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Home My WebLink AboutBLD2024-00730 MFG Home - BLD Inspections - 3/17/2025 _ r >r + � 615 W.Alder St.Bldg 8,SHELTON,WA 98584 MASON COUNTY SHELTON: 360-427-9670,EXT 352 COMMUNITY SERVICES BELFAIR: 360-275-4467,EXT 352 Building Planning,Environmentdl He Ith.Community Health ELMA: 360-482-5269,EXT 352 www.co.mason.wa.us INSPECTION CARD AND CERTIFICATE OF OCCUPANCY— To schedule an inspection call or visit http://www.co.mason.wa.us/community-services/bid-inspectioA.ph Permit Number BLD2024-00730 Date Issued 07/18/2024 Issued By Project NEW MODULAR HOME Site Address 540 E South Island Dr Applicant WEISKOPF DANIEL MARK&ELIZABETH JUNE Contractor ORCA CONSTRUCTION INC Contractor Phone 360-791-0157 Primary Code UPC IBC,IRC,IFC,IEC,IMC,& Type Permit Type MANUFACTURED HOME Occupancy -APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS. -DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED. -THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION,FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY. -ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION. -OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION. **THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.** PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET Public Works Access/Driveway Other Health Septic Well Deptartment Planning Site Inspection Department Fire Marshall Fire Apparatus Access Fire Sprinkler Auto Fire Alarm Hood and Duct Other Final Building Department Building Official: Community Services Designee Concrete Setbacks 7 Slab Footing Perimeter 7-31_2 zEC. Point load Footing 7 2 Footing Interior Footing Decks/Porches L-1 \V >4 Foundation Stem Walls �1 z�( �� Other Rough-In Groundwork Plumbing Framing Groundwork Mechanical Plumbing Groundwork Gas Pipe Mechanical Gas Piping Shear Wall Nailing Underfloor Other Insulation Slab Ceiling Floor Vaulted Ceiling Walls Vapor Barrier Other Wallboard Interior Wall Brace Panels Fire Walls Nailing Other Final Building Manufactured Setbacks Setup Home Concrete Foot/Runners Final Other 1 _Iew WA r , Compressive Strength of Concrete Report#:CC-000002-01 ,r P 9 Report Date: 08/29/2024 13:10 Test Method:ASTM C 39 Sample:822 M.vaeuu rastwc a .arc. Olympia Client: Project: 2118 Black Lake Blvd.SW Orca Construction, Inc. 245165-01 (Permit:BLD2024-00730) Olympia,WA 98512 3434 Martin Way E#5, Weiskopf Modular Foundation Phone:(360)534-9777 Olympia,WA 98506 540 East South Island Drive Shelton,WA 98584 Sample Details Set#: 1 Technician: Cecil Clark Batched: 07:10 PDT Specimen Size: 4"X 8" Cast By: Cecil Clark Sampled: 08:17 PDT Specimens In Set: 5 Date Cast: 08/01/24 Cast: 08:25 PDT Truck/Ticket#: 8110/20247006 Sampled From: Chute Truck Empty: 08:30 PDT Contractor: BAMF Concrete Placement Method: Pump Placement Time: 80(min) Location Placement Location: Building Exterior-Footing Location Details: Building perimeter footings between all grids Sample Location/Notes: West Edge of building Batch Log Specifications Supplier: Frontier Mix Design: FRM7855B Strength: 3000(psi) Plant: Bayside Sample Condition: On-Site Admixtures: None Field Measurements Weather: Partly Cloudy Slump(in): 4(ASTM C143) Plastic Unit Weight: Air Temperature(F): 64 Concrete Temp(F): 71 (ASTM C1064) Air Content: Load Volume: 9.00(yd3) Lab Test Results Testing Lab:Olympia,2118 Black Lake Blvd.SW,Olympia,WA,98512 Specimen Test Test Field/Lab Average Cylinder Cylinder Max Load Strength Fracture Break Capping Number Age Days Date Cure Days Diameter(in) Area(in') (Ibs) (psi) Type Remark Method 1-1 7 08/08/24 1 /6 4.00 12.57 32,788 2,610 2 U 1-2 28 08/29/24 1 /27 3.99 12.50 61,197 4,900 2 CID U 1-3 28 08/29/24 1 /27 3.99 12.50 62,495 5,000 2 CID U 1-4 1 28 08/29/24 1 /27 3.99 1 12.50 59,847 1 4,790 1 2 CID U 1-5 1 28 H 08/29/24 1 /27 Test Age Average Strengths(psi):7 Day-2610,28 Day-4900 Capping Methods CP:Compressive Strength meets project requirements at design strength age. U: Unbonded Caps(ASTM C1231) Checked In:08/02/2024(1,2,3,4,5) General Remarks 15 gallons of water added to load prior to placement El E 9 [1 [111 TYPE1 TYPE2 TYPE3 TYPE4 TYPES TYPE6 As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and Page 1 of 1 authorization for publication of statements,conclusions or extracts from or regarding our reports is reserved pending our written approval. as= Report#:CC-000002-01 Compressive Strength of Concrete Re ort Date: 09/04/2024 12:28 Test Method:ASTM C 39 p Sample:886 .,Zymmts TiSTN6 L CONSULTING.NtG. Olympia Client: Project: 2118 Black Lake Blvd.SW Orca Construction, Inc. 245165-01 (Permit:BLD2024-00730) Olympia,WA 98512 3434 Martin Way E#5, Weiskopf Modular Foundation Phone:(360)534-9777 Olympia,WA 98506 540 East South Island Drive Shelton,WA 98584 Sample Details Set#: 2 Technician: John Magerstaedt Batched: 08:15 PDT Specimen Size: 4"X 8" Cast By: John Magerstaedt Sampled: 09:10 PDT Specimens In Set: 5 Date Cast: 08/07/24 Cast: 09:15 PDT Truck/Ticket#: 8119/7524 Sampled From: Chute Truck Empty: 09:45 PDT Contractor: BAMF Concrete Placement Method: Pump Placement Time: 90(min) Location Placement Location: Building Exterior-Wall Location Details: stem walls Sample Location/Notes: east wall Batch Log Specifications Supplier: Frontier Mix Design: 7855BA Strength: 2500(psi) Plant: 1 Air: 3.5-6.5(%) On-Site Admixtures: 165.00 Gal Water,gals.(8 yd'),4120.00 LB Cement,lbs.(8 yd 3), 12420.00 Slump: 4-6(in) LB Coarse Agg,lbs.(8 yd'), 10700.00 LB Sand(8 yd'),40.00 Oz AEA-Air Entraining Admixture(8 yd 3) Field Measurements Weather: overcast Slump(in): 5 Plastic Unit Weight: Air Temperature(F): 67 Concrete Temp(F): 71 Air Content: 3.0 Load Volume: 8.00(yd') Lab Test Results Testing Lab:Olympia,2118 Black Lake Blvd. SW,Olympia,WA,98512 Specimen Test Test Field/Lab Average Cylinder Cylinder Max Load Strength Fracture Break Capping Number Age Days Date Cure Days Diameter(in) Area(in 2) (Ibs) (psi) Type Remark Method 2-1 7 08/14/24 1 /6 3.98 12.44 23,166 1,860 3 U 2-2 28 09/04/24 1 127 3.99 12.50 45,933 3,680 3 CID U 2-3 28 09/04/24 1 127 3.99 12.50 44,652 3,570 2 CID U 2-4 1 28 09/04/24 1 127 3.99 12.50 43,796 3,500 2 CID U 2-5 1 56 H 10/02/24 1 /55 Test Age Average Strengths(psi):7 Day-1860,28 Day-3580 Capping Methods CP:Compressive Strength meets project requirements at design strength age. U: Unbonded Caps(ASTM C1231) Checked In :08/08/2024(1,2,3,4,5) TYPE 1 TYPE 2 TYPE 3 TYPE 4 TYPE 5 TYPE 6 As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and Page 1 of 1 authorization for publication of statements,conclusions or extracts from or regarding our reports is reserved pending our written approval. INSPECTION RESULTS Page MASON COUNTY Department of Community Development COMMUNITY DEVELOPMENT 615 W Alder St, Shelton,WA 98584 Permit&s'Adme Center,Budding,f1win,ng (360)427-9670 ext. 352 7 Application# BLD2024-00730 Application Type MANUFACTURED HOME Owner WEISKOPF DANIEL MARK & ELIZABETH JUNE Parcel# 220103091004 Site Address 540 E South Island Dr Shelton, WA 98584 Inspector Inspection Type Date Status Comments 3-5-25 DEC Drew Carlson BLD-FINAL INSPECTION 03/05/2025 FAIL COMPLETE INSTALLATION OF FULL DEPTH BLOCKING BETWEEN JOISTS AT BEAMS MAKE CORRECTION CALL FOR RE INSPECTION (.vrnrrr�`Gns t�.ut �ow✓t �- Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov BLD2024-00730 MANUFACTURED HOME PROJECT DESCRIPTION: NEW MODULAR HOME ISSUED: 07/18/2024 SITE ADDRESS: 540 E SOUTH ISLAND DR SHELTON EXPIRES: 01/14/2025 PARCEL: 220103091004 APPLICANT: WEISKOPF DANIEL MARK&ELIZABETH OWNER: WEISKOPF DANIEL MARK&ELIZABETH JUNE JUNE 2012 E MILLER ST 2012 E MILLER ST SEATTLE,WA 98112 SEATTLE, WA 98112 646-326-3274 CONTRACTOR: ORCA CONSTRUCTION INC 3434 MARTIN WAY E, SUITE 5 OLYMPIA,WA 98506 360-791-0157 GENERAL CONTRACTOR'S LICENSE: ORCA CONSTRUCTION INC License: ORCACI'217DA 3434 MARTIN WAY E, SUITE 5 Expires: 10/28/2024 OLYMPIA,WA 98506 360-791-0157 VALUATIONS: FEES: Paid Due Uncovered Deck 283.89 $4,258.35 Planning Review Fee $240.00 $0.00 Modular/Manufactured Home $360.00 $0.00 Fee- 1 st half collected at submittal Modular/Manufactured Home $360.00 $0.00 Fee-2nd half collected at ready to issue State Fee-Residential $6.50 $0.00 Technology Surcharge $22.15 $0.00 Building Plan Review/Change of $135.00 $0.00 Use- Onsite Sewage Modular/Stick-Built Foundation $151.50 $0.00 Plan Check Fee $80.00 $0.00 Building Permit Fee $156.00 $0.00 Total: $4,258.35 Totals : $1,511.15 $0.00 Printed by:Amber Selby on:07/18/2024 01:50 PM Page 1 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MANUFACTURED HOME BLD2024-00730 REQUIRED INSPECTIONS Setback Inspection Set-Up Inspection Footing Inspection Connection is to be verified by Health or Utilities Foundation Wall-Pre-Pour Inspection BLD-Final Inspection CONDITIONS * A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan"constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. * The foundation/footing must be placed on undisturbed, firm-native soil. Proper