Correspondence •
Juy 31,1997 CITY OF TIGARD •
� �
Carlson Testing
P.O. Box 23814
Tigard, OR 97281
PERMIT NO: :. BUP 97 -0353
OWNER McDonalds
- PROJECT ADDRESS: • 11201 SW 72nd
PROJECT DESCRIPTION: Sign
TYPES OF SPECIAL INSPECTION: Structural Special Inspections
• Dear Mr. Leach:
•
' The owner has notified us that he/she will retain your services to perform Special Inspections in accordance
with the provisions of the State Building Code, permit documents, and special inspection requirements.
• • . The owner or the ownees agent must also confirm with you that they have authorized you to do the special
• Inspection work.
As the reg
gulatory agency, the City requires that you do the following:
•
.1. ' Submit copies of all inspection reports promptly to the Building Division, architect, engineer,
•
and the oontrac�or.
2. " Maintain one copy of each field report at the job erte.
3. Submit a final report at the completion of each category of work that you inspect (See
• - ' U.B.C. 3318 for soils special inspection final report requirements).
If you fail to comply with the above requirements, there may be cause for the City to revoke your authority as
special inspector for this job.
•
Should you have any questions, please call the Building Division at (503) 639.4171.
Sincerely, •
Ate-.
R rt Poskin, CBO
. Building Division ,
•
Enclosure
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• 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 TDD (503) 684 -2772
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Strucarral Special Inspections
The owner or architect or engineer of record shall complete Parts B & D of this form and then return it to the Building Division tor
approval prior to issuance of a building permit. (Plo35e no that a separate soils special inspection form may be required and
additional special inspections may be required for contracor design items.) /+
Project Address: t t?f7t s w 124 VI�Ta
Project Name: d�'c CS∎ic J \
Architect of Record (Finn): .Jec.704 Phone No: Sac - /al 6
Engineer of Record (Firth): 15g..S IP-R+• J o•J 6% Phone No: 69 `S - VI '$ Z
The following inspections and structural obsen ations shall be performed ae eordtng to the State Btolding Code and the
City of Tigard 's Municipal Code Chapter 14.08.010 - 14.06.020 unless a schedule of inspecbonss is subtilized by the Engineer of
Record and approved by the 6uBding Division
A. ❑Reinforced Concrete ❑Prestressed Concrete
❑ Structural Steel ❑Structural Masonry, fm =
® Held Weitin9 0Fr roofin9 •
iiii Shop Febtiseeon ®Other N1GI .rdn
b. B. Indicate tme special inspector or approved testing agency to perform the special inspec dons noted in Pan A above,
including addresses and phone numbers. Submit names, qualifications and eeroficabons of the special inspectors
as.-.igned to the project The =tidal inspector or inspection agency shall submit a final sigma report to the Building
Division Ming that an hams requiring special impaction and tesdng were fulfilled and warted and. to the best of hislher
des dr awings. sp ec icaoons. approved knowledge, in conformance with the approved design change orders and the
appri able workmanship provisions of the U .2.C. (see U.B.C. 3318 for soils special inspection final report requirements).
Items not in conformance, unr olled items or any rfisccepancies in inspection covenge (I.e.. missed inspections.
periodic inspections when continuous was required. etc.) shall be apex CallY itemized ill this ds repo
® _ill .�� �7 h '.o. 40) _ F t_ _. • _ ..
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C. ❑ Structural Site Obsery a 0t" by Engineer of Record
D. The owner hereby agrees to employ the special inspector. approved testing agency and/or engineer tor the above -noted
special inspections and/or structural obser abon.
- (",11„,
x Signature of Owner
x Print Name
7 t )(Phone No. LS"V3 --A07-0 -P« 7
-,[ Frm p+ s = a /bw) CO • )( Date 7 0 f 7
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Structural Plan finer signature oisuisewzacwak
13125 SW Nall Blvd Tigard. OR 97223 (503) 639 -4171 TDD (503) 6Sa -2772