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Home My WebLink About101 EVERGREEN WAY BLDG 100 r DEPARTMENT DECISION �Q APPLICATION FOR HVAC PERMIT Appl' ti s y: TOWN OF SOUTH WINDSOR PERMIT# BUILDING DEPARTMENT APPROV 1540 SULLIVAN AVENUE Bldg.Permit# J 644-2511 ext. 230 3 C) at Application must be printed or typed I LP FEE SCHEDULE Location of Job: Evergreen Walk Buckland Road Building j0� $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 N/A or any fraction thereof Tenant Designation Apt.No. APPLICANT New England Mechanical Services , Inc . APPLICANT ADDRESS 166 Tunnel Road Vernon, CT 06066 APPLICANT PHONE# ( 8 6 0 ) 8 71-1111 SOW N SFq OWNER Poag and Mcewen Lifestyles < OWNERADDRESS 6410 Poplar Avenue, Tower2 . Suite 850 Memphis , TN 38119 O - o � E■ OWNERPHONE ( 901 ) 761-7604 C ESTIMATED COST$ 0 3 G 5 P o U C� x � IS THIS A CONTRACT COST? __2L Yes _No FEE ENCLOSED$ 105 . 00 �OS�R•CO�y� TYPE OF JOB: New Installation Alteration/Addition/Repair Revised 4!01 H2002 APPLICATION FOR RVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: 6 HEATING ❑ RESIDENTIAL IN ABC 0 COMMERCIAL 21 VENTILATION ❑ INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRON(C ❑ WARM AIR ❑ UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS (BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE &MODEL NO.) All work will be in exact accordance with Elkus/Manfredi Architect drawings H0. 11 , HO. 12 , HO. 13, H2 . 10 , M2 . 11 , H4 10 ,M4 11 , M8 . 10 , M8 . 11 dated November 21 , 2003 GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) TYPE OF FUEL ❑OIL—GPM OIL TANK LOCATION :❑ INSIDE❑ OUTSIDE CAPACITY ❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW AIR CONDITIONING DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DES RBEA 'LCOLINGEQUIEPENT(ICLUDINGMAKE&MODEL A t NO.) Architect drawings HO.11 , 110.12 , HO. 13 , H2 . 10 , M2 . 11 , H4 .10 , M4 . 11 , M8 . 10 , M8 . 11 dated November 21, 2003 TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) All work will be in exact accordance with Elkus/Manfredi Architect drawings H0.11 , HO. 12 , HO. 13 , H2 . 10 , M2 . 11 , H4 . 10, M4 . 11 , M8 . 10, M8 . 11 dated November 21 , 2003 TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. Heating, Piping, & 302974 rnn1 ; ng - S1 �anne�tiru+ CONTRACTORS LICENSE NO_ TYPE /ST TE SIGNATURE OF APPLICANT DATE 7 / Elec,ric # APPLICATION FOR BUILDING PERMIT Plumbing# I I T7 Le 101 Evergreen Date: HVAC # iI LA -- Sprinkler# ln_ 30316 FINAL APPROVALS - Estimated Cost $_1 O�11ti OG� - 1 Permit Fee $_ I y 3q 0 Engineering Building ineering COMPLETE RED BOXED AREAS Occupancy Fee $ 'w,00 Affidavit TYPE OR PRINT ONLY Eng. Insp. Fee $ Appr. for CO. ► SIGN ON REVERSE SIDE ,- Total Fee J` l stio�^ - $_ TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: 01` �.{s -�t�,� ��- Applicant WOA1L CON-MUw1o� Location of Work �, Lot No. Applican's Address a (ZTrOPLEX 06JU6 Tel.# aOS-gc13-dR3 c-) Town L Zip35o �?C? Lic.# MCO 9o174'7 Owner c & Ew-f P L E S 7'fLE G, Architect C[.K uS f M r9 N r6 e0 l /ARCH IT E cT S Owner's Address Qo 410 S' k E 90 rchitect's Address s3 o Art-AL"T c & �T r m is _TW Zip 38/1 cl osTa;u 14.4 Zip Oda I Sq. Ft. New Area: 1st FI. Q X 161�© 2nd A. 3rd FI. Total New Area Purpose of this permit S rle!LL. C nrj!'V Vj r_h-rj RUI .01W& l oo Ftju%/v Q*4c, City Water(( Well❑ Septic System❑' Sewerx Ins: HO S Cert. Area Basement Garage Approved by Date 'Z 7�V Use Group Construction Type,,.�-.,-- Rwlssd 0102 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked.and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building and its is allowed. Signed / I hereby apply for a Certificate of Occupancy for the work descnbed in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS \fin DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: � 3S BUILDING DEPARTMENT App ZD 1540 SULLIVAN AVENUE Bldg.Permit# I old644-2511 ext. 230 J U Dak tblff Building ctor Application must be printed or typed FEE SCHEDULE Location of Job: / $0-$1,000=$15.00 F;T�Mnant - Street Lot No. Over$1,000= $15.00 per$1,000 "d or any fraction thereof gnation Apt.No. APPLICANT A&.i.ST&M F1" 5PRtNi4t_Es 1 Ike- . APPLICANT ADDRESS F•c• 15-x 235z=' {.4►R.7FaR-t7� G�' of�l4� APPLICANT PHONE# 8(00- 21140- -1-W ,w 0W N s t.4 OWNER WEB epi LIFESTYLE C.EN71Ezs oF= cT- LLC. OWNER ADDRESS ♦ OWNER PHONE C = ESTIMATED COST$ S.3,00.