2001, 08-21 Inspection & Testing Agreement 08/21/2001 13:51 GEO ENGINEERS 4 Spokane County NO.227 p002
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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: August 21,2001
Project Address: 12606 E.Mission Ave.
Project Name: Valley Hospital Addition Bid Pacs 4&5 Permit No. not yet issued
Inspection or Lab Finn Name: GeoEngineers,Inc.
Address: 523 East Second Ave.,Spokes,WA.99202
Phone: 363-3125 Fax: 363-3126
Name of Individual performing work:
; i,V,AziE Tim Barber Gary Panther Dave Lyon Scot Wise Jerry Amann
0855800-88,ACI 62512,ACI AC1 Tech.I ACI Tech I ACI Tech.I
wyiM%' 0855800-84 0866959-84 -
" _: 0855800-85 5060705-85
77-1:‘..:4 0855800-86
STATEMENT OF UNDERSTANDING
1,Timothy Barber,hereby affirm that GeoEngineers,Inc. has been employed by Valley Hospital and
Medical Center for a duration of the project(hours,days,weeks)to provide special inspections wider
Section 1701 of the Uniform Building Code of: Concrete.bolts in concrete,concrete reinforcing,structural
steel andwelding hielt strength bolting,adhesive anchors special rgra g.excavatio aid �)
as it relates to the above stated project and that I am aware that as a special inspector,ray 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
Supervising Special Inspector's Signature
(required if individual is a Trainee)
08/21/2001 13:51 GEO ENGINEERS 4 Spokane County NO.227 D003
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SPECIAL INSPECTION AND
TESTING NOTICE/AGREEMENT
Project Title:Valley Hospital Addition and Remodel Project Address:1,2606 E.Mission.Svokane,W.A.
Project Owner:Valley Hospital and Medical Center Permit Number. unknown
The above-referenced project requixes special inspection or testing per Section 1701 of the Uniform
Building Code. Please acknowledge and return this Agreement to the appropriate department
PART 1.GENERAL CONDITIONS
1. The Policy Manual for Special inspection under the Uniform Building Code in the City and
County of Spokane sets forth the accepted and recommended practices associated with special
inspection. A copy is attached for your reference.
2. The Special Inspector,special inspection agency and testing lab,hereinafter referred to as the •
Special Inspector,must be approved by the Spokane County Department of Buildings.
3. The Special Inspector is responsible for immediately notifying the Building Official of any
concerns and/or problems encountered.
4. Copies of all routine reports shall be submitted by the Special Inspector directly to the Building
Official on a weekly basis.
5. The Special Inspector shall submit the naxties and qualifications of on-site inspectors and lab
technicians to the Building Official for approval using the Employment Acknowledgement Form.
6. The Special Inspector shall use only those construction documents which have been approved by
the Building Official.
• 7. The contractor is responsible for reviewing the approved plans for additional inspection
requirements that may be noted.
S. The contractor is responsible for notifying the Special Inspector as to when items listed in the
Tests and Inspections Schedule will be ready for inspection.
PART 2.SPECIFIC REQUIREMENTS •
1. Which must be accomplished prior to issuance of a permit
a. The owner or his designated representatives shall,on the advise of the responsible design
professional,complete,sign and submit two copies of this Agreement to the Building
Official for his approval.
b. The Special Inspector shall submit completed Employment Acknowledgement Forms.
All areas listed on the Tests and Inspections Schedule must be covered by a qualified
Special Inspector
2. Which must be accomplished prior to issuance of a Certificate of Occupancy.
a. All Special Inspector reports must have been received by the Building Official.
08/21/2001 13:51 GEO ENGINEERS -) Spokane County NO.227 1)004
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b. The Special Inspector chill submit a final report to the Building Official stating that all
items requiring testing and inspections were fiilfilled and reported,and that all work was
done in accordance with the approved plans. Items not tested and/or inspected shall be
noted in this report A copy of this report must be maintained on the job site until the
Certificate of Occupancy has been issued.
PART 3.TESTS AND INSPECTIONS SCHEDULE
1. The following checklist has been completed by the Building Official and indicates which tests and
inspections are required to be performed by a Special Inspector.
❑ CONCRETE—During the taking of test specimens and placing of reinforced concrete and pneumatically
placed concrete.
