Commercial Special Inspection And Testing Request Form printable pdf download

Commercial Special Inspection and Testing

Request form

Building and Safety Division/Permit Application Center

City Hall / 555 Liberty St. SE / Room 320 / Salem, OR 97301-3513

baspac@cityofsalem.net

503-588-6256 *

If you need the following translated in Spanish, please call 503-588-6256.

Si usted necesita lo siguiente traducido en español, por favor llame 503-588-6256.

Work site location and information

Permit #

Street address of work site

Acknowledgments

I have read and agree to comply with the terms and conditions in this agreement:

Company name and signor's

Signature

Date

name

Owner

Contractor

Engineer/Architect

Special Inspection

Agency

Request response

(For office use only)

City of Salem Authorized Signature

Date:

Approved

Denied

Terms and conditions

Purpose: To permit applicants of projects requiring special inspection and/or testing per chapter 17 of the State of Oregon

Structural Specialty Code (OSSC).

Before a permit can be issued: The owner, or the engineer/architect of record acting as the owner’s agent, shall complete

two (2) copies of this agreement and the attached structural tests and inspections schedule including the required

acknowledgments. A pre-application conference with the parties involved may be required to review the special

inspection requirements and procedures.

Approval of special inspectors: Each special inspector shall be approved by the Building and Safety Division prior to

performing any duties. The OBOA Special Inspection Program is the preferred method of verifying the qualifications. If

the special inspection agency is not registered in the OBOA Special Inspection Program, the owner and/or architect/

engineer of record shall supply the list of all proposed inspectors and their certification/registration numbers. Each special

inspector shall submit his/her qualifications to the Building and Safety Division and is subject to a personal interview for

pre-qualification. Special inspectors shall display approved identification as stipulated by the Building and Safety

Division when performing the function of a special inspector.

IAS 4.2.2.1; 7.2.4.1; Annex A, clause A7.1;

Commercial Special Inspection and Testing Request Form - Page 1 of 3

Annex A, clause A7.5 - 8/7/17

Commercial Special Inspection And Testing Request Form

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