HomeMy WebLinkAboutSpecial Inspection Field Test & Inspection Report 5-5-11
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City of Springfield
Community Services Division
225 Fifth Street
Springfield, OR 97477
Telephone: (541) 726-3759
Fax: (541) 726-3689
Building Pennit #
,Kohrs -Gateway Mall
May 11, 2005
Date
Project Title
3000 Gateway Street (Within Gateway Mall)
Project Address
Special Inspection and Testing
To applicants of projects requiring special 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 iniuU1J"tion by sigmng below, and return this form to the City.
BEFORE A PERl\flT CAN BE ISSUED: The owner 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 approval this form completed on both the front and back.
The owner and General Contractor, where applicable, shall also acknowledge the following conditions applicable to Special Inspection and/or Testing.
1. Contractor is responsible for proper notification for the Inspection or Testing ofitems 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. Special Inspection Agency is to submit 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 additional inspection or testing requirements that may be noted.
BEFORE A CERulllCATE OF OCCUP ANCY'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 conformance with the ap'proved plans, specifications and applicable worlm1an!lhip
provisions. Those items not tested and/or inspected sha11 be noted in the statement The report is to be submitted to the City prior to a request for final inspections.
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Owner Name (Printed) Owner Sign~ J I Gen. Contractor Finn Name (Printed) ~enetatContractor Signature
WRG Design Inc. - ~ k:-'~ GeoDesign I .
Engineer or Architect Finn (Printed)' ~gin.ee eerr? (}rr.t}iC ychftect ~ture "..-- Spi''''i<>l ~ection ~e (Print~) ~ Special~. . ....6~U...J~
GeoDesign y-t/ ~ - . ",-. ~\..') ~ ~k<C.\ \ \J <-..\ ~ _ \--
Testing Laboratory Name (Printed)' t~6n~boratoryRep. Signature BuilamgOfficial Name (Printed) Build'mg 111iiciaISigruiture
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