O BOLTS INSTALLED IN'CONCRETE—During installation of bolts and placing of concrete around such
bolts when stress increases permitted by Footnote No.5 of Table No.26—G of the Uniform Building Code
are utilized.
O DUCTILE MOMENT RESISTING FRAME— required in Section 2625(j)of the Unifoma Building Code.
O REINFORCING STEEL AND PRESTRESSING STEEL—During all stressing and grouting of prestressed
concrete and during placing of reinforcing steel,placing of tendons and prestressing steel for all concrete
required to have special inspection.
❑ WELDING—Ductile moment-resisting steel frames as required by Section 2722(1)of the Uniform Building
Code and all structural welding,including welding of reinforcing steel,
❑
HIGH-STRENGTH BOLTING—During all bolt installations and tightening operations.
Q STRUCTURAL MASONRY—During preparations of masonry wall prisms,sampling and placing of all
masonry units,placements of reinforcement,inspection of grout space,immediately prior to closing of
cleanouts,and during all grouting operations.
O REINFORCED GYPSUM CONCRETE—When cast-in-place Class B gypsum concrete is being mixed and
placed
❑ INSULATING CONCRETE FILL—During the application of insulating concrete fill when used as part of a
structural system.
❑ SPRAY-APPLIED FIREPROOFING—As required by Uniform Building Code Standard No.43-8,
❑ PILING,DRILLED PIERS AND CAISSONS—During driving and testing of piles and construction of cast-
in-place drilled piles or caissons.
O SHOTCRETE—During the taking of test specimens and placing of all shotcrete and as required by Section
2621(j)and(k)of the Uniform Building Code.
O SPECIAL GRADING,EXCAVATION AND FILLING-During earthwork excavations,grading and filling
operations inspection.
O SPECIAL CASES—Work which,in the opinion of the Building Official,involves unusual hazards or
conditions.
2. The owner hereby certifies that the special inspector(s)named in this Agreement have been
engaged to perform tests and inspections,as indicated in the checklist below,during construction
to satisfy all applicable portions of the Uniform Building Code.
08/21/2001 13:51 GEO ENGINEERS -4 Spokane County NO.227 D005
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PART 4.DESIGNATION 0)'SPECIAL INSPECTOR(S)
List special inspector(s)intended to be employed by the owner. Include mac,address and phone nwmber
for all individuals who will be doing on-site or lab work relating to the required tests and inspection&
Tim Barber,GeoEngineers-Gifford,523 East Second,Spokane,WA 99205 (509)363-3125
Jen!Ani.GeQEngineers-Gifford,523 East Second.Spokane.WA 99205(509)363-3125
Gary Panther. GeoEngineers-Gifford,523 East Second, Spokane,WA 99205(509)363-3125
Scot Wise.GeoEngineets-QiJ ord,523 East Second.Spokane.WA 99205(509)363-3125
Dave Lyon,GeoEngineers-Gifford,523 East SecondLSpokane,WA 99205 (509)363-3125
FART 5. ACKNOWLEDGEMENT
I have read and agree to comply with the terms and conditions of this Agreement
OWNER: BY: DATE:
CONTRACTOR: BY: DATE:
ARCHITECT: BY: DATE:
ENGINEER: BY: DATE:
PART 6. ACCEPTANCE BY BUILDING OFFICIAL •
I accept the special inspector(s)listed in part 4 for the purposes of performing required tests and inspections
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listed in Part 3.
)3111WING OFFICIAL: BY: DATE:
08/21/2001 13:51 GEO ENGINEERS + Spokane County NO.227 E001
,y ,
Geo Engineers
523 Fast Second Avenue
FAX TRANSMITTAL Spokane,WA 93lephone: (509)363-31125
Tel25
Fax: (509)363-3126
To: Spokane County Dept of Date: August 21,2001
Building&Planning
File: 8675-001-04
Fax Number: 477-4703
Attention: Jun Mascardo
Regarding: Special Inspection Form-Valley Hospital
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Pages Date Description
1 8/21/01 Fax Txansouittal
4 8/21/01 Special Inspection Employment Acknowledgement Form
Total Pages: 5
Comments:
Signed:
Tim Barber
tbarber@geoengineers.coat
DISCLAIMER
This facsimile and any attachments are confidential and intended solely for the use of the individual or entity to
whom they are addressed.