APPROVED BLD BLD2021-1546+SIGNED SI FORM+12.21.2021_8.54.37_AM+2584657RESUB
Dec 21 2021
4 OFEDAf
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Fst. 1890
CITY OF EDMONDS
DEVELOPMENT SERVICES
SPECIAL INSPECTION AND TESTING AGREEMIENT
Permit #: BLD2021-1546
Project: McCallum, 21630 981" Avenue West
Prior to issuance of a permit, this form must be completed in its entirety and returned to the City for
approval. The completed form must have signatures of acknowledgment by all parties.
DUTIES AND RESPONSIBILITIES
Special Inspection Firm and Special Inspectors:
The Special Inspection firm of Geotech Consultants, Inc. 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 Epoxy
High Strength Bolting
Spray applied Fireproofing
Smoke Control Systems
Lateral Wood
Structural Observation by design professional
X Soils
X Pipe piling installation
Piling refusal verification
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 WABO
certified, a detailed resume of the inspector and firm 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.
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. 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 and approved revisions or addenda. Any unresolved discrepancies must be
detailed in the final report.
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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.
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 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 ensure 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: John McCallum SignatureJerOAA -4•-OCea!!un
Contractor: Howard Clark
Arch./Eng:
Dennis Titus
Date 12 / 17 / 2021
SignatureDate: 12/20/2021
Signature its ;� Date: 12/17/21
Special Insp. Robert Ward Signature A Roiet� pymd
Special Insp. Agency Geotech Consultants, Inc.
ACCEPTED FOR THE CITY OF EDMONDS BUILDING DIVISION
By: W. W pfILsZIL Date: 12 / 2 2 / 2 0 21
Date: 12 / 17 / 2021
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McCallum.doc 11 /22/2021
Doc ID: aa6369le692967f679d13169298acfcOa90f69c9
OHELLOSIGN
Audit Trai
TITLE
FILE NAME
DOCUMENT ID
AUDIT TRAIL DATE FORMAT
STATUS
Document History
McCallum Deck/Patio/Driveway Special Inspection Form
BLD2021-0873_SPEC... REEMENT_Epoxy.pdf
aa63691e692967f679d13169298acfcOa90f69c9
M M / DID / YYYY
Completed
`:J 12 / 17 / 2021 Sent for signature to John A. McCallum
SENT 17:46:37 UTC 0Icalmc@comcast.net), Howard Clark
(howard@foundationsupports.com) and Robert Ward
(robw@geotechnw.com) from cgcontracts@cgengineering.com
IP: 50.237.138.130
<0 12 / 17 / 2021 Viewed by Robert Ward (robw@geotechnw.com)
VIEWED 18:00:25 UTC IP: 96.69.202.193
12 / 17 / 2021 Viewed by Howard Clark (howard@foundationsupports.com)
VIEWED 19:56:59 UTC IP: 174.204.78.174
12 / 18 / 2021 Signed by Robert Ward (robw@geotechnw.com)
SIGNED 00:10:03 UTC IP: 96.69.202.193
(0 12 / 18 / 2021 Viewed by John A. McCallum Qlcalmc@comcast.net)
VIEWED 02:18:03 UTC IP: 71.231.157.101
Powered by OHELLOSIGN
OHELLOSIGN
Audit Trai
TITLE
FILE NAME
DOCUMENT ID
AUDIT TRAIL DATE FORMAT
STATUS
Document History
McCallum Deck/Patio/Driveway Special Inspection Form
BLD2021-0873_SPEC... REEMENT_Epoxy.pdf
aa63691e692967f679d13169298acfcOa90f69c9
M M / DID / YYYY
Completed
12 / 18 / 2021 Signed by John A. McCallum Olcalmc@comcast.net)
SIGNED 02:21:00 UTC IP: 71.231.157.101
12 / 20 / 2021 Signed by Howard Clark (howard@foundationsupports.com)
SIGNED 20:45:19 UTC IP: 73.53.33.196
0-// 12 / 20 / 2021 The document has been completed.
COMPLETED 20:45:19 UTC
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