1998, 05-07 Inspection & Testing: 98-3307 May-07-98 01 : 52P Giffc i Consultants 509 42925 P.02
SPECIAL INSPECTOR AND TESTING LAB
EMPLOYMENT ACKNOWLEDGEMENT FORM.
Please complete one form for each INDIVIDUAL performing Special Inspection or Testing work on each
project.
Date May 7, 1998
Project Address 5908 E. Broadway
Project Name Advertizing Sign Project No. 98-3307
Inspection or Lab Firm Name Gifford Consultants, Inc.
Address 2020 E. Springfield Ave. , Spokane, Washington 99202
Phone (509)534-3670; FAX (509) 534-2925
Name of Individual performing work Timothy D. Barber
ICBO Number 66513 ( ) Non-Certified Trainee
Supervisor(if Trainee) ICB0 No
(must be Certified Special Inspector).
STATEMENT OF UNDERSTANDING
Timothy D. Barber ,hereby affirm that I have been
employed by Gifford Consultants, Inc. for a duration of as needed
(hours, days, weeks)to provide special inspections under Section 306 of the Uniform Building Code of:
Field welding & high strength bolting
as it relates to the above stated project and that I am aware that as special inspector, my duties and
responsibilities include: 1)Observation of the work assigned for conformance with the approved design
drawings and specifications,2)Furnishing inspection reports to the building official, and the engineer or
architect of record, in addition to other designated persons. All discrepancies shall be brought to the
immediate attention of the contractor for correction, then, if uncorrected, to the proper design authority
and to the building official, and 3) Submitting a final signed report stating whether the work requiring
special inspection was, to the best of my knowledge, in conformance with the approved plans and
specifications and the applicable workmanship provisions of the Uniform Building Code.
I also agree to immediately notify the building official if my employment as it relates to this project is
modified in any way or terminated prior to submittal of my final report.
Individual's Signature "'" O - (3w.4.._.
Supervising Special Inspector's Signature
(required if indivual is a Trainee)