APPROVED BLD - SI FORM BLD2021-1101OF ED4O SPECIAL INSPECTION AND TESTING AGREEMENT
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BLD2021-1101 RECEIVED
�St. I Oct 19 2021
Permit #: BLD2021-1101 CITY OFEDMONDS
SERProject: 17808 73rd PL W DEVELOPMENDEPARTMMENTENT CES
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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
Krazan
will perform special inspection for the following types of work (separate forms must be submitted if more than one
firm is to be employed):
X- Verify element materials, sizes and lengths comply with the requirements.
X- Determine capacities of test elements and conduct additional load tests as required.
X- Inspect driving operation and maintain complete and accurate records for each element.
X- Verify placement locations and plumbness. Confirm type and size of hammer. Record
number of blows per -foot of penetration. Determine required penetrations to achieve design
capacity.
X- Record tip and butt elevations and document any damage to foundation elements.
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.
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.
Owne r•
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: Steven Mitchell
Signature 5&"-1L
R&R Foundation Specialist LLC
Contractor: Signature
Longitude One Twenty M�� rhA&6Wz
Arch./Eng: g Y SlgnatureMans Thurflell (Sep 3 02107:05 PDT)
Special Insp Krazan
Special Insp. Agency Krazan
72A2 StiIMO/-
Slgnaturejeffrey S Mer er (Sep 1, 202106:51 PDT)
Date 8/31 /2021
Date: 8/31 /2021
Date: Sep 30, 2021
Date: Sep 1, 2021
ACCEPTED FOR THE CITY OF EDMONDSS BUILDING DIVISION
By: �iQi(i�/%� 900�Kl�ld _ - Date: 10/20/2021
BLD2021-1101 _Required_Prior_to_Issuance_8-
31-2021 SI FORM-MITCHELL FOUNDATION
STABILIZATION (1) Steven Mitchell
Final Audit Report
Created: 2021-08-31
By: Barbara Stasiak (barbara@rrspecialist.net)
Status: Signed
Transaction ID: CBJCHBCAABAAzwed8s8D145ffvuJLDmfgnkaaYHfSHwx
2021-09-30
"BLD2021-1101_Required_Prior_to_Issuance_8-31-2021 _SI_FO
RIVI-MITCH ELL_FOUNDATION_STABILIZATION (1) Steven Mit
chell" History
') Document created by Barbara Stasiak (barbara@rrspecialist.net)
2021-08-31 - 11:06:09 PM GMT- IP address: 73.254.117.42
P+ Document emailed to Jeffrey S Mercer Qeffmercer@krazan.com) for signature
2021-08-31 - 11:06:33 PM GMT
n Email viewed by Jeffrey S Mercer (jeffmercer@krazan.com)
2021-08-31 - 11:27:38 PM GMT- IP address: 73.42.232.164
A0 Document e-signed by Jeffrey S Mercer (jeffmercer@krazan.com)
Signature Date: 2021-09-01 - 1:51:36 PM GMT - Time Source: server- IP address: 50.243.99.61
Document emailed to Mans Thurfjell (mthurfjell@1120engineering.com) for signature
2021-09-01 - 1:51:38 PM GMT
`) Email viewed by Mans Thurfjell (mthurfjell@1120engineering.com)
2021-09-30 - 2:04:41 PM GMT- IP address: 76.121.94.23
CSo Document e-signed by Mans Thurfjell (mthurfjell@I120engineering.com)
Signature Date: 2021-09-30 - 2:05:01 PM GMT - Time Source: server- IP address: 76.121.94.23
Agreement completed.
2021-09-30 - 2:05:01 PM GMT
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