
�a SPECIAL INSPECTION AND TESTING AGREEMENT
U N
Permit #: BLD2020-0581
Project: Murray, 630 Alder 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
X Structural Epoxy
_ High Strength Bolting
Spray applied Fireproofing
Smoke Control Systems
Lateral Wood
Structural Observation by design professional
Soils
Expansion Bolts/Threaded Expansion Inserts
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\userprof$\dakau\Desktop\Comments Letters and Special Inspection fomns 2019\Special Inspection forms\Sl 2020-0581 Murray,
Epoxy hold down existing foundation.doc6/30/2020
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. �I
Owner: Signature Date / ,LA' ZOOP
Contractor: (U N r) (-I p E D� Signature
Date:
�g.� ��-�5 (11"i ��6�r wsmj Signature I ptj � ' f �/L 1 Date: 7 �l D ' & ZV
Special Insp.Z41 20str0w — Signature49&v��Date: I ao ;L O
P�cs�d�k
Special Insp. Agency
Dct Roscnax& dr►1C
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
M.
(Um" Date: 8/18/2020
\\edmsvr-userfs\userprof$\dakau\Desktop\Comments Letters and Special Inspection forms 2019\Special Inspection forms\SI2020-0581 Murray,
Epoxy hold down existing foundation.doc6/30/2020
f'allRlA7 N �
STANDARD
�: Q MMJW DETAIL /
ER-9oo
4-
�---+5E4SonIaL yE�P
A
�o 4
Loi iy FLAT
W
QIw
.,•.. ,. `I r TOPSOIL.."R" �
�enodE ��xi�a I
,�'i�
r
F3&
W
N U1 Rao F
W l
W
Zel FPXkf1
5b, .0
cum Wurto 0
DATUM '
I dd.D'
D LDE IZ STD r14
rLvvL
O
Ca3� �LDM e37-
f,:DMwv,5 qVnZD-
CCU) FoUND�'(IDIU c7a�N5
t�4 DOWELS f-PoxY.
i
IJ°T�: �KoNr rOZC14
rro mv-E
Rio" ihl(o �rpac�,
1
OTTO ROSENAU & ASSOCIATES, INC.
Geotechnical Engineering, Construction Inspection & Materials Testing
6747 M. L. King Way South, Seattle, Washington 98118-3216 USA
Tel: (206) 725-4600 . Toll Free: (888) OTT04-US • Fax: (206) 723-2221
WBE W2F5913684. WABO Registered Agency • Website: www.ottorosenau.com
New Project Questionnaire: Please fill in the following fields completely so we can ensure that your project is set
up correctly.
Project Information
Project Name: Murray
Site Address: 630 Alder St, Edmonds
Building Dept.: City of Edmonds
Superintendent:
Project Description:
Testing & Inspection Scope: Epoxy
Billing Information
Company Name: Jerry Murray
Mailing Address: 630 Alder St
Phone Number:
Contact Person:
Contact Phone No.:
P.O. Number:
City: Edmonds
425-770-4073
Permit Number: BLD2020-0581
Phone Number:
State: WA Zip: 98020
Fax Number:
Email Address.:
Prefers Invoices: ❑ via email P via mail
Job Number:
Report Distribution (Note: If the building dept. is specified above, they are included automatically and do not need to be listed below)
Company Name: Hanson Design
Mailing Address: 652 Alder St
Contact Person:
Phone Number:
City: Edmonds
Kristin Hanson
425-774-7129
Company Name:
Mailing Address:
City:
Contact Person:
Phone Number:
Company Name:
Mailing Address:
City:
Contact Person:
Phone Number:
Company Name:
Mailing Address:
City:
Contact Person:
Phone Number:
State: WA Zip: 98020
Email Address: hansondesign@hotmail.com
Project Role: ❑Owner❑✓ Arch. ❑Eng. ❑Cont. ❑Other
State:
Email Address:
Project Role: ❑Owner ❑Arch. ❑Eng
Zip:
❑Cont. ❑Other
State: Zip:
Email Address:
Project Role: ❑Owner ❑Arch. ❑Eng. ❑Copt. ❑Other
State: Zip:
Email Address:
Project Role: ❑Owner❑Arch. ❑Eng. []Cont. ❑Other