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Home My WebLink AboutCBPR-9-10-7542 Lutheran Home West Hickory Statement of Special Inspection.tif i SICC 2009 - Appendix A Blank Forms Page 1 of 3 ' CATAWBA COUNTY, NORTH CAROLINA SPECIAL INSPECTIONS PROGRAM Statement of Special Inspections TPI Permit #1: TPI Permit #2: TPI Permit #3 (TPI Permit Numbers to be furnished by CCBSD) I PROJECT: Lutheran Home — Hickory West NCBC Edition: 2009 NCBC I Address: 2140 Medical Park Drive Occupancy: Type 1 -2 i Hickory, North Carolina 28601 Construction Type: Type II -B f Building Owner: Kesha Smith Lutheran Services for the Aging Name Company F I Owner's Address: 1416 S. Martin Luther Kinq Jr. Ave. / Salisbury, North Carolina 28145 Architect of Record: Marcus B. Terry/ NC License No. 11588 RPA Design, P.C. Name & License Company Structural Engineer of Record: Tom N. Smiley / NC License No. 24312 Smiley Engineering Inc. Name & License Company Geotechnical Engineer of Record: Channin H. Bennitt/ NC License No. 26966 Allied Design, Inc. Name & License Company Special Inspections Engineer of Record 1: ECS Carolinas, LLC Name & License Company Special Inspections Engineer of Record 2: Name & License Company Special Inspections Engineer of Record 3: Name & License Company General Contractor Aaron Beam/ NC License No. 1145 Hickory Construction Co. 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: Marcus Bruno Terry, AIA (Type or print) Name Signature tPate Building Owner's Authorization: Signature & Date Building Official's Acceptance: Catawba County Building Services Signature & Date Page 1 t x SICC 2009 - Appendix A Blank Forms -i - Page 2 of 3 STATEMENT OF SPECIAL INSPECTIONS Date: € PROJECT: Prepared By: i ACTIVITY /SYSTEMS Y/N AGENT * Continuous or Periodic Inspection ref. below Steel Construction, Fabrication & Y NC Building Code 1704.2, I Seismic Resistance 1708.4 & SICC Chapter 6 j Concrete Construction, Fabrication & Y NC Building Code 1704.2, 1704.4, 1708.3 Seismic Resistance SICC Chapter 7 & 8 Masonry Construction, Fabrication & Y NC Building Code 1704.2, 1704.5, 1708.1 & Seismic Resistance SICC Chapter 9 Wood Construction, Fabrication & N NC Building Code 1704.2, 1704.6, 1707.3 Seismic Resistance & SICC Chapter 10 Soils Y NC Building Code 1704.7 & SICC Ch. 11 Pile Foundations & Fabricators N NC Building Code 1704.2, 1704.8, 1808, 1809, 1810, 1811 & SICC Section 1104.2 Pier Foundations N NC Building Code 1704.9, 1808, 1812 & SICC Section 1104.2 Earth Retention Systems Y NC Building Code 1806.2 & SICC Ch. 12 Sprayed Fire Resistance Materials Y NC Building Code 1704.10 & SICC Ch. 13 Mastic & Intumescent fire- resistant coatings N NC Building Code 1704.11 & SICC Ch. 13 EIFS N NC Building Code 1704.12 & SICC Ch. 14 Smoke Control N NC Building Code 1704.14 & SICC Ch. 15 Seismic Resistance Architectural, Y NC Building Code 1705.3 para 4.2, 4.3, 4.4, Components 4.5, &1707.7 & SICC Ch. 16 Seismic Resistance Mechanical Y NC Building Code 1705.3 para 2- 5, 1707.8, Components 1707.9, 1707.10, & 1708.5 & SICC Ch. 16 Seismic Resistance Electrical Y NC Building Code 1705.3 para 2- 5, 1707.8, Components 1707.9, 1707. 10, & 1708. 5 & SICC Ch. 16 Structural Observations required in Y SER NC Building Code 1702 & 1709 To be Occupancy Category III or IV per Table conducted by the Structural Engineer of 1604.5 1 Record Special Cases N I NC Building Code 1704.13 * INSPECTION AGENTS Name, Company, Address 1. Special Inspections Engineer of Record 1: 2. Inspection and Testing Agency 1 A: 3. Special Inspections Engineer of Record 2: 4. Inspection and Testing Agency 2 A: 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 E work is to be inspected or tested. Any conflict of interest must be disclosed to the Building Official, prior to commencing work. Page 2 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 i Identification of Seismic Systems Required 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): HOUSING WINGS: LT. GAGE FRAME WALLS LABELED "SHEARWALL" - SEE ALSO 4/S111 AND APPROVED SHOP DRAWINGS. CENTER BUILDING: ORDINARY STEEL CONCENTRIC BRACING LABELED "BR" - SEE ALSO S3.01 AND APPROVED SHOP DRAWINGS. 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): - ANCHOR BOLT PLACEMENT FOR "SHEARWALL" AND 'BR" LOCATIONS - METAL ROOF DECK ATTACHMENT PATTERN TO SUPPORTS 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): Identification of Wind Force Resisting System 1705.4 Basic Wind Speed 3 second gust) 90 MPH Wind Exposure Category B Identification of MWFR Systems Required (Y/N) YES 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): HOUSING WINGS: LT. GAGE FRAME WALLS LABELED "SHEARWALL" - SEE ALSO 4/S111 AND APPROVED SHOP DRAWINGS. CENTER BUILDING: ORDINARY STEEL CONCENTRIC BRACING LABELED "BR" - SEE ALSO S3.01 AND APPROVED SHOP DRAWINGS. 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 Page 3