HomeMy WebLinkAboutM_SPECIAL_INSPECTION_FORM_210318_V1H:\CED\Data\Forms-Templates\Self-Help Handouts\Building\Special Inspection Form.docx Rev.
Project Name:
Address:
Responsibility under Section 109 of the International Building Code (IBC) for selection of a testing
laboratory lies with the owner or his agent (architect or structural engineer of record).
The following have been or will be contracted with to perform all SPECIAL INSPECTIONS required
per Chapter 17, IBC and the Renton Building Department.
o Structural Considerations
Testing Agency:
Telephone:
Address:City/State/Zip:
o Geotechnical Considerations Per Soils Report
Geotechnical Engineer of Record:
Testing Agency:
Telephone:
Address:City/State/Zip:
We understand that these assignments cannot be changed (transferred) once the building permit
has been issued without the approval of the Building Official.
The completed form must be returned to the City of Renton Plans Examiner prior to issuance of
the Building Permit.
Print Name
Signature of Owner/Authorized Agent Date
AUTHORIZATION FOR SPECIAL
INSPECTION ACTIVITIES
07/31/2020
RECEIVED
03/19/2021 striplett
BUILDING DIVISION
B20003319_V2