-' IS THIS A CONTRACT COST? ✓Yes _No FEE ENCLOSED$ ( J s TYPE OF JOB:SOR'CO ✓New Installation _Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR SPRINKLER PERMIT (Continued from reverse side) TYPE OF BUILDING TYPE OF CONSTRUCTION 2G USE GROUP M _ NO. OF STORIES 1 ❑RESIDENTIAL ❑BUSINESS IS THIS APPLICATION ASSOCIATED WITH A ❑ASSEMBLY BUILDING PERMIT APPLICATION? OYES ❑NO QeMERCANTILE ❑EDUCATIONAL CURRENT USE AND OCCUPANCY S+l e�L$otLv�.►c,. ❑ INSTITUTIONAL ❑FACTORY FUTURE USE AND OCCUPANCY ❑ STORAGE ❑GARAGE ENGINEER'S NAME AAA PHONE 761-l72-31� ❑MIXED USE (Other please specify) ADDRESS Io MA4oyez 14 ►9, 5 ►r7E 310 CITY STATE MA ZIP 024-V KIND OF INSTALLATION SIZE OF MAIN DRAIN 2 WATER PRESSURE AT STREET(PSI) !67 PS j ARE SPRINKLER HEADS ALTERED? ❑YES IJ NO IF YES,CHECK ALL THAT APPLY: ❑ADDED ❑DELETED ❑ALTERED IF MORE THAN 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE) ❑PROFESSIONAL ENGINEER ❑INSURANCE COMPANY WATER FLOW ;0.0%. WATER PRESSURE AT SPRINKLER HEADS(PSI) 18 *st ARE PUMPS REQUIRED? ❑YES WINO IF YES,CHECK ALL THAT APPLY: ❑FIRE ❑BOOSTER ❑OTHER ARE STANDPIPES PROVIDED? ❑YES ZINO IS A SPRINKLER SYSTEM PROVIDED? ❑YES L'NO SPRINKLER SYSTEM MAIN WATER SUPPLY RATING to,0C> GPM TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP M!^► PSI DESCRIPTION OF WORK SELL_ sutt.DiN4 wa¢y_ vNl.,4 IN t7&,a-Ljm4 R.ISEfC A sSEKBL y & ja Bv�K.►-►i►�.a to yriA Gorr t- ya L, 3 For. Fv Tve.-F- T-SP4 f=1 T 0P THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. Ft o59 0 F 1 �T CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE 5-24-C%d- Inspection / Approval Date By Appl Code Description Due Whom Code Comment ------------------------------------------------------------------------------- **-30316-B 1,026,000 BO1 FOOTING 02/19/04 JFF A FOOTINF LINE6 A TO MID D AN E WITH JIM EASTER BO1 FOOTING 02/20/04 JFF A E LINE ENTIRE ALINE 3PLUS TO A6 BLANKETS BO1 FOOTING 02/23/04 JFF A 1 LINE E TO A A LINE 1 TO MID2 BO1 FOOTING 02/24/04 JFF A FORMING WALLS ALINE 3TO6 6LINE A TO E E LINE ENTIRE BO1 FOOTING 02/19/04 PJP A D6-A6 FOOTING , A3 5-A6 BLANKETS/HEAT B02 FOUNDATION 02/26/04 JFF A LINE A-E RETURNS ON E LINE& A LINE DO1 FOOTING 02/26/04 JFF A A LINE MID 2 TO 3 B09 OTHER 02/27/04 JFF WALLS ALL POURED INSTALLING WALL INSULATION B01 FOOTING 03/01/04 JFF A WALL POUR A LINE MID 1 TO2 TO MID 3TO4 P02 UNDERGROUND 04/20/04 PJP A WATER TEST E02 UNDERGROUND 04/21/04 JFF A WITH PAUL SEMAC ELECT E02 UNDERGROUND 04/04/04 CJD D NO WRNG TAPE TO VAULT E02 UNDERGROUND 05/05/04 PJP A 3 ROW WARNING TAPE, CLEAN FILL, GRD RODS E09 OTHER 05/13/04 JFF A INTERIOR GROUNDING CAD WELD 3 OUGHT 1 GRD CAD WELD WITH PAUL SEMAC E02 UNDERGROUND 07/02/04 PJP A W/PAUL SEMAC,TRENCH, WNING TAPE, SITE CONDUIT LIGHTING BEHIND BLDG 100 Inspection / Approval Date By Appl Code Description Due Whom Code Comment ------------------------------------------------------------------------------- E03 ROUGH 07/14/04 CJD A W/PAUL-SWITCHES/OUTLETS UTILITY ROOM E02 UNDERGROUND 08/04/04 PJP A SEASONAL LIGHTING, WRNING TAPE IN PLACE W/PAUL SEMAC B10 FINAL 04/27/05 CJD A CLOSED OUT. **-1359-5 8,300 **-12204-H 6,365 **-11576-P 21,000 **-18889-E 88,000 **-18890-E 58,000 ALLSTATE P.O. Box 2350 ■ Hartford, Connecticut ■ 06146 FIRE SPRINKLER (860) 246-771 1 ■ FAX (860) 246-7707 INC. May 27, 2004 Town of South Windsor South Windsor, CT Attn: Building Official Re: Application for Permit Job#6614 Gentlemen: In accordance with the Public Act 91-95, this letter authorizes the below named agent to sign the above referenced application for Thomas L. Jacquel (License# F10590) Fire Sprinkler Contractor-Allstate Fire Sprinkler, Inc. P.O. Box 2350 Hartford,CT 06146 Project Name: The Shops @ Evergreen Walk Location: Buckland Road-Bldg. 100 Authorized Agent: David K. Thompson Thank you for your cooperation, GdYX�`o Thomas L. cq 1 President rARCCertified Small Business Enterprise .,- Conn. Contractor's License #F 10590 DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is_hereb - .— TOWN OF SOUTH WINDSOR : BUILDING DEPARTMENT /PROV J _ 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 3 3 1),11e Building In ector Application must be printed or typed FEE SCHEDULE (01 CC) P� `�i e f h Location of Job: 151 •J Buckland Road :-No. $0-$1,000=$15.00 Street No. Street No. Over$1,000= $15.00 per$1,000 To Re Mari dad or any fraction thereof Tenant Designation A APPLICANT New England Mechanical Services, Inc. APPLICANT ADDRESS 166 Tunnel Road VPrnnn, CT 06066 APPLICANT PHONE# ( 86 0 ) R 71 -1 1 1 1 N Se OWNER Poaq and Mcewen Lifestyle Centers OWNER ADDRESS 5100 Poplar Avenue Memphis Tennessee 38137 0 * OWNER PHONE ( 2 0 5 ) 8 0 3-2121 C = ESTIMATED COST$ 21 , 000 . 