frost depth, minimum 12 inches, shall be observed below grade in undisturbed soils. * All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor increase the velocity flow entering or abutting to any state or county culverti ng/d itch i ng system or road way. * All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. * This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indicated on the plot plan. * Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. * The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. * Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. * By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your "Approved Site Plan"to ensure these structures meet the setback conditions listed. Printed by:Amber Selby on:07/18/2024 01:50 PM Page 2 of 5 Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MANUFACTURED HOME BLD2024-00730 * All other necessary permits from Mason County, Washington State, Federal Agencies, and/or other agencies/groups that are required for this proposed development and construction must be obtained PRIOR TO DEVELOPMENT AND CONSTRUCTION. The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. " All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant one or more extension of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicate that circumstances beyond the control of the permit holder prevented action from being taken. " All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. " REQUIRED INSPECTIONS (Footing Inspection-prior to pour(set-up manual must be on-site), Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWN ER/CONTRACTOR(indicate which) OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION UNLESS OTHERWISE APPROVED. " Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. * All property lines shall be clearly identified at the time of foundation inspection. " All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. " Any retailer, manufacturer or contractor who installs a manufactured structure warrants that the manufactured structure is installed in accordance with the State Installation code, chapter 296-150M WAC.All installers hired to do installation work shall be certified manufactured structure installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer certification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three feet of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed or installed. Certification number and signature of the certified installer responsible for each major part of the installation.WAC365-210 Printed by:Amber Selby on:07/18/2024 01:50 PM Page 3 of 5 Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MANUFACTURED HOME BLD2024-00730 Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Code 14.28 and 14.17. When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and approved by the Washington State Department of Transportation. For more information contact Washington State Department of Transportation, at (206)357-2620, ext. 630. If you are installing a manufactured structure and no longer have the installation manual, you must use the instructions of the most current 24 CFR. " When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For any construction which is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. For more information contact Public Works, at(360)427-9670, ext. 450 or 100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and approved. Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance contact the Mason County Public Works Department prior to construction at Ext 450 The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions,shall be available in this location OR placed in the location specified by WAC 296-150M. Support configuration shall be clearly marked in the installation instructions. CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. * All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections being performed or approvals granted. PLN SETBACKS Front (E): 25' Sides: 20' Rear: 165'from OHWM .all setbacks measured from the farthest projection of the building 'subject to EH setbacks .all changes are subject to review and approval ` Prior to inspections the shoreline setback, and entire building envelope (including roof eaves, landings, and decks) must be identified and staked. Failure to do so will result in a failed inspection and require re-inspection at a later date. Printed by:Amber Selby on:07/18/2024 01:50 PM Page 4 of 5 Mason County Mason County - Division of Community Development 615 W. Alder St. Building 8 Shelton, WA 98584 360-427-9670 ext 352 www.masoncountywa.gov MANUFACTURED HOME BLD2024-00730 * Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered. A.) Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations. B.) Septic tank(s) requires 5ft setback from all footing/foundations. C.) No foundation/Perimeter Drains within 30ft, down gradient of Drainfield/ Reserve area. D.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/ Reserve area. * In addition to the inspections required in IBC, Section 110, the owner, the engineer or architect of record acting as the owner's agent shall employ one or more special inspectors who shall provide inspections during construction on the types of work listed under Chapter 17 and as specified by the design professional. The special inspectors duties& responsibilities shall be as specified in Chapter 17. Special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton WA 98584 and available for inspection. Inspection reports shall be completed and submitted to the dept. in a timely manner and shall be submitted prior to the framing and final occupancy inspections. * ALL FIELD WELDING TO BE PERFORMED BY A WABO CERTIFIED WELDER hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting o rmit does not presume to give authority to violate or cancel the provisions njotr state/I la egulating construction or the performance of construction. Issued d Contractor or Authorized Agent: Date: -/B- Zd l Printed by:Amber Selby on:07/18/2024 01:50 PM Page 5 of 5 '1 MASON COUNTY COMMUNITY 5ERVICES 3a &-Zi _drlJ7 H0627 540 E South Island Drive Shelton Permit Number Project Title project AddresslParcel Number Applicants of projects requiring Special Inspection or Testing per Chapter 1704&1705 of the International Building Code, as amended by Washington State.Please acknowledge and return this form to the Mason County Permit Center. THESE INSPECTIONS ARE NOT PERFORMED BY THE BUILDING DEPARTMENT AND MUST BE PERFORMED BY QUALIFIED SPECIAL INSPECTORS, HIRED BY THE OWNER AND APPROVED BY THE COUNTY PERMIT CENTER. Individuals certified in a special inspection category by Washington Association of Building officials(WABO)or individuals employed by a recognized testing laboratory and under the direct supervision of a Registered Professional Engineer are typically considered qualified at the discretion of the local jurisdiction having authority for enforcement. BEFORE A PERMIT CAN BE ISSUED: The Owner or his/her representative, on the advice of the responsible Project Engineer or Architect, shall fill out completely, sign and submit two (2) copies of the attached "Structural Tests and Inspection Schedule"to this Department for review and approval including any requirements related to the Mason County Municipal Code. The Owner, General Contractor, and Inspection/Testing Agency, where applicable, shall also acknowledge the following conditions applicable to Special Inspection and/or Testing. 1. Inspection/Testing Agency shall submit names and qualifications of on-site Special Inspectors to the Building Inspection Permit Center for approval PRIOR TO PERMIT/S BEING ISSUED. 2. All Special Inspections shall be noted on the approved plans or attached approved documents. 3. All special inspections shall be approved by the County or as recommended by the Engineer of Record (EOR). 4. It is the responsibility of the General Contractor to review County approved plans for additional inspection or testing requirements that may be noted or required per IBC as noted on approved plans. 5. The General Contractor is responsible for proper notification to the InspectionlTesting Agency for items listed on this form. 6. Special Inspectors shall provide detailed reports on company letterhead to the Building Inspector of all required inspection activities.These may also be provided when the inspector visits the jobsite for the scheduled inspection but must be completed before the subject of inspection is approved by the building inspector. 7. Copies of all ongoing laboratory and testing reports shall be sent directly to the Building Inspector by the Inspection/Testing Agency or other responsible party within a reasonable time to test results. 