HomeMy WebLinkAboutSpecial Inspection Field Test & Inspection Report 2009-5-8
5/o,/D9-
B~I<li;'gyennil # Dale'
h \ ,""... .~~ {j~H KI+1L r/ 0;J ~'-i....
Project Title ._
.;' '4/.11 H . '.de; 1> J 1
.J1.,f vO +I'*W '- /.J L . d.
Project Address
City of Springfteld
Community Services Division
225 Fifth Street
Springfield, OR 97477
Telephone: (541) 726-3759
Fax: (541) 726-3689
'"
A
"-
'"
'"
"-
'"
'"
'"
'"
(!C(-47><...
Silt,J
~
w
~
~
Special Inspection and Tesling
-.J
'"
'"
w
'"
-.J
'"
To llppli-caflls of projects requiring spechd inspe:[;tion or testillg as per Section 1704 oflh.e Oregon StructurnlSpeciaJt)' Code. Please revrew Ihe jnformnlion below. When you {mve
finished, acknowlcdge3nllnder~tartding of the information by sigl1ing below, and retum this form 10 IhcClty.
BEFORE A PERMIT CAN BE ISSUED: -rhe owner or owner's Icprcsenlnlive. on Ihe'advtceoflf1e respon.5ible Projec.t Engiru:er or Architect, shall complele, sign. and submit 10 Ihe
City ror r<:vie\~ 3!1d approval this form completed on butl1 the front ilndba<:k.
The-owner al1d Oeiterol Contrac.tor, where applicable, .shall also llckllo\....ledge the following condilions applieable.o Speciallnspedion and/or Testing_
L Conlrnc:tor is responsiblt: for proper nolitica(lOn ror tile Inspection or Testing ofit~ms listed.
2. Testing.lnboralory shall lake appropriate sElmplcs nnd transport I}l(:m (0 their labordtory for proper eva.ILla.ion or tt':sting_
· Copies orall laboratory repods and inspeclions are to be sent [0 the City by tile Testing-Agency_
3. Spccillllnspeclion Agency is to submit names and qualifiealions of on.site Sptdallnspectors to (he City lornpproval.
o
H
--<
-<
o
..,
Ul
"
;0
H
Z
Gl
..,
H
'"
r
'"
4. SpeciaJ Inspector shall provide inspection reports to the building offil::iaJ of all inspection a<:'ivities:
5. Contracror i:s responsible: to review rhe Cily ~pproved plans for additional inspectio.n o~ tesling r~quin:men(s (hat may be noted.
BEFORE A CERTIFICATE OF OCCUPANCY WILL BE ISSUED: The Sp,cial Impeclion Agency ,hall submit 10 the Building Ollicial a S1al'menl Ihalall ilem, ",quiring
inspection have been fulfilled and reported and \llere to the bestofthe inspector's knowledge, in confOmlar1Ce.with rile opprovt:d plalls, specifications Dnd applicahle workmanship
provisions. Those items nollesled W1d1or ioopccted shall De noloo jn the sln!ement. The r,eporl jg to be stJbmiUed to the City prior_to a request for final inspections.
~OW1fEDGEI\'IENTS '~/J I ( /J.
i-I1--!Je-KJ9/11 ~ ~
~er Name (. Pr~nt~d) .'. O,vner Sign...'l- .a~~! /
~:~4Ec:. 5. i3 'IF':Ee' -.t<w.'7PC~~ '" / ..
. 1 ~or Architect Firm (prinred) ~r$f~ ~e.
Testing Laboratory Name (Prinfed) T~ti~titorafol)' Rep. Signature
Kci/ J4o(j}~2, LLt..
Gen. Co"rractor FIrm N.~e (prinled), ~~nir~t~Si~lt,,':. \ 17
tl~aJAL 5fi.J!lelZ Z;J'f:iT1!t-e<: fur., 1..JaM) -t,. _ . ~
Speeiallnspeclion Agency Name (Prinled) Special Insp. Agency Rep SIgn.
Building Official Name (Prinled)
"
l>
Gl
'"
Bl1ilding Official Signa\me
'"
w
I
I
I
I
I
I
I
I I I
.J . Precast/Pre-stressed Concrete:
I Pile, P",,[-Tens I. Pre-Tens
i
Reinrorccd Concrt:le. Gunilc. Groul and Mortar:
Concrete Gunile Grout I Morrar
Claddin2
SPECIAL INSPECTION AND TESTING SCHEDULE
A~l!fe!!'ate Test arMi-x De.siIlR
Reinforcing Test
I Mix DesjJ!:n~ Weiehmaster Cerl."
i Reintorcine Placemcl11
j Continuous Batch Planllflspecl.
I fnsvccl Placim~
I Cast Samole.s
I Sam~les (PjeklllJlDelivercd)
I Comorcs.5ion Test'
A2y.ref,ale T (:"Iots
ReinfDrtin~ Tesls
I Tendon Test
I Mi~ Oesi.l!:ns.
I Rejnforcin!! Placement
I roserl Placement
Concrete BatchinJ!
Conc.r.eb: Plac:em-.:nt .
Installation fnsDc<:lion
eml Sanm les
~Ck.llIJSamDre.!
Coml)(css1fln Tests
I
SMOKE CONTROL:
Leakage lesting
Conlrol Verifj~;alioll
ROOli"lNG:
Insuhuion insf~llnljonlR~Vnh,e.
Test strips/seAms
FIREPROOFING:
PJm:emen.l.inspection
Density tests
Thi4;;!o;ncsstests
Inspect balching
ADDITIONAL INSRUCTJONS, OTlIf:R TEST, & INSPECTIONS:
-*~#L3.€.ZJL)~7J#Jffi'-e :)!5.L, 75
J
.I
GRADING, EXCAVATION,AND FILL
Acceptance tests" PSF
Establish fmal gmcJe
Fill placement inspccti[1ll/cofltinuous
Soil. Density
J
J
j
1
I
J
STRUCTUIL\L STEEL/WELOlNG,
Si:lmpJe and tesf (lisl specific members helm..")
Shop mntcrial idl:nlHicalio!}-(mill ct=rt)
Weld inspeclion ~Shop_Field
UltrD.SQnic inspection _Sht)p-----'-Field
High S[reng.l. Bolling_Shop _field
...\J25 _N _X
A490 _N _X
Melallleck weJdillg inspection
Reinlarcing Sled welding inspection
Reinforcing st.eel mill cerli ti..:ale
Melal3tud \V1':l<.ling.in3pt:dion
Concrele inst:r1 welding. inspection
.....I<<Jment resislrng steel tiaml':::I
STRUCTURAL WOOD:
Shear wall nailing inspection
SheW" wall anchors
Inspection ofGtu.lam fab. . TIC psi
rnsp-eclion of trussjoisf fab.
SwnpJe and te:.n cortlponents
Fabrication welding.of ~l1eeJ "<lC(essOlies
Fonn Completed DY'
'PROVIDE STRENGTH REQUIRED 8Y ARCHITECT OR ENGINEER OR CONTRACT DOCU~'IENT LOCATION OF VALUES
'"
A
'"
IV
'"
'"
IV
, '"
'"
o.D
~
W
P'
~
""
IV
'"
W
'"
""
'"
~F
_F
Cl
~
-<
<
o
."
lJ)
"ll
;0
~
Z
Gl
."
~
'"
c-
o
Dale
"ll
l>
Gl
'"
'"
A