00 IS THIS A CONTRACT COST? x Yes _No FEE ENCLOSED$ 315 . 00 TYPE OF JOB:SO R•C O XX New Installation _Alteration/Addition/Repair Revised 4/01H2002 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? a YES ❑NO ❑RESIDENTIAL ®BUSINESS CURRENT USE AND OCCUPANCY N/A ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY Retail ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME AHA PHONE ( 7 81 ) 3 7 2-3 0 0 0 ❑ STORAGE ❑ GARAGE ADDRESS_1n Magic i re Rnarl� �qii i to 11 (1 ❑MDCED USE CITY Lexington STATE MA ZIP 02420 (Other please specify) TYPE OF INSTALLATION SIZE OF MAIN DRAIN NO.OF TOILETS STYLE NO.URINALS STYLE NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE AREA OF ROOF NO.OF CATCH BASINS NO. OF FLOOR DRAINS NO.OF OTHER FIXTURES KIND ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW ❑YES ❑NO SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER WATER HEATER: TYPE MANUFACTURER DESCRIPTION OF WORK Plumbing work per R1kus.ZMnnfrPrjJ Architects drawings- P1 . 1 , P2 .lA, P2 . 113, P3 . 1 , P4 .1, P6 . 1 , P7 . lA, P8 . 1 , P8 . 11A, P8 . 11B, & P8 . 12 dated November 21 , 2003 . Work also includes the rough-in of a below-grade sanitary system and water pipe. I'HE UNDERSIGNED HEREBY APPLIES FOR A PERMIT Pro PERFORM THE WORK DESCRI ED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. 203519 Plumbing and Piping Connecticut CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applic ere y: '$1 9 0 BUILDING DEPARTMENT P 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Permit# 22( kZ t"Cate ul o iff Application must be printed or typed FEE SCHEDULE Lo` �2fg�^ 0"1Location of Job: /5-/ d"C'16k,"' Si— Aurlying /Oy $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT St Ph c4 r. E-Zer7-7L,c-, APPLICANT ADDRESS PO Qoxff 2f APPLICANT PHONE# 'j 6o - 2 alc O 3-0 y -e,=-7T 3 2 7 O W N S 4. OWNER ,E r/et"c En1 L ce c?v/e Ce,7-e .r LL C OWNER ADDRESS 6/y/0 / mplu/L Ave— SwT ` 7 Al O o , OWNER PHONE 9/D/- 76/- 76D}� C = ESTIMATED COST$ �� 0D .� IS THIS A CONTRACT COST? ZYes _No FEE ENCLOSED$ -1 O. 00 r/y TYPE OF JOB: �SO R•C0 _ZNew Installation _Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? RtES ❑NO ❑ SIDENTIAL I�BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME /� PHONE 3 71-3v 0 0 ❑STORAGE / ❑GARAGE ADDRESS S"JZ 310 ❑MIXED USE CITY Lc wnr 7-w STATE M ZIP 01;? (Other please specify) TYPE OF INSTALLATION/WIRING METHOD Gy��G�.9r psn /l/.Ec - (�l/G. y,•�..y�,«�C - Es•�TF...�«j-M�/;„s,.{ SIZE OF SERVICE ys 274, SIZE OF MAIN CONDUCTORS_ 33 s•? SZk�.,,c.w q�,.�✓�.x NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK �ri.y V!K t t.J,/�.��O A S 5�..,y..+ J n �►��I�iUK.w MI'S 0 N rlt' L.��. �••cLcoC.r61 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. CONTRACTORS LICENSE NO. E STA-TE/ SIGNATURE OF APPIJ - .fP.�Ey.�T, DATE 3`.z-//O t HOAR CONSTRUCTION Two Metroplex Drive Suite 400 Birmingham,AL 35209 April 25, 2005 205 803 2121 (T) 205 423 2323 (F) FAX 8601644-3781 Mr.Chris Dougan Town of South Windsor 1540 Sullivan Avenue South Windsor, CT 06074 RE: Building 100 To the Commissioner,Town of South Windsor Building Department: I state that I, or my authorized representative, have periodically observed the work associated the above referenced building in accordance with Permit No. 30316, dated December 31,2003, located at 101 Evergreen Way and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the South Windsor Building Department and with the provisions of the Connecticut State Building Code. Stace Berthon Hoar Construction, LLC--VrCe President Two Metroplex Drive, STE 400 Birmingham AL 35029 Address 205/803-2121 Phone Then personally appeared the above-named Stacey Berthon and made oath that the above statement is true. Before me, My Commission expires h 118/6 5 Date 4'�5��,oa 5 www.hoarl[c.com birmingham houston nashville orlando ELKUS MANFREDI ARCHITECTS April 27,2005 ARCHITECTURAL FINAL AFFIDAVIT To the Commissioner,Town of South Windsor Building Department: I state that I,or my authorized representative,have periodically observed the work associated with Permit