8. BEFORE A CERTIFICATE OF OCCUPANCY APPROVAL CAN BE ISSUED: The Inspection/Testing Agency shall submit a FINAL REPORT LETTER stating that all items requiring testing and inspection have been fulfilled and reported and a final inspection report shall be provided. A copy of the statement is to be maintained at the jobsite for the Building Inspectors review prior to final inspections. Page 1 of 4 MASON COUNT) COMMUNITY SERVICES ACKNOWLEDGEMENTS Prior to issuance of a building permit, the Owner, on the advice of the Project Engineer or Architect, shall complete, sign,and submit this form to the County Permit Center. Declaration of Owner I, as the owner of the project,declare that the testing agency firm/s or individual/s listed herein are hired by me to perform "Special Inspections" and/or "Structural Testing" in accordance with the provisions of the International Building code IBC)Chapter 1.7. �Gi ;e � Ube-1"s D 7 ��d�2 Owner(print) Owner(Signature) (date) Declaration of Registered Professional Architect/Engineer I, as the design professional in responsible charge of the project listed herein, declare that the special inspection listed herein are required for this project in accordance with the provisions of the International Building Code (IBC) Chapter 17. Jesse Landers NSF- ns I�f Architect/Engineer(print) Architect/Engineer Stamp/Signature(date) �o ?i .c�sR�r STERF v~ s NAL Testing Agency Name/Contact info: The Special Inspection/Testing Agency listed above must have a c:c::c. Portfolio of Qualifications on file with the County to performing work. Declaration of the General Contractor I, as the General Contractor of the project, agree to comply with the"Contractor spo ' ility"items not General Contractor(print) General Contract Signature (date) Page 2 of 4 II ec'al Inspection Requiremen MASONCOUNTY cONIMUN n SMICE-s Required Special Inspections International Building Code; Chapter 17: A completed and signed copy of pages 1 through 4 of this form shall be submitted to the "Permit Center" prior to building permit approval. Engineer shall check the applicable items: ❑ Special inspection of fabricated items 1704.2.5 ❑ Submittals to the building official 1704.5 ❑ Structures over 75' in height located in Seismic Design Category D, 1704.6.1 ❑ Structures classified as Risk Category III or IV located in Seismic Design Category D, 1704.6.1 El Steel construction & structural Steel 1705.2.1 ❑ Cold form steel deck 1705.2.2 ❑ Open-web steel joists &girders 1705.2.3 ❑ Cold form steel trusses spanning 60 feet or greater 1705.2.4 I] Concrete construction 1705.3 & Table 1705.3 ❑ Sbotcrete 1705.3 ❑ Welding of reinforcing bars 1705.3.1 ❑ Material Tests 1705.3.2 ❑Masonry Construction 1705.4 ❑ Empirically designed masonry, glass unit & masonry in Risk Category IV 1705.4.1 ❑Vertical masonry foundation elements 1705.4.2 ❑Wood construction 1705.5 ❑High Load Diaphragms 1705.5.1 ❑ Metal-plate connected wood trusses spanning 60 feet or greater 1705.5.2 ❑ Soils 1705.6 & Table 1705.6 ❑Driven deep foundations 1705.7 & Table 1705.7 ❑ Cast in-place deep foundations 1705.8 & Table 1705.8 ❑Helical pile foundations 1705.9 ❑ Fabricated items 1705.10 Page 3 of 4 ' I edal '1 -spec i quirementsv MA50\COUNTY -: COM. *NrIY SERVICES ❑ Special inspections for wind resistance 1705.11 ❑ Structural wood 1705.11.1 ❑ Wind resisting components 1705.11.3 ❑ Cold formed steel light frame 1705.11.2 ❑ Special inspection for seismic resistance 1705.12 ❑ Special inspection for structural steel per 1705.12.1 ❑ Seismic force-resisting systems 1705.12.1.1 ❑ Structural steel elements 1705.12.1.2 ❑ Special inspection for structural wood per 1705.12.2 ❑ Special inspection for cold-formed steel per 1705.12.3 ❑ Designated seismic systems 1705.12.4 ❑ Architectural components 1705.12.5 ❑ Plumbing, mechanical&electrical components 1705.12.6 ❑ Storage racks 1705.12.7 ❑ Seismic isolation systems 1705.12.8 ❑ Cold-formed steel special bolted moment frames 1705.12.9 ❑ Testing for seismic resistance 1705.13 ❑ Structural steel 1705.13.1 ❑ Seismic fore-resisting systems 1705.13.1.1 ❑ Structural steel elements 1705.13.1.2 ❑Nonstructural components 1705.13.2 ❑ Designated seismic systems 1705.13.3 ❑ Seismic isolation systems 1705.13.4 ❑ Sprayed fire-resistance materials 1705.14 ❑ Physical and visual tests 1705.14.1 ❑ Structural member surface conditions 1705.14.2 (1705.14.3 through 1705.14.6.3) ❑ Mastic & intumescent fire-resistance costings 1705.15 ❑ Exterior insulation&finish systems (EIFS) 1705.16 ❑ Fire-resistance penetrations and joints 1705.17 ❑ Penetration firestops 1705.17.1 ❑ Fire-resistant joint systems 1705.17.2 ❑ Testing for smoke control 1705.18 ❑ Testing Scope 1705.18.1 Page 4 of 4