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SPECIAL INSPECTIONS CATAWBA COUNTY
(SICC -2009)
~- 2009 Edition
Effective: July 1 st 2009
Based on North Carolina State Building Code (2009) Edition,
effective July 1st, 2009
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1 842
Administered by
CATAWBA COUNTY, NORTH CAROLINA
BUILDING SERVICES DIVISION
100A Southwest Boulevard
Newton, NC 28601
(828) 465 -8399
http:// www. CatawbaGountync .gov /depts /u&e /buildin.g.asp
SICC 2009 - Appendix A Blank Forms
Page 1 of 3 CATAWBA COUNTY, NORTH CAROLINA
SPECIAL INSPECTIONS PROGRAM
Statement of Special Inspections
TPI Permit #7: TPI Permit #2: TPI Permit #3
(TPI Permit Numbers to be furnished by CCBSD)
PROJECT: Sarstedt, Inc. — Logistics Center NCBC Edition: 2009
Address: 1025 St James Church Road Occupancy: Storage S -2
Newton, North Carolina 28658 Construction Type: II -B
Building Owner: Sarstedt, Inc.
Name Company
Owner's Address: 1025 St James Church Rd. Newton North Carolina 28658
Architect of Record: J. Stan Winstead NC Registered Architect 6908 Winstead Architecture PLLC
Name & License Company
Structural Engineer of Record Jason M Reep NC Engineer 27874 Taylor & Viola Structural Engineers
Name & License Company
Geotechnical Engineer of Record James D. Hoskins III PE # 18493 ECS LP of the Carolinas
Name & License Company
Special Inspections Engineer of Record 1 : James D. Hoskins III PE #18493 ECS LP of the Carolinas
Name & License Company
Special Inspections Engineer of Record 2:_ James D. Hoskins III PE # 18493 ECS LP of the Carolinas
Name & License Company
Special Inspections Engineer of Record 3:
Name & License Company
General Contractor: Matthews Construction Company NC #4280 — unlimited Matthews Constructions Company
Name & License Company
This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the North Carolina Statewide
Building Code.
The Special Inspections Engineer of Record shall keep records of specified special inspections and testing and shall furnish copies of
inspection and testing reports to the Catawba County Building Services Division and to the appropriate registered design professionals
of record. Discrepancies from the approved plans and specifications and code violations observed during the conduct of special
inspections services shall be brought to the immediate attention of the contractor for correction, to the attention of the Catawba County
Building Services Division, and to the appropriate registered design professionals of record. A final report of special inspections
documenting completion of specified special inspections and correction of any discrepancies and observed code violations noted in the
inspection and testing reports shall be submitted to the Catawba County Building Services Division prior to the request for final building
inspection and building inspection approval by County staff.
Prepared by Registered Design Professional in Responsible Charge:
John Stanley Winstead �� �� 9
(Type or print) Name Signature _ &1, e
Building Owner's Authorization:
Signature & Date
Building Official's Acceptance:
Catawba County Building Services Signature & Date
Page 1
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i SICC 2009 - Appendix A Blank Forms
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Page 2 of 3 STATEMENT OF SPECIAL INSPECTIONS Date:
PROJECT: Prepared By:
ACTIVITY /SYSTEMS Y/N AGENT " Continuous or Periodic Ins on ref. below
j Steel Construction, Fabrication & Yes #1 NC Building Code 1704.2, 1704.3, 1707,
Seismic Resistance 1708.4 & SICC Chapter 6
Concrete Construction, Fabrication & Yes #1 NC Building Code 1704.2, 1704.4, 1708.3
Seismic Resistance SICC Chapter 7 & 8
Masonry Construction, Fabrication & NC Building Code 1704.2, 1704.5, 1708.1 &
Seismic Resistance SICC Chapter 9
Wood Construction, Fabrication & NC Building Code 1704.2, 1704.6, 1707.3
4 Seismic Resistance & SICC Chapter 10
Soils Yes #1 NC Building Code 1704.7 & SICC Ch. 11
Pile Foundations & Fabricators NC Building Code 1704.2, 1704.8, 1808,
1809, 1810, 1811 & SICC Section 1104.2
Pier Foundations NC Building Code 1704.9, 1808, 1812 &
SICC Section 1104.2
Earth Retention Systems Yes #1 NC Building Code 1806.2 & SICC Ch. 12
Sprayed Fire Resistance Materials NC Building Code 1704.10 & SICC Ch. 13
Mastic & Intumescent fire - resistant coatings NC Building Code 1704.11 & SICC Ch. 13