No.30316,dated December 31,2003, locus 101 Evergreen Way(Building 100) and that to the best of my knowledge, information,and belief the work has been done in conformance with the permit and plans approved by the South Windsor Building Department and with the provisions of the Connecticut State Building Code. � ��tNNi//�� David P. Manfredi,#7719 � Q.......... Fc�`�� Architect—CT.Reg.No. o _ 530 Atlantic Avenue,Boston,MA 02210 �k Address JAZ ' v 617.426.1300 Phone �u Then personally appeared the above-named David P.Manfredi and made oath that the above statement is true. Before me My Commission expires October 17 2008 Date ELKUS MANFREDI ARCHITECTS LTD [add- d 530 ATLANTIC AVENUE BOSTON MASSACHUSETTS 02210 [tell 6174261300 (r41 WWW.ELKUS-MANFREOI COM ELKUS MANFREDI ARCHITECTS April 27, 2005 Mr. Christopher J. Dougan Chief Building Inspector Town Of South Windsor 1540 Sullivan Avenue South Windsor, CT 06074 Re: Statutory Completion Certification— The Shops at Evergreen Walk Building 100 Permit No. 30316 Dear Mr. Dougan: In our professional opinion we affirm that the completed construction of the base building referenced above(exclusive of tenant improvements which are not the subject of this certification) is in substantial compliance with the approved plans and design specifications. (CT General Statues, Sec 29-276b (c)) In our professional opinion we affirm that the completed structure of the base building referenced above(exclusive of tenant improvements which are not the subject of this certification) is in substantial compliance with the approved plans and design specifications on file with the Town of South Windsor Building Department. (CT General Statues, Sec 29-276c (b)) The above represents an expression of the professional opinion of the undersigned, and is made to the best of the undersigned's knowledge, information and belief,based upon the undersigned's performance of services under the Architect's agreement for architectural services with the owner of the project referenced above, in accordance with generally accepted practice. As such, the opinions expressed herein constitute neither a guarantee nor warranty, expressed or implied. Sincerely �\��'�;:o QE(ERrl9gy- 'o''/ ELKUS /�MANFREDI ARCHITECTS LTD `�:oP\ 9i''G'` ay: avid Panfredi, AIA,Principal .. 'r�\`\0 A�c p �i�,rtpilll lt!1!\il\1\\\\�Q L/02049/letters Building 100 TSW.doc ELKUS MANFREDI ARCHITECTS LTD [.dd—d 530 ATLANTIC AVENUE BOSTON MASSACHUSETTS 02210 t,.q 617426-1300 I-b] WWW.ELKUS-tI ANFREDI.COM FINAL AFFIDAVIT CONSTRUCTION CONTROL PERMIT NUMBER: 30316 PROJECT TITLE: The Shops at Evergreen Walk PROJECT LOCATION: The Shops at Evergreen Walk,Bldg 100,South Windsor,CT NAME OF BUILDING: Building 100 NATURE OF PROJECT:Retail Space IN ACCORDANCE WITH SECTION 116.0 OF THE CONNECTICUT STATE BUILDING CODE,I Daniel A. Campia,PE REGISTRATION NO. 14987 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPERATION OF ALL DESIGN PLANS,COMPUTATIONS AND SPECIFICATION CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL _MECHANICAL FIRE PROTECTION _ELECTRICAL _Plumbing (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE CONNECTICUT STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.I FURTHER CERITFY THAT I OR MY OR MY AUTHORIZED REPRESENTATIVE SHALL PERFOM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEDDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING SPECIFIED IN THE CONNECTICUT STATE BUILDING CODE. Uf COJ�� THE PROJECT IS COMPLETE AND READY FOR OCCUPANCY. ��e`�. A�C 9 .�% Seal ��¢ 70% No. 14987 e CF N Sti�.'� �;` < .000�oNA.pEN'"�� ignature SUBSCRIBED AND SWORN TO BEFORE ME THIS 276'DAY OF April 2005. NOTARY PUBLIC MY COMMISSION EXPRIRES 5/18/08. p -ENE M .•�j(ssf— y V�oM�P`(;82p0�.%`�9 CM °1� �q NO •� y. P oTSSAC P�\�gRY FINAL AFFIDAVIT CONSTRUCTION CONTROL PERMIT NUMBER: 30316 PROJECT TITLE: The Shops at Evergreen Walk PROJECT LOCATION: The Shops at Evergreen Walk,Bldg 100,South Windsor,CT NAME OF BUILDING: Building 100 NATURE OF PROJECT:Retail Space IN ACCORDANCE WITH SECTION 116.0 OF THE CONNECTICUT STATE BUILDING CODE,I Kevin T. Jensen.PE REGISTRATION NO.22544 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPERATION OF ALL DESIGN PLANS,COMPUTATIONS AND SPECIFICATION CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL —MECHANICAL FIRE PROTECTION X ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE CONNECTICUT STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.I FURTHER CERITFY THAT I OR MY OR MY AUTHORIZED REPRESENTATIVE SHALL PERFOM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEDDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING SPECIFIED IN THE CONNECTICUT STATE BUILDING CODE. r \ .