HomeMy WebLinkAboutBLD2020-00317 Special Inpsection and Testing - BLD Inspections - 9/10/2020 Mason County Community Services
Building Uvision
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.co.mason.wa.us
(All references are per the_2015 International Building Code)
Project Name: e 1 rp'/► o , 0 1 v
Project Address: ?'Z E' 1 l2Ct•9C ! I �1� •T f��� [� ® UJA
Building Permit Number: Date Issued:
BEFORE A PERMIT CAN BE ISSUED: The registered Design Professional in responsible charge shall fill out the Agreement
and include the name and address of the company or inspector. Two (2) copies of this form are to be submitted to the
County prior to the issuance of a building permit. If changes are made as to who will perform the special inspections a new
form shall be submitted and turned into the Building Permits&Inspections Division for approval.
STATEMENT OF SPECIAL INSPECTIONS: In addition to this Agreement, a "Statement of Special inspections" shall be
provided per IBC 1704.3. This Statement shall be made as part of the approved plans, and be placed in a conspicuous
location,such as the first page of the construction plans or the first page of the structural sheets.
SPECIAL INSPECTORS: All special inspectors shall be approved by the Building Division prior to performing any duties. The
special inspector shall provide proof of certification as a special inspector for each inspection item and be licensed by the
State of Washington.
SPECIAL INSPECTION REPORTS: Special inspection reports are to meet the requirements of IBC 1704.2.4. Copies of each
report are to be sent to the address listed in the letterhead noting the Project Address and Permit Number. A final report
shall be submitted stating that all special inspection and structural testing items were completed and are in conformance
with the approved design drawings and specifications. Items not in conformance,unresolved items,or any discrepancies in
inspection coverage (i.e. missing inspections, periodic inspections when continuous was required,etc.)shall be specifically
itemized in the final report.
Areas requiring special inspection: Name of Agency: Address&Contact Information
❑ Unapproved Fabricators(IBC 1704.2.5)
Other than Structural Steel(IBC Table 1705.2.2)
❑ Steel floor&roof decks
❑ Welding of reinforcement
❑ Cold-formed steel
Structural Steel
❑ Welding(Per N5.4 of AISC 360-10)
❑ Details(Per N5.7 of AISC 360-10)
❑ High-strength bolts(Per N5.6 of AISC 360-10)
Concrete Construction(per IBC Table 1705.3)
Reinforcement,embeds,anchors
Formwork
Materials
❑ Shotcrete
❑ Post-tensioned/Pre-stressed Concrete
❑ Erection of precast concrete
Page 1 of 3
Mason County Community services
Building Division
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.co.mason.wo-us
Areas requiring special inspection: Name of Agency: Address&Contact Information
Masonry Construction(IBC 1705.4)
❑ Prior to Construction(Article 1.15,TMS-602)
❑ As Construction Begins(Article 1.19.2,TMS-402)
❑ Prior to Grouting(Table 1.19.2,TMS-402)
❑ During Construction(Per TMS-402&TMS-602)
Wood Construction
❑ High-Load Diaphragms(IBC 1705.5.1)
❑ Wood Trusses>60ft(IBC 1705.5.2)
❑ Soils(IBC Table 1705.6)
❑ Driven Deep Foundations(IBC Table 1705.7)
❑ Cast-in-place Deep Foundations(18CTable 1705.8)
❑ Helical Pile Foundations(IBC 1705.9)
❑ Sprayed Fire-Resistant Materials(IBC 1705.13)
❑ Mastic&Intumescent Coatings(IBC 1705.14)
❑ EIFS(IBC 1705.15)
❑ Fire-Resistant Penetrations(IBC 1705.16)
❑ Smoke Control(IBC 1705.17)
❑ Structural Steel(IBC 1705.12.1&AISC 341-10)
❑ Structural Wood(IBC 1705.12.2)
Page 2 of 3
Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 IN Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.co,mason.wa.us
❑ Cold-formed Steel(IBC 1705.12.3)
❑ Mechanical&Electrical Components(1705.12.4)
❑ Architectural Components(IBC 1705.12.5)
❑ Storage Racks(IBC 1705.12.7)
❑ other (IBC 1705.1.1)
❑ Structural Observations
Declaration by Architect/Engineer
I, the design pr onal in responsible charge for this project, declare that the above listed
special' ion d ructural testing items are required for this project in accordance with
p $ q P J
1B hap r 7.
Sign a Date
Ci f5T t i 005o� Cati:S��l i lIIJ tr �NC°i� rl
Declaration by Owner
1,the Owner of the project,declare that the above listed firm(s)or individual(s)are hired by me to perform
special inspections and structural testing for the project pursuant to IBC 1704.2.
_.
r/7
Signature Date
CONTRACTOR RESPONSIBILITY: Each contractor involved with the construction of wind or seismic force-resisting
systems shall comply with the requirements of IBC 1704.4. The contractor is responsible for providing the
special inspector access to approved plans and contract documents at the job site. All special inspection records
shall be retained at the job site by the contractor and shall be made available to the Building Department upon
request,
Declaration by General Contractor
I, the General Contractor of the project, agree to comply with the "Contractor Responsibility" items noted
above.
