20130312154328773.pdfV ED
CITY OF EDMONDS — ENGINEERING DIVISION
SPECIAL INSPECTION AND TESTING AGREEMENT
PERIVf IT 9- Zb 1 0 09 DATE: I / I Z'
r
PROJECT -SITE ADDRESS: '102-0 At aytiM '!S'
PROJECT NAME: g K. ( IjAJ
_5 e—f770
SPECIAL INSPECTION AGENCYGro-Fec- ff,+f 1 cQ 61 �Xkg�.
*One form must be completed by each Special Inspection Agency or Inspector.
SPECLA-L INSPECTIONS RE QUI ED- Special inspections are required for this project, as
applicable, in accordance with Title 18 Edmonds Community Development Code (ECDC), When
required, the project must be installed/constructed per approved plans and specifications. The owner or
the registered design professional in charge shall employ an independent testing -/,inspection agency/special
inspector to perform required special inspections. The special inspector shall be a qualified person with
competence for inspecting the specific type of construction or operation requiring special inspection. The
owner, registered professional, contractor and special inspector/agency shall provide a special inspection
report detailing compliance with approved plans and specifications directly to the Engineering Division.
WORK REQUIZING SPECIAL INSPECTION: Special inspections will be required for the following
categories of work: FOR 'SPECIFIC INFORMATION REGARDING REQUIRED SPECIAL
INSPECTIONS SEE THE STATEMENT OF SPECIAL INSPECTION NOTED AS A CONDITION ON
THE BUILDING PERMIT AND/OR ON THE APPROVED PLANS.
F1 Permeable Pavement (asphalt, concrete, paving blocks,, "grass-crete" and others)
F1 Raingarden (Bioretention Cells)
Erosion and Sediment Control
E] Vegetated Roofs
E] Soil Conditions Prior to Placing Footings and During Construction:
0 Retaining Wall Drainage:
BEFORE A PE RMIT CAN BE ISSUED: The owner and contractor and special inspector shall
complete this agreement and return to a Permit Coordinator prior to permit issuance.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the
Engineering Division prior to performing any duties or inspections. The credentials of the specific person
ZD
performing the inspection shall be submitted. When applicable, the company performing inspections
must be accredited by the American Association of State Highway and Transportation Officials
(A-A-SHTO) RI 8.
A. Duties and Responsibilities of the Special. InsnEctor
g
1. OBSERVE, WORK
C:\Users\kgontiyUppData\Local\Microsoft\Windows\Temporary Internee
Files\Content.Outlook\V3ESY4HA\Speciallnsp-IctionA-reement-ENG.doc Revised 06.06.2012
C. Cit- of Edmonds Eninee>rin Division Responsibilities
1. APPROVE SPECIAL INSPECTION
The Engineering Division shall approve all Special Inspectors and special inspection requirements.
2. MONITOR SPECIAL'INSPECTIONS AND APPROVE REPORTS
Work requiring special inspection and performance of special inspectors shall be monitored by the
Engineering Division Inspector. Engineering Inspector approval must be obtained prior to
placement of concrete or other similar activities in addition to that of the special inspector.
3. FINAL APPROVAL
The Engineering Division may provide final inspection approval after the special inspection
report(s) have been submitted and accepted by the City.
D. Owner Responsibilities
1. The project owner or the engineer or architect of record acting as the owner's agent shall fund
special inspection services.
E. Engineer or Architect of Record Responsibilities
1. Prepare Statement of Special Inspections.
2. Review the special inspection reports and provide corrective action for work that may not conform
to the approved plans.
ACKNOWLEDGEMENTS
I have read and agree to comply with the termsand conditions of this agreement.
Owner name k.�a,.-} s;\t12�u
e`!!0—Ht or ty
Signature Date 0 1 t
General Contractor Campan Owner Warne
Iease riot or type)
Signature` ! Q� f' Date 1 13 l ZZ®
Special Inspector/Agency name GJet.k alt, 1
_ (please print or type)
Signature
Engineer of Record name
(please print or type)
Date
4eA
Date 1 24191 t 7--''��
S:\ENGR\REFERENCE-LIBRARY\FORMS-Form Letters-Checklists\Special Inspection\SpeciallnspectionAgreement-
ENG.doc Revised 06.06.2012