Tr1: Technical Report Statement Of Responsibility

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TR1: Technical Report
Statement of Responsibility
Orient and affix BIS
job number label here
This form must be typewritten
Required for all applications.
1 Location Information
House No(s)
Street Name
Work on Floor(s)
Required for all applications.
2 Applicant Information
Choose all that apply:
Design Applicant 3A, 4A, 5
Special Inspections Applicant 3B-D, 6-9
Progress Inspections Applicant 4B-D, 6-9
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
License Type
choose one:
P.E.
R.A.
Other:
License Number
Special Inspection
Agency Number
Required for all applications, continued on page 2; █ indicates report required.
3 Special Inspection Categories
3B Identification of
3C Certificate of Complete
3D Withdraw
← Identification of Requirement
3A
Responsibilities
Inspections / Tests
Responsibilities
Y
N
Special Inspections
Code/Section
Initial & Date
Initial & Date
Initial & Date
Structural Steel – Welding
BC 1704.3.1
Structural Steel – Details
BC 1704.3.2
Structural Steel – High Strength Bolting
BC 1704.3.3
Structural Cold-Formed Steel
BC 1704.3.4
Concrete – Cast-In-Place
BC 1704.4
Concrete – Precast
BC 1704.4
Concrete – Prestressed
BC 1704.4
Masonry
BC 1704.5
Wood – Installation of High-Load Diaphragms
BC 1704.6.1
Wood – Installation of Metal-Plate-Connected Trusses
BC 1704.6.2
Wood – Installation of Prefabricated I-Joists
BC 1704.6.3
Subgrade Inspection
BC 1704.7.1
Subsurface Conditions – Fill Placement & In-Place
BC 1704.7.2
Density
BC 1704.7.3
Subsurface Investigations (Borings/Test Pits)
█ TR4
BC 1704.7.4
Deep Foundation Elements
█ TR5
BC 1704.8
Helical Piles (BB # 2014-020)
█ TR5H
BC 1704.8.5
Vertical Masonry Foundation Elements
BC 1704.9
Wall Panels, Curtain Walls, and Veneers
BC 1704.10
Sprayed fire-resistant materials
BC 1704.11
Mastic and Intumescent Fire-resistant Coatings
BC 1704.12
Exterior Insulation and Finish Systems (EIFS)
BC 1704.13
Alternative Materials - OTCR Buildings Bulletin #
BC 1704.14
Smoke Control Systems
BC 1704.15
Mechanical Systems
BC 1704.16
Fuel-Oil Storage and Fuel-Oil Piping Systems
BC 1704.17
High-Pressure Steam Piping (Welding)
BC 1704.18
High Temperature Hot Water Piping (Welding)
BC 1704.18
High-Pressure Fuel-Gas Piping (Welding)
BC 1704.19
Structural Stability – Existing Buildings
BC 1704.20.1
Excavations—Sheeting, Shoring, and Bracing
BC 1704.20.2
BC 1704.20.3
Underpinning
BC 1814
Mechanical Demolition
BC 1704.20.4
TR1
August 2016

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