Fillable SPECIAL STRUCTURAL TESTING and INSPECTION SCHEDULE (City of Edina)

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SPECIAL STRUCTURAL TESTING and INSPECTION SCHEDULE (City of Edina)

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File type: PDF

U.S.A. forms for City of Edina

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I:\Building\SafetyPoliciesInformation\2017\Website\COMMERCIAL SD02 SPECIAL INSPECTION SCHEDULE.pdf
SPECIAL STRUCTURAL TESTING and INSPECTION SCHEDULE
This Special Structural Testing and Inspection Schedule is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural
Testing requirements of the 2012 International Building Code as adopted by the current Minnesota State Building Code. It includes a schedule of Special
Inspection services applicable to this project and the identity of agencies to be retained for conducting these inspections and tests.
Proj
ect Name: ___________________________________________________________________ Project No: ____________________________
Project Location: _________________________________________________________________ Permit No: (1)__________________________
This schedule to be filled out by SER prior to completion of the ACKNOWLEDGMENTS section.
Project Section and/or
IBC Section (2)
Description
(3)
Inspector Type
(4)
Report Frequency
Inspection Frequency
Assigned Firm
(5)
(1) Permit No. to be provided by the Building Official (3) A description of the item being inspected or tested (5) Firm contracted to perform services
(2) Use project specification section number and/or IBC section number. (4) Special Inspector – Technical (SIT), Special Inspector - Structural
The Special Inspector shall keep records of all inspections and shall furnish inspection reports to the Building Official, the Architect and Structural Engineer of Record.
Discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected, the discrepancies shall be brought
to the attention of the Building Official, the Architect and SER. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim
reports shall be submitted to the Building Official the Architect and SER.A Final report of Special Inspections documenting completion of all required Special
Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use
and Occupancy.
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ACKNOWLEDGMENTS
Project Location: _________________________________________________________________ Project No: ______________________________
Each appropriate representative shall complete below:
OWNER:
_______________________________________ _____________________________________ ____________________________ _______
____________
Firm Print Name Signature Date
CONTRACTOR:
_______________________________________ _____________________________________ ____________________________ ____________
_______
Firm Print Name Signature Date
ARCHITECT:
_______________________________________ _____________________________________ ____________________________ _________
__________
Firm Print Name Signature Date
SER:
_______________________________________ _____________________________________ ____________________________ ___________
________
Firm Print Name Signature Date
SI-S:
_______________________________________ _____________________________________ ____________________________ ______________
_____
Firm Print Name Signature Date
SI-T:
_______________________________________ _____________________________________ ____________________________ ____________
_______
Firm Print Name Signature Date
SI-T:
_______________________________________ _____________________________________ ____________________________ ____________
_______
Firm Print Name Signature Date
TA:
_______________________________________ _____________________________________ ____________________________ ______________
_____
Firm Print Name Signature Date
TA:
_______________________________________ _____________________________________ ____________________________ ____________
_______
Firm Print Name Signature Date
FABRICATOR:
_______________________________________ _____________________________________ ____________________________ _______
____________
Firm Print Name Signature Date
FABRICATOR:
_______________________________________ _____________________________________ ____________________________ _________
__________
Firm Print Name Signature Date
LEGEND: SER = Structural Engineer of Record SI-T = Special Inspector - Technical SI-S = Special Inspector – Structural TA = Testing Agency F = Fabricator
If
requested by engineer/architect of record or building official, the individual names of all prospective special inspectors and the work they intend to observe shall be identified
ACCEPTANCE
Accepted for the Inspections Department of the City of ________________________________By: ________________________________________
Signature: _______________________________________________ Date: ___________________________
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SPECIAL STRUCTURAL TESTING and INSPECTION SCHEDULE (City of Edina)

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Completed 13 August 2020

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