FORM: INSP-1
PAGE 1
CITY OF LACEY
Community & Economic Development Department
420 College Street SE
Lacey, WA 98503
(360) 491-5642
____________________________________________________
SPECIAL INSPECTION AND TESTING AGREEMENT
City of Lacey Building Department
Permit # _________________
Prior to issuance of a permit, this form must be completed in its entirety and returned to the City for
approval. The completed form must have the original signatures of acknowledgement of all parties.
Project:
________________________________________________________________________________________________________________________________
Address:
______________________________________________________________________________________________________________________________
Owner:
________________________________________________________________________________________________________________________________
Architect:
______________________________________________________________________________________________________________________________
Engineer:
_____________________________________________________________________________________________________________________________
Contractor:
___________________________________________________________________________________________________________________________
DUTIES AND RESPONSIBILITIES
Special Inspection Firm and Special Inspectors:
The Special Inspection firm of
__________________________________________________________________________________________ will
perform special inspection for the following types of work (separate forms must be submitted if more
than one firm is to be employed):
Reinforced Concrete ( )
Bolting in Concrete ( )
Pre-stressed Concrete ( )
Shotcrete ( )
Structural Masonry ( )
Structural Steel & Welding ( )
High-Strength Bolting ( )
Spray-Applied Fireproofing ( )
Smoke-Control Systems ( )
Grading* ( )
Other ( ) Specify: _______________________________________________________________
*Grading does not require WABO certification.
All individual inspectors to be employed on this project will be WABO certified for the type of inspection
they are to perform. If inspection is for work that is not covered by the WABO categories, a detailed
resume of the inspector and firm must be submitted. The resume must show the inspector and firm are
qualified to perform the work and testing required by the project design and specifications.
FORM: INSP-1
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The work shall be inspected for conformance with the plans and specifications approved by the City.
Revisions and addenda sheets will not be used for inspection unless they have been approved by the
City. The special inspector shall report to the City any revisions that are not approved.
A daily record will be maintained on site itemizing the inspections performed, for the review of all parties.
Any nonconforming items shall be brought to the immediate attention of the contractor for resolution.
A weekly report shall be submitted to the City; detailing the inspections and testing performed, listing any
nonconforming items and resolution of nonconforming items. Unresolved nonconforming items will be
detailed on a discrepancy report and presented to the building department.
A final report shall be submitted to the building department prior to the Certificate of Occupancy being
issued. This report will indicate that inspection and testing was completed in conformance with the
approved plans, specifications and approved revisions or addenda. Any unresolved discrepancies must
be detailed in the final report.
The special inspector and special inspection firm serve in the role as "deputy" City of Lacey inspectors
and as such are responsible to the City of Lacey Building Department in the performance of the
required work.
Contractor:
The contractor shall provide the special inspector or agency adequate notification of work
requiring inspection.
The city approved plans and specifications must be made available, at the job site for the use of the
special inspector and the City inspector. The contractor shall maintain all daily inspection reports, on site,
for review.
The special inspection functions are considered to be in addition to the normal inspections performed by
the City and the contractor is responsible for contracting the City to schedule regular inspections. No
concrete shall be poured or other work covered until approval is given by the City inspector.
Building Department:
The building department shall review any revisions and addenda. Approved copies will be given to the
contractor to maintain as part of the approved plan set.
The City inspector will monitor the special inspection functions for compliance with the agreement and the
approved plans.
The City inspector shall be responsible for approving various stages of construction to be covered and
work to proceed.
Design Professionals:
The architect and engineer will clearly indicate on the plans and specifications for the specific types of
special inspection required, and shall include a schedule for inspection and testing. The architect and
engineer will coordinate their revision and addenda process in such a way as to insure all required City
approvals are obtained, prior to work shown on the revisions being performed.
Owner:
The project owner, or the architect or engineer acting as the owners agent, shall employ the special
inspector or agency.
FORM: INSP-1
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ENFORCEMENT
A failure of the special inspector or firm to perform in keeping the requirements of the UBC, the approved
plans and this document may void this agreement and the Building Officials approval of the special
inspector. In such a case a new special inspector and/or firm would need to be proposed for approval. A
failure of the design and/or construction parties to perform in accordance with this agreement may result
in a STOP WORK notice being posted on the project, until nonconforming items have been resolved.
ACKNOWLEDGEMENTS
I have read and agree to comply with the terms and conditions of this agreement.
Owner:
__________________________________________________________________________ Date: ________________________________
Contractor:
_____________________________________________________________________ Date: ________________________________
Architect:
_______________________________________________________________________ Date: ________________________________
Engineer:
_______________________________________________________________________ Date: ________________________________
Special Inspector
or Inspection Agency:
________________________________________________________ Date: ________________________________
ACCEPTED FOR THE CITY OF LACEY BUILDING DEPARTMENT
By:
_____________________________________________________________________________ Date: ________________________________