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Approved SI AgreementSPECIAL INSPECTION AND TESTING AGREEMENT Permit #: Project: _BLD2021-0775 Foundation Stabilization 10623 2291h PL SW Prior to issuance of a permit, this form must be completed in its entirety and returned to the Cityfor 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): 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 Helical Pile Installation 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\userpr•of$\ecarter\Desktop\Special inspection form I.doc6/22/2021 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. e Jun 23, 2021 Owner: Jeffrey Maxin Signature Jerrre Maxin Jun23,202110:49PDT) Date Contractor: R&R Foundation Specialist Signature a�� S� Date: 6/23/2021 Arch./Eng: Longitude One Twenty Signature Date: Special Insp. Krazan Signature Date: Special Insp. Agency Krazan ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION By: Date: _mac Z Q \\edmsvr-userfs\userprof$\ecarter\Desktop\Special inspection form I.doc6/22/2021 Signature: S Mom" Jef r y S f ercer (Jun 23, 2021 11:14 PDT) Email: jeffinercer@krazan.com Signature: Mans Thur�jell Mans Thurfjell (Jul 1, 202111:41 PDT) Email: mthurfjell@1120engineering.com BLD2021-0775_Required_Prior to_Issuance_6- 23-2021_SI_Agreement_2021-0775_(unsigned) Final Audit Report 2021-07-01 Created: 2021-06-23 By: Barbara Stasiak (barbara@rrspecialist.net) Status: Signed Transaction ID: CBJCHBCAABAA78uzX971aclYMWBA7LdxOGj3GIRVThUy "BLD2021-0775_Required _ Prior_ to_ Issuance_6-23-2021 _SI_Agr eement_2021-0775_(unsigned)" History Document created by Barbara Stasiak (barbara@rrspecialist.net) 2021-06-23 - 4:34:01 PM GMT- IP address: 73.254.117.42 Document emailed to Jeffrey Maxin Qeffrey.maxin@gmail.com) for signature 2021-06-23 - 4:34:26 PM GMT `1l Email viewed by Jeffrey Maxin (jeffrey.maxin@gmail.com) 2021-06-23 - 5:48:48 PM GMT- IP address: 66.249.84.95 S© Document e-signed by Jeffrey Maxin Qeffrey.maxin@gmail.com) Signature Date: 2021-06-23 - 5:49:48 PM GMT - Time Source: server- IP address: 205.251.233.183 Document emailed to Jeffrey S Mercer Qeffmercer@krazan.com) for signature 2021-06-23 - 5:49:50 PM GMT Email viewed by Jeffrey S Mercer (jeffmercer@krazan.com) 2021-06-23 - 6:13:55 PM GMT- IP address: 50.243.99.61 Yo Document e-signed by Jeffrey S Mercer Qeffmercer@krazan.com) Signature Date: 2021-06-23 - 6:14:26 PM GMT - Time Source: server- IP address: 50.243.99.61 Document emailed to Mans Thurfjell(mthurfjell@1120engineering.com) for signature 2021-06-23 - 6:14:27 PM GMT i Email viewed by Mans Thurfjell(mthurfjell@1120engineering.com) 2021-07-01 - 6:40:21 PM GMT- IP address: 24.22.249.53 Document e-signed by Mans Thurfjell (mthurfjell@1120engineering.com) Signature Date: 2021-07-01 - 6:41:36 PM GMT - Time Source: server- IP address: 24.22.249.53 a Adobe Sign 10 Agreement completed. 2021-07-01 - 6:41:36 PM GMT a Adobe Sign Toe Seattle Chimes The Seattle Times P.O. Box 34698 Seattle, WA 98124 1-800-542-0820 Billing Address: Dev Services Dept City of Edmonds 121 5th Ave N Edmonds Washington 98020 Account Number 100129095 Account Balance $0.00 Purchase Order RECEIPT Product Name Charge Detail Service Period Cost Daily Sunday Unit Price: $58.50 02 Jul 2021 to 05 Aug 2021 $58.50 Total: $58.50 Jul 02 2021 Payment ($58.50) Invoice Balance: $0.00 Payment Related Information Payments Payment Method Payment Number Payment Date Payment Credit Card Number CreditCard P-07483788 07/02/2021 ************4929 Powered by ZUOra Page 1 of 1