HomeMy WebLinkAboutSpecial Inspection Miscellaneous 2008-7-2
7-2 -0 8
Date
rlltE- S TA1"lo,</ 4'Ff{,
PlOject Title
Sf". Sf~r>4t!l.~/tf;'-D. DR
Project Address
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CIty of Sprmgfield
Commultlty Services DIV1StOn
225 ftfth Street
Spnngfield, OR 97477
Telephone (541) 726-3759
Fax (541) 726-3689
BUlldmg Pelmlt #
S f'1t IJ-l 6 F'f-I-D
'86'1.
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Special Inspection and Testl1lg
To nppl1cants of proJects reqUll1ng special mspecbon or testIng as per ~echon ]704 of the Oregon Structural Specialty Code Please reVIew the mforma110n below When you have
fimshed. acknowledge an understandIng of the mfonnatlon by sIgning below, cUld return tillS form to the City
BEFORE A PERMIT CAN BE ISSUED~ TIle owner or owner's representative, on the adVice ofthe responslble Project Engmeer or Arcllltect. shall complete, Slgn, and submit to the
CIty for revtew and approval tlus form completed on both the front and back
The owner and General Contractor. where applicable, shall also acknowledge the followrng condIoons applicable to Specla1lnspectlDn and/or Testmg
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COllll actor IS responsIble for proper nottficatlOll for the Inspection or Testll1g of Items llsted
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2 Testtng laboratory shall take appropnate sdmples and lransport them to tbelT laboratory for proper evaluation or testing
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Caples of all laboratory ,reports and l11spectlans are to be sent to the City by the Testing Agency
3 SpecIal InspectIon Agency lS to sub~t names and qualtficatIons of on-site Spec181 Inspectors to the CIty for approval
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4 SpecIal Inspector shall provide Inspection reports to the bUlldmg offiCIal of all mspectton acttvrtles
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5 Contrador IS responsIble to reView the City approved plW1S for addltlOnallllspeCtlOn or testmg reqUIrements that may be noted
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BEFORE A CERTIFICATE OF occur ANCY WILL BE ISSUED The Speclallnspecllon Agency shan submIt to the Bulldmg OffiCIal a ,talement thaI all lIems reqUlrmg
In'lpectlOl1 have been fulfilled and reported and were to the best of the m~pectorls knowledge, U1 confonnance Wlth the approved plans, specLficatlOns and apphcable workmanshIp
provl~lons Those ttems not tested and/orllDspected sban be noted In the statement The report IS to be subnutted to the CIty pnorto a request for final mspecttons
ACKNOWLEDGEMENTS ; ~ e2/ [) 1/
~IM ~/~-ID/l ! ~_~
Owner Name (Prmted) ,er Stgnatur
f,NNALt..E. WE-'irE-CAI.'NC: ~~~
Englnee! or Architect rum (Plinted) ~Zofi'i'f~lgnature
L /,,"" t;,...t'~~7. ,zW_ ! jiLt:.-
Testmg LabOlatory Name (Plmled) Testmg LabOlatory Rep SIgnature
"2iolllA \~I;\"'" ~L",'fI'- :1.{\L
Gen Contractof Fmn Name (Printed)
Cf~,... C~~4I1y J :IitG
Specta1.InjectlOn ~~c.:;::f'e (pnnted)
'~\JU \V\ti\\
'mftldmg Officllrl1<iallle (prmted)
.si- \kV
GenerarSlgnatule
tf~\(CU-~ tt\
Butldmg Offic~Slgnature
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S}'ECIAL INSPECTION AND TESTING SCHEDULE
I Remforced Concrete. Gumte. Grout and Mortar
I Concrete GUnlte Grout Mortar
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IX
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P(..{l.(o~,,- . '
1c.<WTI"'''''''~ f'~I"'I>IC.
I II I X
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PrecastJPrc.ljtrec;sed Concrete
Plies I Post-Tens Pre-Tens
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x
Claddme
SMOKE CONTROL
Leakage testmg
Control Venficatlon
ROOFING ,
Insulanon mstallanonJR.- Value'"
Test stnps/seams
Af!g~egate Test ofMtx DesIgn
RemforclIUt Test
I MlXDeslJ~n~WeHthmaster Cert '"
I Re1Dforc1n~ Placement
I Contmuous Batch Plant Insoect
I Inspect Plaeme
I Cast Samp-Ies
I Samples (Plckup/Delrvered)
I Comnrec;slOl1 Tcst* (~t!c.."'fClt'( O,.!C)}
Aggrel!ate rests
RemforcmJ!: Tests
I Tendnn Test
I MIX Desums*
I Retllforcm1!: Pldcement
I Insert Placement
I Concrete Batchm~
Concrete Placement
Installation InsoectIon
Cast Samples
I PIck-up Samoles
I ComoreSSIon Tests
I
FIREPROOFING
Placement lllspectlOn
DellSlty tests
TIuckIlesS tests
Inspect batchlll&
ADDI'nONAL INSRUCTlONS, OTHER TEST, & INSPECTIONS
GRADING, EXCA V A nON. AND FILL
A<...ceplance tests. PSF
EstablIsh [Uta' grade
X Fdt placement lllspecttonlcontmuous
)( SOIl DenSIty
(>1>10 C>~ )
1.M'-€- orA 7
STRUCTURAL STEEUWELDING
Sample and test (lIst specIfic members below)
Shop materlalldentLficatJOn (mIll ce~~
1'f:f!:.JEJ2LC- Weld mspeetJon L.Shop ~Fleld
UltrasonIC mspecllon _Shop _FIeld
HIgh Streugtb J3oltJllg_Shop _FIeld
A325 _N _X
A490 _N _X
Metal deck weldmg Inspection
Remforcmg Steel weldmg InspectIOn
)( Rcmforcmg steellmll certificate
Metal stud weldmg inspectIOn
Concrete msert weldmg mspectlOn
Moment reslstlOg steel frames
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STRUCTURAL WOOD
Shear wallllollmg inspection
Shear wall anchors
InspectIon ofGlu-lam fab *
Inspection of truss )015t fab
Sample and test components
FabncatIOn weldmg of steel accessones
MASONRY (~6-e esse. rA8~A 1704 t; '3)
X SpeClalmspectlOn stresses used'/:5'<x>f-fmtOO6'%1 f'g
Prehmmary acceptance tests (masonry umts, wall pnsms)
Subsequent tests (mortar, grout, field wall prISms)
Pldcement mspectton ofuruts. and reinforcement
Masonry, ntOltar. grout, and remforcmg steel certificates
TIC pSI
X
PU.10f)IC-
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Fnm. Completed by Sco"-" f/A.. IIi'!. 'I
Date 7- z -oS
'PROVIDE S t'IlliNGTII IlliQUlRED BY ARCHITEC r OR ENGINEER OR CONTRACf DOCUMENT-I..\lCAlION OF VALVES
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