HomeMy WebLinkAboutBLD2022-00809 Special Inspection and Testing Agreement - BLD Inspections - 6/24/2022 Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 WAIder 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:
Project Address: ZgOAIE Vier .49f- f?J Gilesf &(P,49-
Building Permit Number: D J)Za2Z-00?Cq Date Issued:
BEFORE A PERMIT CAN BE ISSUED: The registered design professional in responsible charge shall fill out the Agreement and
include the name of each inspector as well as their appropriate license/certification number. 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 INPSECTION 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.
GENERAL SPECIAL INSPECTION ITEMS(per IBC Chapter 17)
(Only checked items are required]
Areas requiring special inspection: Name of Agency: Name of Inspector: License/Cert.No.
❑ 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
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Mason County Community Services
d21-- Building Division
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
TESTING AGREEMENT 360.427.9670 ext. 352
www.co.mason.wo.us
GENERAL SPECIAL INSPECTION ITEMS(per IBC Chapter 17)-continued
[Only checked items are required]
Areas requiring special inspection: Name of Agency: Name of Inspector: License/Cert.No.
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)
❑ Other (IBC 1705.1.1)
❑ Other (IBC 1705.1.1)
SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE (IBC Section 1705.11)
[Only checked items are required]
Areas requiring special inspection: Name of Agency: Name of Inspector: License/Cert.No.
❑ Structural Steel(IBC 1705.11.1&AISC 341-10)
❑ Structural Wood(IBC 1705.11.2)
❑ Cold-formed Steel(IBC 1705.11.3)
❑ Mechanical&Electrical Components(1705.11.4)
❑ Architectural Components(IBC 1705.11.5)
❑ Storage Racks(IBC 1705.11.7)
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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
Declaration by Architect/Engineer
I, the design professional in responsible charge for this project, declare that the
above listed special inspection and structural testing items are required for this
project in accordance with IBC Chapter 17.
Signature Date
SEAL
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
I, the General Contractor of the project, agree to comply with the "Contractor Responsibility" items noted
above.
Signature Date
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