�-9 c o NNFeaz, THE PROJECT IS COMPLETE AND READY FOR OCCUPANCY. s C 1 Seal `) (r f NO.533 l7 ; /ONA\_'-'- Signature SUBSCRIBED AND SWORN TO BEFORE ME THIS 27 DAY OF April 2 5. GLEN 1;�i �r•� .,x"iV SBI o y NOTARY PUBLIC /��/�f �j MY COMMISSION EXPRIRES 5/18 8V � »�o`�p9 • Q^VI' M1 V(� • }. CU*' FINAL AFFIDAVIT CONSTRUCTION CONTROL PERMIT NUMBER: 30316 PROJECT TITLE: The Shops at Evergreen Walk PROJECT LOCATION: The Shops at Evergreen Walk,Bldg 100,South Windsor,CT NAME OF BUILDING: Building 100 NATURE OF PROJECT:Retail Space IN ACCORDANCE WITH SECTION 116.0 OF THE CONNECTICUT STATE BUILDING CODE,I Daniel A. Campia,PE REGISTRATION NO. 14987 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPERATION OF ALL DESIGN PLANS,COMPUTATIONS AND SPECIFICATION CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL X MECHANICAL FIRE PROTECTION _ELECTRICAL _ (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE CONNECTICUT STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.I FURTHER CERITFY THAT I OR MY OR MY AUTHORIZED REPRESENTATIVE SHALL PERFOM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEDDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING SPECIFIED IN THE CONNECTICUT STATE BUILDING CODE. THE PROJECT IS COMPLETE AND READY FOR OCCUPANCY. *.m"D om A. Seal o O` No. r NS Signature �/exn o11100 SUBSCRIBED AND SWORN TO BEFORE ME THIS 27 h DAY OF April 2005. ENS ,Z.P M�ssio NOTARY PUBLIC MY COMMISSION EXPRIRES 511 �� CA- O+;�SSAcvk\ ''�O � Y Pv�'y FINAL AFFIDAVIT CONSTRUCTION CONTROL PERMIT NUMBER: 30316 PROJECT TITLE: The Shops at Evergreen Walk PROJECT LOCATION: The Shops at Evergreen Walk,Bldg 100,South Windsor,CT NAME OF BUILDING: Building 100 NATURE OF PROJECT:Retail Space IN ACCORDANCE WITH SECTION 116.0 OF THE CONNECTICUT STATE BUILDING CODE I Daniel A. Campia,PE REGISTRATION NO. 14987 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPERATION OF ALL DESIGN PLANS,COMPUTATIONS AND SPECIFICATION CONCERNING: ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL X FIRE PROTECTION _ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT TO THE BEST OF MY KNOWLEDGE,SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE CONNECTICUT STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.I FURTHER CERITFY THAT I OR MY OR MY AUTHORIZED REPRESENTATIVE SHALL PERFOM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEDDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING SPECIFIED IN THE CONNECTICUT STATE BUILDING CODE. THE PROJECT IS COMPLETE AND READY FOR OCCUPANCY. On C�nnabba N °*y i Seal A. cot g NO. 14937 '%�47 c 10 9e �F N S Signature •46oSZ01VAL le-••,•••N 0a, SUBSCRIBED AND SWORN TO BEFORE ME THIS 27" DAY OF April 2005. ¢ACNE of gicjNOTARY PUBLIC MY COMMISSION EXPRIRES 5 `�p,V18 oe�Oi��'9 o N . pip. ?i ? G` 'SSAc • ' 01/12/2004 Cl?:15 16173976990 SCDT PAGE 03 STRUCTURAL CONSULTING DESIGN TEAM, INC, January 6,2004 Mr.Mark Grambergs Poag&McEweri Lifestyle Centers 6410 Poplar Avenue Memphis,TK 38110 J v" Re!The Shops @ Evergreon Walk IkA, South Windsor,CT N(0 Poor Review 5(v-•%- Subject: Independent Structural Poor Review Buildings#100,200,300,400,600,800A #800C Dear Mr. Grarriberg: We have concluded our threshold review of the permit docurnent submission for the above referenced Project. The purpose of our task was to review the Primary structural component and systems of the superstructure for cornpliaijee with the Connecticut state building code/ 1999 edition. We have performed independent structural.calculations using the follo"Aing documents received from McNamara/Salvia,Inc. as the basis of our review: • Structural Dravvings S0.00,S 1.00, S2.10,S2.20,S3.1 0-,S3.20, S4.00,S6.10, .56.20,S7.10, S7.20, SSA.00, S83,01,S813.02, S8C.00,S9.10, S9,20, S9.30. S9.40, SI0.10,S]0.20, SI0.30,SI0.40,S10.50, andS10.60. • Subsurface Investigation and G.