HomeMy WebLinkAboutSPECIAL INSPECTION STATEMENT - 22-00059 - Java EspressStatement of
Special Inspections
The design engineer (or design architect if no engineer; applicant if no design professional) must complete
this form in accordance with IBC Chapter 17 and submit with plans for building permit.
Building Permit Number:
Project Name:
Special Inspection Firm
Project Address:
Special Inspectors must be certified in the applicable discipline of work needing special inspection.
Name:
E-mail:Phone:
Design Professional in Responsible Charge Acting as the Owner's Agent
Name (print):
E-mail:
Owner
Phone:
Name (print):
E-mail:Phone:
Please note: The owner or registered design professional in responsible charge acting as the owner’s agent - not the
contractor - shall employ one or more approved agencies to perform special inspections services.
I acknowledge that I have read the note above and will employ the
special inspector(s).
Owner’s Signature Date
Structural Engineer
Name:
E-mail:
Phone:
Name of Design Professional / Applicant completing the Statement of Special
Inspection (Print):
Date:
Design Engineer (or Design Architect if no
engineer) provide Design Professional stamp,
signature and date completing the Statement
of Special Inspections.
01/2019
www.cityofboise.org/pds
City of Boise Planning & Development Services
P.O. Box 500 • 150 N. Capitol Blvd • Boise, Idaho 83701-0500
Phone: 208/608-7100 • Fax: 208/377-3529 • TTD/TTY 800/377-3529
Department Application
#310 PD
S
Statement of Special Inspections ( 2 )
Scope of work to be inspected by Special Inspection firm to meet IBC Section 1704
Yes
No
1705.12.1
Structural Steel AISC 341
If yes complete TABLE 8
Yes
No
1705.2.1
Structural Steel AISC 360
If yes complete TABLE 9
Yes
No
1705.2.2
Cold-formed steel deck-SDI QA/QC
If yes, specify:
Yes
No
1705.2.3
Open-web steel joists and joist girders
If yes complete TABLE 1
Yes
No
1705.3
Concrete Construction
If yes complete TABLE 2
Yes
No
1705.4
Masonry Construction
If yes complete TABLE 3 or 4
Yes
No
1705.4.2
Vertical masonry foundations elements
If yes complete TABLE 3 or 4
Yes
No
1705.5
Wood Construction
High-load diaphragms
Metal plate connected wood trusses
spanning 60 feet or greater
Yes
No
1705.6
Soils
If yes complete TABLE 5
Yes
No
1705.7
Driven Deep Foundations
If yes complete TABLE 6
Yes
No
1705.8
Cast in Place Deep Foundations
If yes complete TABLE 7
Yes
No
1705.9
Helical Pile Foundations
If yes, specify:
Yes
No
1705.10
Fabricated Items
If yes complete section 1704.2.5
Yes
No
1705.11
Special inspection for wind resistance
Structural wood (continuous)
Cold formed steel light-frame construction
(periodic)
Wind resisting components (periodic)
Yes
No
1705.12
Special inspection for seismic resistance
Complies with one of the exceptions there-
fore sections 1705.12.1 - 1705.12.9 don't
apply
If special inspection is required complete
TABLE 8
Yes
No
1705.13
Testing for seismic resistance
If yes complete section 1705.13.1 – 1705.13.4
unless exempted from special inspections by
section 1704.2
Yes
No
1705.14
Sprayed Fire-Resistant Materials
Yes
No
1705.15
Mastic & Intumescent Fire -Resistant Coatings
Yes
No
1705.16
Exterior Insulation & Finish Systems (EIFS)
Statement of Special Inspections ( 3 )
Yes
No
1705.17
Fire-Resistant penetrations and joints
If yes, specify:
Yes
No
1705.17.1
Penetration firestops
If yes, specify:
Yes
No
1705.17.2
Fire-resistant joint systems
If yes, specify:
Yes
No
1705.18
Special Inspection for Smoke Control
If yes, specify:
Statement of Special Inspections ( 4 )
TABLE 2
1705.3 Concrete Construction
Yes No MATERIAL / ACTIVITY Continuous Periodic
1. Inspection of reinforcing steel, including prestressing tendons, and placement. - X
2. Reinforcing bar welding:
a. Verify weldability of reinforcing bars other than ASTM A 706;
- X
b. Inspect single-pass fillet welds, maximum 5/16” X
c. Inspect all other welds X
3. Inspect anchors cast in concrete -
X
4. Inspect anchors post-installed in hardened concrete members
a. Adhesive anchors installed in horizontally or upwardly inclined orientations to
resist sustained tension loads.
X
b. Mechanical anchors and adhesive anchors not defined in 4.a
5. Verify use of required design mix - X
6. Prior to concrete placement, fabricate specimens for strength tests, perform
slump and air content tests, and determine the temperature of the concrete.
X
-
7. Inspect concrete and shotcrete placement for proper application
techniques. X -
8. Verify maintenance of specified curing temperature and techniques. - X
9. Inspection of prestressed concrete for:
a. Application of prestressing forces X -
b. Grouting of bonded prestressing tendons X -
10. Inspect erection of precast concrete members. - X
11. Verify in-situ concrete strength, prior to stressing of tendons in post-tensioned
concrete and prior to removal of shores and forms from beams and structural slabs.
-
X
12. Inspect formwork for shape, location and dimensions of the concrete member
being formed. - X
TABLE 1
1705.2.3 Required Special Instructions of Open-Web Steel Joists and Joist Girders
Yes No MATERIAL / ACTIVITY Continuous Periodic
1. Installation of open-web steel joists and joist girders
a. End connections – welding or bolted. - X
b. Bridging – horizontal or diagonal. -
1. Standard bridging. - X
2. Bridging that differs from the SJI specifications listed in Section 2207.1. X