EIFS NC Building Code 1704.12 & SICC Ch. 14
Smoke Control Yes #2 NC Building Code 1704.14 & SICC Ch. 15
Seismic Resistance Architectural, Yes #1 NC Building Code 1705.3 para 4.2, 4.3, 4.4,
Components 1 4.5, &1707.7 & SICC Ch. 16
Seismic Resistance Mechanical NC Building Code 1705.3 para 2- 5, 1707.8,
Components 1707.9, 1707.10, & 1708.5 & SICC Ch. 16
Seismic Resistance Electrical NC Building Code 1705.3 para 2- 5, 1707.8,
Components 1707.9, 1707.10, & 1708. 5 & SICC Ch. 16
Structural Observations required in sER NC Building Code 1702 & 1709 To be
Occupancy Category III or IV per Table conducted by the Structural Engineer of
1604.5 Record
Special Cases Yes #2 NC Building Code 1704.13
* INSPECTION AGENTS Name, Company, Address
1. Special Inspections Engineer of Record 1: James D. Hoskins III PE ECS of the Carolinas 4811 Koger Blvd. Greensboro, NC
2. Inspection and Testing Agency 1A: James D. Hoskins III PE ECS of the Carolinas 4811 Koger Blvd. Greensboro, NC
3. Special Inspections Engineer of Record 2: James D. Hoskins III PE ECS of the Carolinas 4811 Koger Blvd. Greensboro, NC
4. Inspection and Testing Agency 2 A:: James D. Hoskins III PE ECS of the Carolinas 4811 Koger Blvd. Greensboro, NC
5. Special Inspections Engineer of Record 3:
6. Inspection and Testing Agency 3 A:
Note: The inspectors and testing agencies shall be engaged by the Owner or the Owner's Agent, and not by the Contractor or Subcontractor whose
work is to be inspected or tested. Any conflict of interest must be disclosed to the Building Official, prior to commencing work.
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SICC 2009 - Appendix A Blank Forms
Page 3 of 3 CATAWBA COUNTY, NORTH CAROLINA
STATEMENT OF SPECIAL INSPECTIONS
Identification of Seismic Systems NCBC 1705.3
Seismic Design Category C
Identification of Seismic Systems Required Y
NCBC 1705.3 para 1 & 1705.3.1 Description of seismic force resisting system requiring special inspections
(Review Section 1705.3, 1707 and 1708 of the NCBC to prepare this section):
Shipping & Receiving Building_
Steel Systems Not Specifically Detailed for Seismic Resistance, Excluding Cantilever Column Systems.
High Bay Storage Building
Industrial Steel Rack System detailed for Seismic Resistance per RMI / ANSI MH 16.1 - 2008
NCBC 1705.3 para 2 & 1705.3.1 Description of designated seismic systems requiring special inspections
(Review Section 1705, 1707 and 1708 of the NCBC and ASCE 7 to prepare this section):
Shipping & Receiving Building:
Not Applicable for Seimic Design Category C Buildings.
High Bay Storage Building
Not Applicable for Seimic Design Category C Buildings,
NCBC 1705.3 para 3, 4, 5 & 1705.3.1 Description of additional seismic systems requiring special
inspections (Review Section 1705, 1707 and 1708 of the NCBC and ASCE 7 to prepare this section):
Shipping & Receiving Building / High Bay Storage Building
HVAC duct work and anchorage for Hazardous materials
Piping & Mechanical units containing flammable, combustible or highly toxic materials
Anchorage of electrical equipment used for emergency or standby power
Identification of Wind Force Resisting System 1705.4
Basic Wind Speed (3 second gust) 90m ph
Wind Exposure Category C
Identification of MWFR Systems Required (Y/N) N
Description of wind force resisting system and designated wind resisting components requiring special
inspections (Review Section 1705.4 of the NCBC to prepare this section):
Statement of Responsibility
List each contractor responsible for the construction or fabrication of a system or component designated above. Each
contractor listed must submit a Statement of Responsibility.
Name Company System or Component
Ray Burris Conover Metal Products Steel Fabrication
Donnie Johnson Matthews Construction Co. Stee/ Erection
Donnie Johnson Matthews Construction Co. Concrete Construction
Justin Oxford Midstate Paving Soils, Earth Retention
Donnie Johnson Matthews Construction Co. Smoke Control
Donnie Johnson Matthews Construction Co. Seismic Architectural
Bill Osterme er Viastore Systems Steel Fabrication and Erection
Bill Osterme er Viastore Systems Special Cases
Page 3
SICC 2009 - Appendix A Blank Forms
Contractor's Statement of Responsibility
Each contractor responsible for the construction or fabrication of a system or component designated in the Quality
Assurance Plan must submit a Statement of Responsibility.
