Report ir.)- ockTo f
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April 9,1996 CITY OF TIGARD
OREGON
Carlson Testing Company, Inc.
PO Box 23814
Tigard, OR 97281
PERMIT NO: BUP95-0507 _
OWNER: John Duncan
PROJECT ADDRESS: 1 S 9 9 5 -055SW 74th Avenue
PROJECT DESCRIPTION: Whse & Manuf.
TYPES OF SPECIAL INSPECTION: Structural special inspections. See attached.
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:
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1. Submit copies of all inspection reports promptly Igthe 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. 7015 for soils special inspection final report requirements). =r
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, E"
Jim Funk
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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Plan Review 0 a - o/ � CITY ®F �G
Date
OREGON
Structural Special Inspections _ I .
The owner or architect or engineer of record shall complete Parts 8 & D of this form and then return it to the Building Division 1
for approval 2 to issuance of a building permd- (Please w
note that a separate sods special on form may be required
and additional special inspections may be required for contractor design items.) 6
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Project Address: �(t 5j 6, 10.1. - 14131 P fo I X18: JOHN DUNCAN $Ltlt.bil.1
Architect of Record (Firm): - Phone No: l' 1 ..
Engineer of Record (Firm): R ‘1,01,1 {i N1:4tNl 2. 114In Phone Na: 40 - ?-Out `_,
The of following 'pedal and structural observations shall be Ong to the State Budding Code and the
Tig ard
Cite of Ti•' 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. 'g Reinforced Concrete- ❑ Prestressed Concrete
❑ Structural Steel - 151 Structural Masonry, fm = 1500
0 Field Welding 0 Fireproofing
fil Shop Fabrication '4 IA Other A 1.- s 0_ l
B. Indicate the special inspector or approved testing agency to pe the special inspections noted in Part A above, K=ll .
including addresses and phone - numbers. Submit names, qualifications and certifications of the special inspectors 14.4.
assigned to the project. The special inspector or inspection agency shall submit a final signed report to the Building
Division stating thatall kerns requiring special inspection
design and testing were fulfilled and reported and• to ders and the
knowledge, in conformance with the approved drawings, specifications, orders . .7
p of the U.B.C. (see U.B.C. 7015 for soils apeaai requirements). _
Items not. in conformance. unresolved items or any dlscrepandes in inspection coverage (Le., missed inspections,
periodic inspections when continuous was required. etc.) shall be specifically itemized in this report. t
X CA 1AoN - Mont•% (I - t, *— 3410 ' ,
C. Ed 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 Y
• special inspections and/or structural observation. -'
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• Sig . 4 f owner Co0�1 O0�'4
Print Name J O11ti tDut4G /t•4 Phone No.
Date 2 ;IA.,°tf0 sw
Firm 14.A. 2
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Structural Plans Examiner signature "r
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13125 SW HON. Bhnd.,ligord: OR 97223 (503) 639 -4171 TDD (503) 684-2772
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