-otechnical engineering report prepared by Professional Service Industries,Inc., dated November 27,2002. Our review is complete,and we find no outstanding issues. If you have any questions,please feel free to call me, ,Ullllr! ov: C01V Sincerely, 0-- E No. 20771 N, i1h R.Hw=ouri, P.B. NRH/niht?oag&McEwinpeerreview2.doc 165 Chelsea Street, Everett, MA 02149 * Telephone: 617-381-6990 Fax: 617-387-6990 01/12/2004 09:15 16179976990 SCDT PAGE 02 STATE OF CONNEC'T'ICUT 1731ene07 DEPARTMENT OF CONSUMER PROTECTION LICENSE SERVICES DIVISION 165 Capito.t Avenue — Room 110 + Hartford Connecticut 06106 RENEWAL NOTICE 2004 Online Renewal Access PIN$ 2605761 Receipt for your records: NAZEIH HAMMOURI Cheek# 23 Z 126 DARTMOUfH ST Date aralrea .L I°I o 3 EVERE . TT MA 02149 aedenr�ar a PEWN71 Cmdwtml Type PROFr=SSIONAL ENGI Your license wr11 expire on 01/31/2004. Cheeks made payable tof"Treasurer, state of Connecticut' P_AY-ME111 PEON 1) By mail-sign the form below and mail it with the noted fee in the enclosed envelope 2)Via the internet-renew on-line using an Internet connection and a Visa or Mastercard for payment by going to DCP's E-commerce website at: www.dcpacress.statextus and select the "13cense Renewal" option LATE FEES 1)if you pay by mail,a late fee of$22.50 will be due on all renewals received after February29, 2004 2) If you pay via the internet,a late fee of$22.50 will be due.on'ali payments made after fanuary3l,2004 **If you wish to request retiree status,do not send in this renewal,contact(860)713-6142 for instructions. Visit the Department of Consumer Protection's wcbsite: ;ffrtle.ct.us/rlc�h Your license will not be issued if you fail to answer the question and/or sign the renewal form below. Detach along perforation below and enclose renewal notice with your payment. STATE OF CONNECTICUT + .DEPARTMENT OF CONSUMER PROTECTION . s 4FROEESSIONALOGNEER MOURI FEE:RENEWAL 225.00 Dq S: 0113i 12004 1TH ST GGJ 1: ]2i49 Nws Lw"r NAwe PEN20771 Gn Have You been convicted of a felony the date of your last license epplication? YES❑ NOZ ayes,attach date(s)and nature d comiction(s). 1 � LYY Signa�re Date: ( ) I do not wish to renew \ PEN0002077120040131002250000247500 174 STATE OF CONNECTICUT 14M DEPARTMENT OF CONSUMER PROTECTION 165 Capitol Avenue + Hartford Connecticut 06106 Attached is your license. Such license shall be shown to any properly interested person on request. No such license shall be transferred to or used by any other person other than the person to whom the license was issued. To report an address change,please contact the Department of Consumer Protection,Licensing Division at(860)713.6000. Visit our web address: wwwAcu at . t.yOicensin /for information and applications. STATE OF CONNECTICUT YROFISS(ONAL ENCfINEER NAZEIH R HAMMQURt NAZEIH HAMMOURI 126 DARTMOU ni 5T 12G DARTMOUTH ST I EVER4Tr.MA 02149 I EVEREETT,MA 02149 U r'Wd No. EFFECTIVE EXPIRES 2ont 02/01/2003 .01/31/2W4 • r SIGNED 'v'\�--'1�--.+�✓•-✓ -��.^.r1..-�-ter v-v�.�'Y-�.-v-- A; al w r .��. �''{� t��{`�,,,r{.. ,1�R,;�+�.�.+.. ,*;,{-: ;Y1+4� .f� :/ ,,d./ :/ti�,,r.{�w�r,►1. .I.y�,�!' {ky,; STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION Be It knoWil that N.A.ZEIH R HAMMOURI ~ ) 126 DARTMO=ST EKEn 1VIA 02149. has been certified by the pepart ' ,ant of o rner Protection as a IicGnsed. PROFg$SI ' N NGINEER -Lice e ,,� •: . D�71 -tom. ••st' C;e E piie 1131 200 Jam T.Fleming,Comm oner T* ' ' t.: .{_ mil. i� �,,/' `+wl'. r'�..}v�'�-'h,.}.,w'' ti.:.l�"'•`wM 'ia� '1. 1� '.IN A. "�..�,1'" �..! 1 R/.P'' ..,�3 � VG 39tld 1QJS 06691BELT31 G1:30 b13OZ/Z1/10 April 27,2005 U � Christoperpougan �` 40 Chief Building Inspector South South Windsor Building Department qu/CDING pAindsor 1540 Sullivan Avenue ART41EN7. South Windsor,CT 06074 Re: The Shops at Evergreen Walk Chris: This letter confirms that we intend to pursue the recommendation set forth in Len Getz's letter to you dated March 22,2005,regarding PVC/Fypon joint repair. Additionally, we are investigating the roof ponding issue at Building 300 you advised us of during today's meeting. We expect this situation to be corrected by the tenant. Thank you for today's issuance of all certificates of occupancy. erely, Ro era L. Rogers,Jr. Senior Vice Presiden and General Counsel 6410 Poplar Avenue,Suite 850 1 Memphis TN 38119 1 901-761-7604 Fax 901-761-5325 d Y f � �f nt� ��, i i r � � � � i �w' �i 1 � �, �- I .'�,.�1 �". 