I
j Project:
Contractor's Name:
Address:
License No.:
Description of designated building systems and components included in the Statement of Responsibility:
j
Contractor's Acknowledgment of Special Requirements
1 hereby acknowledge that I have received, read, and understand the Quality Assurance Plan and Special Inspection
program.
I hereby acknowledge that control will be exercised to obtain conformance with the construction documents approved by
the Building Official.
a
Signature Date
Contractor's Provisions for Quality Control
Procedures for exercising control within the contractors organization, the method and frequency of reporting and the
distribution of reports is attached to this Statement.
Identification and qualifications of the person(s) exercising such control and their position(s) in the organization are
attached to this Statement.
• Contractor's Statement of Responsibility •
Page 4
SICC 2009 - Appendix A Blank Forms
DISCREPANCY NOTICE
Catawba County, North Carolina
G Date TPI Permit #
4
General Inspection Type: ❑ Steel ❑ Concrete ❑ Masonry ❑ Wood ❑ Soils ❑ Pile ❑ Pier
(Check one box only.) ❑ Earth Retention Systems ❑ Sprayed /Coated Fire Resistance ❑ EIFS
❑Smoke Control ❑ Architectural Components ❑ Mechanical Components
❑Electrical Components ❑Structural Observations ❑ Special Cases
Seismic Inspection Type: ❑ Steel ❑ Concrete ❑ Masonry ❑ Wood ❑ Architectural Components
- (Check one box only.) ❑ Mechanical Components ❑Electrical Components
Fabrication Inspection Type: (Check one box only.) ❑ Steel ❑ Concrete ❑ Masonry ❑ Wood
I �
Describe discrepancy, including locations:
❑ Make the following corrections and request special inspection approval prior to proceeding with the next
phase of work:
❑ List or attach a description of the action recommended by the AR,SER as appropriate to correct the
condition:
Notice delivered to: ❑ Engineer /Architect Date Time
❑ Contractor Date Time
❑ CC Building Services Date Time
Printed Name: Signature: Date:
( This report to be submitted with the Monthly Engineers Summary Report or furnished to the code enforcement official at time of TPI
scheduled site visit.)
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SICC 2009 - Appendix A Blank Forms
Monthly Engineers Summary Report
s
Catawba County, North Carolina
E
Date TPI Permit # Report #
i
❑ Monthly Summary Report Covering Daily Reports dated: From To
❑ Summary Report Covering Laboratory Test Results dated
Describe inspections made:
I
i
Describe tests made (attach copy of test results)
Discrepancy, list items requiring correction, corrections of previous listed items and previously listed
uncorrected items:
List changes to approved plans authorized by architect or engineer:
Comments:
To the best of my knowledge, work inspected and tests reviewed are in accordance with the building services
division approved design drawing, specifications and applicable workmanship provisions of the NC State
Building Code except as noted above.
Prepared By:
Printed Name:
Date:
Design Professional Seal
( This report to be furnished to the code enforcement official at time of TPI scheduled site inspections.)
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SICC 2009 - Appendix A Blank Forms
4 CATAWBA COUNTY, NORTH CAROLINA
SPECIAL INSPECTIONS PROGRAM
Final Report of Special Inspections
TPI Permit #: Building Permit #:
PROJECT:
Address:
E
Special Inspections Engineer of Record:
The following is a list of completion dates for all special inspection activities conducted for the types of work listed on the
Statement of Special Inspections.
t
Types of Work listed on Statement of Special Inspections Completion Date
r
Engineer summary reports numbered to , and test reports numbered to , all
submitted prior to this final report, form a basis for, and are to be considered an integral part of, this final report.
The special inspections specified for this project and itemized in the County approved Statement of Special Inspections have
been completed pursuant to the Catawba County Special Inspection Program requirements. The building elements subject to
special inspections have been found to be in compliance with County approved documents and in conformance with project
specifications. Violations of the North Carolina Statewide Building Code observed in the conduct of special inspections services
were brought to the attention of the appropriate registered design professional of record, the County, and the owner for
resolution and the resolution was approved by the County.
Submitted by Special Inspections Engineer of Record:
Signature & Date
(Type or print) Name
SIER Design Professional Seal
Accepted by Building Official:
Signature & Date Catawba County Building Services
(Type or print) Name
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