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°� SPECIAL INSPECTION AND TESTING AGRE EMENT
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Permit #: l
Project:
Prior to issuance of rG pei mit, this foi-m inust he completed in its entirety rarart reframed to the City for•
upprovuL The completed form must have signutures of acknowleflgnient by call parties.
DUTIES AND RB SPONSIBILITU1,S
Special Inspection Firm and Special Inspectors:
r
The Special Inspection firm of ��i Pl�� , f e ° 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
a
Other
❑ Other
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 WA 30
certified, a detailed resume of the inspector and film 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. t
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. hispection
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 apruue> iosaddenda. Any unresolved discrepancies must
be detailed in the final report. U �
OCT 12 2012
BUILDING DEPAR.MENI'
CITY OF EDMO DS
LRBuilding New Polder 2010\Forms\Special inspection rorm.doc4/30/2012
t 3
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,
Buildina 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.
Desian 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 insure 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.
/ _
Owner: ��� Signature Date
_;x ✓`
Contractor: 511W OLS &U) Signature.
Date:
Arch./Eng: Signature Date:
Special Insp,
Special Insp. Agency
Signature
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DEPT.
Date:
LABuilding New Folder 2010Torms\Special inspection form.doc,1/30/2012
Date:
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 i$ 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-digate on the plans and specifications the specific types of special
inspection required, and shall include a schedTsle for inspection and testing. The architect and/or engineer will
coordinate their revision and addenda process in such a way as to insure that all required City approvals are
obtained, prior to work shown on the revisions'beingperformed in the field.
Owner: {
The project owner, or the architect or engineer,acting as the owners agent, shall employ the special inspector or
agency- '_ -�—. ----------
A failure of the special inspector or firm to perform in Iceeping 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 anew special inspector and/or firm would need to be proposed for approval. A. failure of the
design and/or construction parties to perform iA accordance with this agreement may result in a STOP WORD
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 thus agreement.
Owner: Signature Date
Contractor: Signature Date:
Arch./Eng: i Signature Date:
lr�
Speciallnsp.
Special Insp. Agency
ACCEPTEDF THE CITY OF EDMONDS BUILDING DEPT.
By Date' ` —1^1
L.Building Nt!w FoTder 2010\Fornts' Speci,ii inspection form.doc4/3012012
BLD2012-0265 REQUIRED SPECIAL INSPECTIONS--
® SOIL CUTS
® TEMPORARY ECO -BLOCK SHORING
® FOUNDATION SUB -GRADE VERIFICATION
RETAINING WALL/ROCKERY PLACEMENT
® PLACEMENT OF FILL AND COMPACTION (INCLUDING SWIlV
POOL)
e SUBSURFACE DRAINAGE INSTALLATION
® TEMPORARY AND PERMANENT EROSION CONTROL
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