Signature Date
Page 3 of 3
Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.Co.mason.wa.us
(All re erences are per the 2015 International Building Code)
Project Name: I i �w O f 0
Project Address: 'Ze VA,5f� CjUtl 621d1 L
Building Permit Number: Date Issued:
BEFORE A PERMIT CAN BE ISSUED: The registered Design Prof ssional in sponsible charge shall fill out the Agreement
and include the name and address of the company or inspector. T ( c S of this form are to be submitted to the
County prior to the issuance of a building permit. If changes are as t ho will perform the special inspections a new
form shall be submitted and turned into the Building Pe ' s&I e Ions Division for approval.
STATEMENT OF SPECIAL INSPECTIONS: In addition is eement, a "S ement of Special Inspections" shall be
provided per IBC 1704.3. This Statement shall be ma a part of the ap oved plans, and be placed in a conspicuous
location, such as the first page of the construction pl ns a first page the s ctural sheets.
SPECIAL INSPECTORS: All special inspectors sh I pproved by e B ' ' g Division prior to performing any duties. The
special inspector shall provide proof of ce atl n as a speciat insp r for each inspection item and be licensed by the
State of Washington.
SPECIAL INSPECTION REPORTS: pe ' I ' ection rl orts ar o meet the requirements of IBC 1704.2.4. Copies of each
report are to be sent to the d ss listed in the letterhea oting the Protect Address and Permit Number. A final report
shall be submitted statin at a I peciaf inspection and tructural testing items were completed and are in conformance
with the approved desig dra ' gs and specifications. ems not in conformance,unresolved items,or any discrepancies in
inspection coverage (i.e. miss' inspections, period' inspections when continuous was required, etc.) shall be specifically
itemized in the final report
Areas requiring special inspection: Name of Agency: Address&Contact Information
❑ Unapproved Fabricators(IBC 1704.2.5)
Other than Structural Steel(IBC Table 1705.2.2)
❑ Steel floor&roof decks
❑ Welding of reinforcement
❑ Cold-formed steel
Structural Steel
❑ Welding(Per N5.4 of AISC 360-10)
❑ Details(Per N5.7 of AISC 360-10)
❑ High-strength bolts(Per N5.6 of AISC 360-10)
Concrete Construction(per IBC Table 1705.3)
Reinforcement,embeds,anchors
Formwork
Materials
❑ Shotcrete
❑ Post-tensioned/Pre-stressed Concrete
❑ Erection of precast concrete
Page 1 of 3
r Mason County Community Services
Building Division
SPECIAL INSPECTION & W WA985
Shhee 4
lton,, WA 85$4
c4a TESTING AGREEMENT 360.427.9670 ext. 352
www.co.mason.wa.us
Areas requiring special inspection: Name of Agency: Address&Contact information
Masonry Construction(IBC 1705.4)
❑ Prior to Construction(Article 1.15,TMS-602)
❑ As Construction Begins(Article 1.19.2,TMS-402)
❑ Prior to Grouting(Table 1.19.2,TMS-402)
❑ During Construction(Per TMS-402&TMS-602)
Wood Construction
❑ High-Load Diaphragms(IBC 1705.5.1)
❑ Wood Trusses>60ft(IBC 1705.5.2)
❑ Soils(IBC Table 1705.6)
❑ Driven Deep Foundations(IBC Table 1705.7)
❑ Cast-in-place Deep Foundations(IBC Table 1705.8)
❑ Helical Pile Foundations(IBC 1705.9)
❑ Sprayed Fire-Resistant Materials(IBC 1705.13)
❑ Mastic&Intumescent Coatings(IBC 1705.14)
❑ EIFS(IBC 1705.15)
❑ Fire-Resistant Penetrations(IBC 1705.16)
❑ Smoke Control(IBC 1705.17)
❑ Structural Steel(IBC 1705.12.1&AISC 341-10)
❑ Structural Wood(IBC 1705.12.2)
Page 2 of 3
Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.co,mason.wa.us
❑ Cold-formed Steel(IBC 1705.12.3)
❑ Mechanical&Electrical Components(1705.12.4)
i
❑ Architectural Components(IBC 1705.12.5)
❑ Storage Racks(IBC 1705.12.7)
❑ Other (IBC 1705.1.1)
❑ Structural Observations
Declaration by Architect/Engineer
I, Xar
onal in responsible charge for this project, declare that the above listed
spd ructural testing items are required for this project in accordance with
IBSig Date
(.�f
Declaration by Owner
I,the Owner of the project,declare that the above listed firm(s)or individual(s)are hired by me to perform
special inspections and structural testing for the project pursuant to IBC 1704.2.
Signature Date
CONTRACTOR RESPONSIBILITY: Each contractor involved with the construction of wind or seismic force-resisting
systems shall comply with the requirements of IBC 1704.4. The contractor is responsible for providing the
special inspector access to approved plans and contract documents at the job site. All special inspection records
shall be retained at the job site by the contractor and shall be made available to the Building Department upon
request.
Declaration by General Contractor
1, the General Contractor of the project, agree to comply with the "Contractor Responsibility" items noted
above.
Signature Date
Page 3 of 3