HomeMy WebLinkAboutPermit Field Test & Inspection Report 2003-4-23
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SPRINGFIELD. ~
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City of Springfield
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225 .Fifth Street
Springfield, OR 97477
Telephone: (541) 126-3759
Fax: (541) 126-3689
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Building Pennit # . . .
Date
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Project Address
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Special Inspection And Testing
To applicants of projects requiring spechil inspection or testing as per Section 1701.5 of the Oregon Structural Specialty Code; Please review.the infonnation below. When you
have finished, acknowledge an understanding of the infonnation by signing below, and return this fonn to the City.
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.BEFORE A PERMIT CAN BE ISSUED: The o~ne(or owner's representative, on the advice of the responsible Project Engineer or Architect, shall complete, sign, and submit
to the City for review and approv'althis Conn completed on both the front and back.
The Owner and General Contractor, where applicable, .shall also acknowledge the following conditions applicable to Special Inspection andlor Testing.
I. Contractor is responsible for proper notification for the Inspection or Testing of items listed.
. 2. Testing laboratory shall take appropriate samples and transport them to their laboratory for proper evaluation or testing.
. Copies of all laboratory reports and inspections are to be sent to the City by the Testing Agency.
3. Specinl Inspection Agency is to submil names and qualifications of on-site Special Inspectors to the City for approval.
4. Special Inspector shall provide inspection reports to the building official of all inspection activities.
5. Contractor is responsible to review the City approved plans for addilional inspection or testing requirements that may be nOled.
BEFORE A CERTIFICATE OF OCCUPANCY WILL BE ISSUED: The Special Inspection Agency shall submit to the Building Official a statement that all items requiring .
inspection have been fulfilled and reported and were to the best of the inspector's knowledge, in confonnance with the approved plans, specifications and applicable workmanship, '
provisions. Those items not tested andlor inspecled shall be noted b the statement. The report is to be submitted to the City prior to a request for fir,al inspections.
ACKNOWLEDGMENTS
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Owner Name (Printed)
Engin1erChitect Finn (Prinled).
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Testing Laboratory Name (Printed)
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,;:ftwner Signature.
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Testi;;ilb~ratol)' Rtp gl1,~ture,~
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Gen. Contractor Finn Nam~ (Prinled)
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General Co#,ctor Signature .
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Special (nsp. Agency Itep Sign.
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Building Official~i~
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Special InsPection Agency Name (Printed)
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ReinCorced Concrete, Gunite, Grout and Mortar:
Concrete Gunite (trnnt Mortar
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PrecasUP"e-stressed Concrete:
Piles Post-Tens Pre-Tens I rln<lllinl:
SMOKE CONTROL:
Leakage testing
Control yerificatilln
ROOFING
Insulation inslallation/R-yalue'
Test strips/seams
STRUCTURAL STEEUWELDING:
Sample and test (list specific members below)
Shop material identification (mill cert)
~ Weld inspeclion Shop p:: Field
. Ullrasonic inspcction Shop _ Field
High strength boiling Shop Field
A325 N X F
A490 N X F
Metal deck welding inspection
Reinforcing Steel welding inspection
Reinforcing steel mill certificate
Metal stud welding inspection
Concrete insert welding inspeclion
Moment resisting steel frames
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.SPECIAL INSPECTION ~nr'~l~Tl~S~~G:!)~H~LE rcU'-
. GRADING, EXCA V A TION. AtlD F,ILL
.. Acceptance tests' PSF
Establish final grade
Fill placement inspection/continuous
Soil Density
A~r:reQ'ate Test of Mix Desi~m
Re!hforcinp Ted
Mix Desi~n.Wf':i':.hmstr rert.'"
~p.i~l? PI3Cp.n:u~nt
Continuous Batch Planl In<n
Tn~nf':c.t PhJ(~inp
r.<l Sample<
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rnmnre~~inn Tf':.c:f*
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Tl:lllW" Te..
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Remforcine- Placement
Tnc:~rt Placement
t:nf1 t:rete Batch in p
~nr'Jcrete Placement
Il1stallation In~nectinn
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STRUCTURAL WOOD:
Shear wall nailing inspection
Shear wall anchors
Inspeclion ofOlu-lam Cab. '
Inspection of truss joist fab.
Sample and test components
Fabrication welding of steel accessories
FIREPROOFING:
Placement inspection
Density Tests
Thickness tests
Inspect balching
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MASONRY:
Special inspection stresses used' fm fg
Preliminary acceplance tests (masonry units, wall prisms)
Subsequent tests (mortar, grout, field wall prisms)
Placement inspedion of unils, mid reinforcemcnl
Masonary, mortar, groul, and reinforcing steel certificates
ADDITIONAL INSTRUCTIONS, OTHER TEST, & INSPECTIONS:
Form completed by:
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. 'PROVIDE STRENGTH REQUIRED BY ARCHITECT OR ENGINEJ;:R OR CONTRACT DOCUMENTLOCA TIONOF VALUES
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