Technical Report Statement Of Responsibility
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3TR1: Technical Report
Statement of Responsibility
Orient and affix BIS
job number label here
This form must be typewritten
1 Location Information
Required for all applications.
House No(s)
Street Name
Work on Floor(s)
2 Applicant Information
Required for all applications.
Choose all that apply:
Design Applicant 3A, 4A, 5
Special Inspections Applicant 3B-D, 6-8
Progress Inspections Applicant 4B-D, 6-8
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 Items
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
Flood Zone Compliance
BC G105
Fire Alarm Test
BC 907, BC 1704.13
█ TR7
Photoluminescent Exit Path Markings
BC 1026.11
Emergency Power Systems (Generators)
BC 1704.13, BC 2702
Structural Steel - Welding
BC 1704.3.1
Structural Steel - Erection & Bolting
BC 1704.3.2, 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 - Off-Site fabrication of Structural Elements
BC 1704.6
Wood - Installation of High-Load Diaphragms
BC 1704.6.1
Wood - Installation of Metal-Plate-Connected Trusses
BC 1704.6.3
Wood - Installation of Prefabricated I-Joists
BC 1704.6.4
Soils - Site Preparation
BC 1704.7.1
Soils - Fill placement & In-Place Density
BC 1704 .7.2, BC 1704.7.3
█ TR4
Soils - Investigations (Borings/Test Pits)
BC 1704.7.4
█ TR5
Pile Foundations & Drilled Pier Installation
BC 1704.8
Pier Foundations
BC 1704.9
Underpinning
BC 1704.9.1
█
Wall Panels, Curtain Walls, and Veneers
BC 1704.10
Sprayed Fire-Resistant Materials
BC 1704.11
Exterior Insulation Finish Systems (EIFS)
BC 1704.12
Alternative Materials - OTCR Buildings Bulletin #________
BC 1704.13
Smoke Control Systems
BC 1704.14
Mechanical Systems
BC 1704.15
Fuel-Oil Storage and Fuel-Oil Piping Systems
BC 1704.16
High-Pressure Steam Piping (Welding)
BC 1704.17
Fuel-Gas Piping (Welding)
BC 1704.18
Structural Safety - Structural Stability
BC 1704.19
Mechanical Demolition
BC 1704.19, BC 3306.6
01/11
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