BRUNSWICK COUNTY BUILDING INSPECTIONS
BRUNSWICK COUNTY GOVERNMENT CENTER
B
UILDING I
B
OLIVIA, NORTH CAROLINA 28422
Statement of Special Inspections
Project Number: _____________________
Project Location/ Address: _________________________________________________________________
Owner’s Representative: _________________________________________________________________
Owner’s Mailing Address: _________________________________________________________________
Architect of Record: _________________________________________________________________
Structural Engineer of Record: _________________________________________________________________
This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the
Special Inspection requirements (Chapter 17) of the North Carolina State Building Code. The Statement includes a
Schedule of Special Inspections applicable to this project as well as the required qualifications for the Special
Inspector and Agents of the Special Inspector to perform on this project.
The Special Inspector shall keep records of all inspections, furnish inspection reports, and identify discrepancies
as required by Section 1704.1.3 of the North Carolina State Building Code.
A final report of Special Inspections, documenting the completion of all required Special Inspections and
confirming the correction of any discrepancies, will be submitted prior to issuance of a Certificate of Use and
Occupancy. The Special Inspections program does not relieve the Contractor of his or her responsibilities. Job
Site safety and means and methods of construction are solely the responsibility of the Contractor.
Schedule of Special Inspections
The following sheets comprise the required schedule of special inspections for this project. The construction
divisions which require special inspections for this project are as follows:
Soils Exterior Insulation & Finishing System (EFIS)
Site Retaining Walls Wood Shear Walls
Special Foundations Smoke Control
Cast-In-Place Concrete Structural Steel: Connections, Welds, Bolts, & Anchors
Structural Load Bearing Precast Concrete Quality Assurance for Seismic Resistance
Wall Panels and Veneers Mastic & Intumescent Fire-Resistant Coasting
Post Tensioned Concrete Quality Assurance for Wind Requirements
Sprayed Fire-Resistant Materials Modular Construction
Structural Masonry- Level 1 Alternative Methods
Cold-Formed Steel Framed “X” Bracing/ Seismic-Resisting Systems
Seismic Design Category: _____________
Basic Wind Speed: _____________
Wind Exposure Category: _____________
Statement of Special Inspections Prepared by (Structural Engineer of Record):
________________________________________________________________________
Signature Date
Owner’s Authorization Accepted for the Building Official by:
__________________________________ _______________________________________
Signature Date Signature Date
