20130731082136475.pdfCITY OF EDMONDS — ENGINEERING DIVISION
SPECIAL INSPECTION AND TESTING AGREEMENT
PERMIT # BLD20120858 DATE:
PROJECT SITE ADDRESS: 15500 75t°' PI WEdmonds WA, 98026,,,_
., _
PROJECT NAME: Olson Single nce
Fam ly Reside
,L _LEarth Subsidence Landslide hazard Area
SPECIAL INSPECTION AGENCY— I N
*One form must be completed by each Special Inspection Agency or Inspector.
SPECIAL INSPECTIONS REQUIRED: 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 REQURING SPECIAL INSPECTION: Special inspections will be required for the following
categories of work: FOR SPECIFIC INFORMATION REGARDING REQUIRED SPECIAL
INSPECTIONS SEE TME STATEMENT OF SPECIAL INSPECTION NOTED AS A CONDITION ON
THE BUILDING PERMIT AND/OR ON THE APPROVED PLANS.
❑ Landslide Repair RE `0141
Erosion and Sediment Control
Detention outfall pipe "JUL 3 ()
DWEIDP�AEN EHO,02013
CITY OF R)MONDS ,
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor and special inspector shall
complete this agreement and return to a Permit Coordinator prior to pen -nit 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
perfon-ning the inspection shall be submitted. When applicable, the company performing inspections
must be accredited by the American Association of State Highway and Transportation Officials
(AASHTO) R18.
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A. Duties and Responsibilities of the Special Inspector
1. OBSERVE WORK
The special inspector shall observe the site work for conformance with the approved (stamped)
plans and specifications. Special inspections are to be performed as needed, to confirm that the
work being completed meets specifications and approved plans.
2. REPORT NONCONFORMING ITEMS
The special inspector shall bring non -conforming items to the immediate attention of the
contractor and engineer of record. The special inspector shall provide a report to the Engineering
Division notifying of any items not resolved and/or not installed per the approved plans and
specifications.
Items not constructed per the approved plans and specifications will result in a review of the plans
to determine what requirements will be needed for the project to meet the necessary stormwater
requirements; such as removal and reconstruction, re -design of the stormwater management
system(s), etc.
Final approval for the project will not occur until installation of all required improvements is
complete and accepted by the Special Inspector and the City.
3. FINAL CONSTRUCTION REPORT
The special inspector or inspection agency shall submit a final signed report or Certificate of
Compliance to the City stating that all items requiring special inspection and testing were fulfilled
and reported. The report shall also include a statement from the inspector stating to the best of
his/her knowledge the project is in conformance with the approved plans, specifications, and
approved plan revisions, if any. Items not in conformance, unresolved items or any discrepancies
in inspection coverage (i.e., missed inspections, periodic inspection when continuous inspections
were required, etc.) shall be specifically addressed in this report.
B. Contractor Responsibilities
1. NOTIFY THE SPECIAL INSPECTOR OF ALL REQUIRED SPECIAL INSPECTIONS
It is the duty of the contractor to notify the special inspector when work is ready for special
inspection. Note, the items listed under the statement of special inspection on -the building permit
and as noted on the approved plans and specifications are required to have special inspections.
Adequate notice shall be provided by the contractor so that the special inspector has time to
become familiar with the project. All work requiring special inspection must be approved prior to
concealing or covering said work.
2. PROVIDE ACCESS TO APPROVED PLANS
The contractor is responsible for providing the special inspector access to approved plans at the
jobsite.
3. RETAIN SPECIAL INSPECTION RECORDS
The contractor is responsible to retain at the jobsite all special inspection records submitted by the
special inspector. These records are to be provided to the City Engineering inspector upon request
and upon completion of work.
C. City of Edmonds Engineering Division Responsibilities
1. APPROVE SPECIAL INSPECTION
The Engineering Division shall approve all Special Inspectors and special inspection requirements.
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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 Reponsibilities
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 terms and conditions of this agreement.
Owner name
print or ty
Date
-
General Contractor Company/Owner name a, oJ) e--,
(please print or typej
Signature
Date
Special Inspector/A ency name I
(please print or type)
Signature
Engineer of Record name
(please print or type)
Date
Signature - Date
Return the original signed agreement to:
City of Edmonds Development Services Department
1215th Avenue North, City Hall Second Floor
Edmonds, WA 98020
F.1110141mul" IrKell 1111mall I
City Official Signatt
Title: 0e..,/kA-6\ i,
GINVERING DIVISION:
0
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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 terns and conditions of this agreement.
Owner name
(please print or type)
Signature Date
General Contractor Company/Owner name
(please print or type)
Signature
Special Inspector/Agency name
(please print or type)
Signature.
Engineer of
Signature
Date
Date
(pleasA print or type)
Date `7 30 11913
Return the original signed agreement to:
City of Edmonds Development Services Department
1215t' Avenue North, City Hall Second Floor
Edmonds, WA 98020
ACCEPTED BY CITY OF
City Official Signature,
Title: 9A t\
INEERING DIVISION: /
Date ' / � � I �
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