APPROVED BLD2024-0473 signed SI formi
SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number: BLD2024-0473
Project: Jeffrey and Pittman, 16012 74"' Place W
Prior to issuance of 'a peranit, this firm inust be completed in its entirety and returned to the Cily for
approval. The completed brit must have signatures of acknowtet figment by all parties.
DtiTIES AND RESPONSIBILITIES
Smehil Inspection Firm and Special Insnectors
The Special Inspection firm of
will perform special inspection for the following types of work (separate forms must be Submitted if more than one
1=irni is to be employed).
LZ 1. Soils as per Gco-technical Engineer Report
CXJ installation of helical piles and Brackets Bolting
Concrete
LX� Installation of Carbon fiber stitch repair
❑ Shotcrcte
❑ Structural Masonry
❑ Structural Steel/Wclding
❑ high Strength Bolting
❑ Spray applied Fireproofing
Smoke Control Systems
-! Lateral Wood
Structural Observation by design professional
11 Water -Resistive Barrier coating and cladding
E�' Retaining Fall Block Installation
J 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. f f inspection is for work that is not: covered by the WABO categories, or the inspector is not WABO certi fied,
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
plaits, specifications and approved revisions or addenda. Any unresolved discrepancies must be detailed in
the final report.
\cdhntivr-uscrfs us(Y1)TAS°clakau Dcsk1op'1-)0N0V;INS Common. Lcucrs and Special Inspection rorm� 2019'Spccial Inspection form, Sf 2024-0473 Pitlman
and Icftcrn Minor I:s111.A,docx 5, 1020'4
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 Dcuartment
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 «ay as to ensure that Al required City approvals are obtained,
prior to work shown on the revisions being perl6rmed in the field.
Owner
The project owner, or the architect or engineer acting as the owners agent, shall employ the spccial 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 agrccmcnt 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 agfrecmcnt 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.
Jeff Pittman and/or Jeff Taylor °� 05-24-2024
Owner: Y Signature JeffievPla,n:m�r.:ev24.2o2413:23PDT! Date
Alesha Stickles- 5/29/24
Contractor: _R$R FoundationSci Sped—s SigTnature -_ Date —
Arch;En,r: L120 Engineering Signature Date 05/29/2024
Special Insp: Signature Date
Jeffrey S Mercer
Uignany signee oy Jettrey S
special Inspection Agency: Jeff Mercer-Krazan Signature a" ce�J w"sMece"'s, Date 5-29-24
— — — - — — Mercer em*am6AWdates.n.-
eil=je0mercwd*azawm
Ogle: 2024.05.200 ZI:25-07'00'
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
By: Va7t_�z c4*,vL&L Date 5/ 3 0/ 2 0 2 4
1,cdInsvr-uscrrsuscrpT,)&dakau Desk top, DON OVANS Comments Lepers and Special Inspection lbimm 2019'Spceial Inspection forms SI2014-0473 Pittman
and Icffcr\ :Minor I S111.A.doex 5: 10/20"_'4