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CITY O'FEDMONDS — ENGINEERING DIVISION
SPECIAL INSPECTION AND TESTING AGREEMENT
PERMIT # BI,D20140317 DATE,
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PR0JEc,,r SITE ADDRESS. 1.591174"' P] W Edmonds W
PROJECT NAME: Saunders Residence
SPECIA1, INSPE CTION AGENCY
*One form must be completed by each Special Inspec0on Agency or Inspector.
SPECIA1, INSPECTIONS REQUIRED: Special inspections are required for this project, as
applicable, in accordance with Title 18 aAnd 19,10 of the Edmonds C'ommurrity Development Code
(17CDC). When required, the protect must be installed/constructed per approved plans and specifications.
The owner or the registered design professional in charge shall employ mi independent testinuYinspection
agency/special inspector to perform required special inspections, The special inspector shall be a
qualified person with competence for inspecting tile, specific type of construction or Oper',16011 requiring
special inspection. The owner, registered professional, contractor and special inspector/agency shall
provide a special inspection report detailing compliance with approved pLaris and specifications directly to
tlu- Engineering Division.
WORK la,QIJRING EC; A1, INSPEC'TION: Special inspections will be required for the following
categories of work: FOR SPECIFIC INFORMATION REGARDING REQUIRED SPECIAL,
INSPECTIONS SEE THE STATEMENT OFSPECIAL, INSPECTION Nam) AS A CONDITION ON
THE BUIL,DING PERMIT AND/OR ONTHE APPROVED PL,ANS.
Site Excavation
`site
m onnoring
firosion and Sediment Control
BEFORE A PERivirr CAN BE ISSUED, '['he owner an(]. contractor and special inspector shall
complete this agreement and return to a Permit Coordinator prior to permit issuance.
APPROVAI, OF SPECIA1, UNISPECTORS: Each special irispector shall be approved by the
Engineering Division prior to performing all), duties or inspections, The credentials of the specific, person
performing the inspection shall be submitted. When appliCable, the company performing inspections
rnum be accredited by the American Association of State Highway and Transportation Officials
(AASI-ITO) R I&
A.Duties and Rv�p.qvisibilifles of the,_,'-S'jktT Ins ecto-r
P
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.
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 storrnwater
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.
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 Regnonsibilities
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.
RN 30,3
1. APPROVE SPECIAL INSPECTION
The Engineering Division shall approve all Special Inspectors and special inspection requirements.
2. MONITOR SPECIAL INSPECTIONS AND APPROVE REPORTS
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Work requidrig special inspection and perforniance of speciai inspectors shall be monitored by the
Enoneefing Division Inspector. Engineering Inspector approval "Just be obtained prior to
placement of concrete or other sirailar activities inaddition to that of the, special inspector.
3. FINAL, APPROVAL
The Engineering Division may provide final inspection approval after ffie special illspection
report(s) have been subiaittedand accepted by the City.
D.
1. The prqject owner or the engineer or afetritext of record acting as the owner's agent shall fund
special inspection services.
E.
I. Prepare Staternent of Special Inspections,
2. Review the special inspection reports and provide corrective action for work that may not conforyu
to the approved plans,
ACKNOWLEDGhME NTS
I have read arad are to coup,ply with the tertras and coudifions of this agreement.
Owner Flame /- &-r 0
ME=
ff
Date
General Contrador Company/owner Hanle
year pflut ortyrat
44
Special Inspector/Agency name fi)ade, ,T Lasse-
(rAnse Pr 1 naw`type)
V -2/2-L
Engineer of Record name
((AMM, pAna urs lype)
flaaal:raa r' Date
Return the ofiginal signed aim-eRupent to:
City W'Edbyaonds Development Services Departaueag
121 5'h Avenue North, City Hall Second Floor
Edmonds, WA 98020
ACCEM.TM BY MY OF EW40NTS K NGIN4 BRING DIVISK.M:
("hy Official Signature
(>
pal -ye 3 t & A
Work requiring special inspection and perforixiance of special inspectors shall be monitored by the
Engineering Division Inspector. Engineering Lispector 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. L)w—neK-R--e..mms-ihL1 Ctm-s-
1. The project owner or the engincerorarchitect of record acting as the owner's agent shall -fund
special inspection services.
+;® Fpgior AgIc
:!gtect ofRecorAR 9M sibififies
�L qn
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.
ACKNOWLE4,DGEMENTS
I have read ated agree to comp4y ivilh the terms and con difloyes of agreement,
Owner rrarne
(Plemprint or type)
Date
General Contractol C m awly/Owiler name.
y
gmw pAnt or ry�L)
Signature w.Date.
Special Inspector/Agency name
(plean print or type)
Date
Enghacer of Record name David Dougherty
August 11, 2014
y2,
Date
Return the o0ginal signed agweement to:
City of Edmonds Development Services Depailment
1215'1' Avermue North, City Hall Second Floor
Edmonds, WA 98020
ACCEVITM ]BY CITY OFEDMONDS ENGINEERING DIVISION -
City Orricial . .....
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