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SPECIAL INSPECTION AND TESTING AGREEMENT
Permit Number:
Project:
1RLD2024m0349
Landsvcrkg 1951194" Place West
Prior to issuance of a permit, this fiorm must be completed in its entirety and returned to the Cityfor
npprnraL The conWletedfornt must have signatures of acknowledgment by all Parties.
DEITIES AND RESPONSIBILITIES
0
SDedal Inspection Firm and Special InsPectors
The Special Inspection firm of _
will perform special inspection for the foil
firm is to be employed).
Z Adhesive Anchor Installation
El Bolting in Concrete
El Prestressed Concrete
D Shotcrete
❑ Structural Masonry
El Structural Steel/Welding
EL High Strength Bolting
owing types of work (separate forms must be submitted if more than one
El Spray applied Fireproofing
r'l Smoke Control Systems
❑ Lateral Wood
D Structural Observation by design professional
El Water -Resistive Barrier coating and cladding
D Retaining Wall Block Installation
El Retaimngr Wall Footings
All individual inspectors to be employed on this project will be WABO certified for the type of work they are to
0
inspect. If inspection is for work that is not covered by the WABO categories, or the inspectoris not WABO certified,
a detailed reswne of the inspector and firm must be submitted. The resume must show that the inspector and the firm
arP ni�alified bv 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
ad( enda 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 mid approval revisions or Adenda. Any unresolved discupatwies usc be detailed 41
the final report.
\V,j,dmsvr-u sed'sViseq)roiWakaull)esktopUx)NOVANS Comments betters and Special Inspection f0mis 2019\ pecial Inspection formss12024-0349
Landsverk.docx 4/15/2024
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The contractor shall provide the special inspector or agency adequate notification of work requiring inspection. 1 tie
Ot), approved plan and specifications must be made available, at the _jobsite for the use of the special inspector and
the City inspector. The conctor shall maintain all daily inspection reports, on site, for review by all parties.
The special inspection functions arc 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.
Buildin2 DeDartment
The buildina0 department shall review any revisions and addenda. The City inspector 1vill monitor the special
inspection functions for compliance with ttie 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
inspection required and shall include a schedule for inspection and testing.
coordinate their revision and addenda process in such a way as to ensure that all r
prior to work shown on the revisions being performed in the field-,
of special
1 he architect and/or engineer will
equired City approvals are obtained,
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�y void this agreement andtill �Uli�illlg Official's approval oftl�e special in
spector. 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 agreemen
on the project until nonconforming items have been resolved.
ACKNOWLEDGMENTS
t may result in a STOP WORK notice being posted
I have read and agree to comply with the terms and conditions of this agreement.
Owner:
Contractor:
Arch/Engr,41
Special Insp:
144 00k N L*AO WSJ MC Signature
gmo.�►t ' '0
Date
Date 512P12on I ----I - -e-%
Signature Date
Digitally signed by: Phil Haberman
Phil Haberman ph I@ obatgeo.comremailman C = AD 0= Cobalt
Cobalt Geosciences for Soils/Geo Phil Haberman Signature Geosciences Date: 2024.05.30 12:18:02-07'00' Date 5/30/2024
Special Inspection Agency: Signature Date
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
Date
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Landsveric.docx 4/15/2024