Correspondence MS% 9(v- 3 8" �
November 14, 1996 CITY OF TIGARD
OREGON
Carlson Testing
P.O. Box 23814
Tigard, OR 97281
PERMIT NO: MST 96 -0380 F F�L
OWNER: 33 Z irw
PROJECT ADDRESS: SW Pfaffle & 83rd
PROJECT DESCRIPTION: Carriage House
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 owner's agent must also confirm with you that they have authorized you to do the special
inspection work.
As the regulatory 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 contractor.
2. Maintain one copy of each field report at the job site.
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,
c�-
Jim Funk
Building Division
Enclosure
i•totsltemotate\ notify dot
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
•
Plan Review # /` 7 y 6 /7
Date CITY OF TIGARD
OREGON
Structural Special Inspections
The owner or architect or engineer of record shall complete Parts B & 0 of this torn and then return it to the Building Division for
approval 'Az to issuance of a building permit (Please note that a separate soils special inspection form may be required and
additional special inspections may be required for contractor design items.)
Project A d d r e s s : 5, 4, . e f A f F / a d o 3 r = Project Name: ( r 4 PR f A- c r f !' 4 r r
Architect of Record (Firm): Phone No:
Engineer of Record (Firm): Phone No:
The following special inspections and structural observations shall be performed according to the State Building Code and the
City of Tigard's Municipal Code Chapter 14.06. 010 - 14.06.040 unless a schedule of inspections is submitted by the Engineer of
Record and approved by the Building Division.
A. 'Reinforced Concrete ['Prestressed Concrete
❑ Structural Steel ['Structural Masonry, Pm =
❑ Reid Welding ❑Freprooting
❑ Shop Fabrication Other «l(7# f e
B. Indicate the special inspector or approved testing agency to perform the special inspections noted in Part A above,
incoming addresses and phone numbers. Submit names, qualifications and certifications of the special inspectors
assigned to the project The special inspector or inspection agency shall submit a final signed report to the Building
Division stating that all items requiring special inspection and testing were fulfilled and reported and, to the best of his/her
knowledge, in conformance with the approved design drawings, specifications, approved change orders and the
awe wodonanship provisions of the U.B.C. (see U.B.C. 3318 for soils special inspection final report requirements).
luaus not in oorfortnanae, unresolved items or any discrepancies in inspection coverage (i.e., missed inspections,
periodic inspections when continuous was required, etc.) shall be specifically itemized in this report
CARLSOtt . M5`71 1 C�
C. ❑ Structural Site Observation by Engineer of Record
D. The owner hereby agrees to employ the special inspector, approved testing agency and/or engineer for the above -noted
special inspections and/or structural observation.
Signature of Owner
Print Name , / ��� /�l /�> L 7 Phone No.
Firm Date /0ZiVp
Stnrctural Plans Examiner signature strsi.doc
13125 SW.Hatl Blvd., Tigard. OR 97223 (503) 639 -4171 TDD (503) 684 -2772