12/30/2003 14: 44 9017615325 PAGE 022/11 • STRUCTURAL Statement of Special Inspections ENGINEERS COALITION CONTIP.CPICUT ENGINEERS IN PRIVATE PRACTICE Project: The Shops at Evergreen Walk-Building 100 Location: Ruckland Road- South Windsor, Connecticut Owner: Poag &McEwen Lifestyle Centers - Connecticut, LLC Owner's Address: 6410 Poplar Avenue, Tower 2, Suite 850 Memphis, TN 38119 Architect of Record: Elkus/Manfredi Architects Structural Engineer of Record: McNamara/Salvia, Inc. This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection requirements of the BOCA National Building Code. It includes a Schedule of Special Inspection Services applicable to this project as well as the name of the Special Inspector and the identity of other approved agencies intended to be retained for conducting these inspections. The Special Inspector shall keep records of all inspections and shall furnish inspection reports to the Building Official, Structural Engineer and Architect of Record. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected, the • discrepancies shall be brought to the attention of the Building Official, Structural Engineer and Architect of Record. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official, Owner, Structural Engineer and Architect of Record. A Final Report of Special Inspections documenting completion of all required Special Inspections and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: or ❑ per attached schedule. Prepared by: care It A Joseph A. Salvia, P_E. (type or print name) � Ain, 11102 �1, 4 r ♦. !� V,.rssenAQNep� Sig a Date Design Professional Seal wn r' A thoriz Building Official's Acceptance: • �Z 3b)d3 Da e SignatureDate ' na ure Si 9 SEC/CT Form 101CT Statement of Special Inspections • OSEClCT 1999 �L STRUCTURAL ENGINEERS Final Report of Special Inspections COALITION CONNECTICUT ENGINEERS IN PRIVATE PRACTICE Project: The Shops at Evergreen Walk— Building 100 Location: Buckland Road —South Windsor, Connecticut Owner: Poag & McEwen Lifestyle Centers—Connecticut, LLC Owner's Address: 6410 Poplar Avenue, Tower 2, Suite 850 Memphis, TN 38119 Architect of Record: Elkus / Manfredi Architects Structural Engineer of Record: McNamara / Salvia, Inc. To the best of my information, knowledge and belief, the Special Inspections required for this project, and itemized in the Statement of Special Inspections submitted for permit, have been performed and all discovered discrepancies have been reported and resolved other than the following: Comments: One 6" roof penetration is not reinforced. This Final Report of Special Inspections applies only to construction observed before or on October 20, 2004. We understand that following this date tenants moving into this building may modify the structural components of the building. JGI makes no claims regarding the acceptability of modifications subsequent to October 20, 2004. Interim reports submitted prior to this final report form a basis for and are to be considered an integral part of this final report. ,,1/►INNN/y Respectfully submitted: ``o f coNti Special Inspector ,.•� � N a. 0 Ryan R. Roy = o c (type or print name) '�o,��sr°'w�E�G��•�'r `SNONAL I0+ Zr O l N11 Signature Date 1 Design Professional Seal SEC/CT Form 102 • Statement of Special Inspections • ©SEC/CT 1999 r , STRUCTURALI Statement of Special Inspections { ENGINEERS COALITION CONNECCICUT ENGINEERS 5I - 1N PRIVATE PRACTICE IL� Project: The Shops at Evergreen Walk-Building 100 '�; Location: Buckland Road-South Windsor, Connecticut Owner: Poag &McEwen Lifestyle Centers - Connecticut, LLC i;1at)_0'' Owner's Address: 6410 Poplar Avenue, Tower2, Suite 850 E31J�LIi3t(!G pEP�+�t t"i"" � Memphis, TN 38119 Architect of Record: Elkus/Manfredi Architects Structural Engineer of Record: McNamara/Salvia, Inc. This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection requirements of the BOCA National Building Code. It includes a Schedule of Special Inspection Services applicable to this project as well as the name of the Special Inspector and the identity of other approved agencies intended to be retained for conducting these inspections. The Special Inspector shall keep records of all inspections and shall furnish inspection reports to the Building Official, Structural Engineer and Architect of Record. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected, the discrepancies shall be brought to the attention of the Building Official, Structural Engineer and Architect of Record. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official, Owner,Structural Engineer and Architect of Record. A Final Report of Special Inspections documenting completion of all required Special Inspections and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. ._—_-- Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: or❑per attached schedule. Prepared by: vF carr�r'r'°�e ��; •''rl A- Joseph A. Salvia, P.E. (type or print name) <_ I;102 i re - °e 7wn a Date Design Professional Seal Jr' A thoriz Building Official's Acceptance: Signa ure Da a Signature Date SEC/CT Form lOICT Statement of Special Inspections ©SEC/CT 1999 Sheet 2 of 10 Project: The Shops at Evergreen Walk Schedule of Special Inspection Services The following sheets comprise the required schedule of special inspections for this project. The construction divisions which require special inspections for this project are as follows: ® Soils and Foundations ® Cold-Formed Steel Framing ® Cast-in-Place Concrete ® Spray Fire Resistant Material ❑ Precast Concrete ❑ Wood Construction ® Masonry ® Exterior Insulation and Finish System ® Structural Steel ❑ Special Cases Inspection Agents Firm Address 1. Special Inspector Eastern Materials Testing Lab 114 Woodlawn Road Division Berlin, CT 06037 2. Testing Laboratory Eastern Materials Testing Lab 114 Woodlawn Road Division Berlin, CT 06037 3. Testing Laboratory 4. Other McNamara/Salvia,Inc. 160 Federal Street Boston, MA 02110 Note: The qualifications of all personnel performing Special Inspection activities are subject to the approval of the Building Official. The inspection and testing agent 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. The credentials of all Inspectors and testing technicians shall be provided if requested. It is recommended that the person administering the Special Inspections program be a Professional Engineer experienced in the design of buildings. Key for Minimum Qualifications of Ins ection Agents where indicated on Schedules PE Professional Engineer EIT Engineering in Training ACI American Concrete Institute Certified Concrete Field Testing Technician AWS American Welding Society Certified Welding Inspector ASNT American Society of Non-Destructive Testing- Level II or III Qualifications of inspection agents may be indicated on the Schedule in instances where the Structural Engineer deems such requirements are appropriate. SEC/CT Form 101CT • Statement of Special Inspections • ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 3 of 10 Soils and Foundations Project: The Shops of Evergreen Walk Item Agent No. Scope (Quallf.) 1. Shallow Foundations 1 Preperation of spread footing on earth. Check preperation as required in geotecchnical report of prepared sections receiving foundations. Interim reports of inspection. 2.Controlled Structural Fill I Check preperation as required in geotechnical report of prepared 1705.7 sections receiving foundations. Interim reports of inspections Review for conformance to the specification. 3. Deep Foundations N/A 1705.8, 1705.9; 1816.13 4. Other SEC/CT Form 101CT . Statement of Special Inspections • ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 4 of 10 Cast-in-Place Concrete Project: The Shops at Evergreen Walk Item Agent No. Scope (Qualif.) 1 Mix Design 1,4 Review mix designs 1705.4.1 2. Material Certification 1,4 Review for conformance to specification 1705.4.1 3. Reinforcement Installation I Inspect reinforcing steel for size, quantity, condition and 1705.4.2 placement. 4. Post-Tensioning Operations4 N/A 1705.4.5 5. Batching Plant N/A 1705.4.4 6. Formwork Geometry I Inspect form sizes. CT 1705.4.3 7. Concrete Placement I Observe concrete placement operations. 1705.4.4 Verify conformance to specifications including cold weather placement procedures.Perform slump,density and air content tests at point of discharge. 8. Evaluation of Concrete I Test and evaluate in accordance with the specifications. Strength6 1705.4.4 9. Curing and Protection 1 Observe rocedures or conformance to the specifications. P I I 1705.4.4 10. Other SEC/CT Form 101 CT . Statement of Special Inspections • ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 5 of 10 Masonry Project: The Shops at Evergreen Walk Item Agent No. Scope (Qualif.) 1. Material Certification 1,4 Review for conformance to specifications 1705.5 2. Mixing of Mortar and Grout 1 Inspect field-mixing procedures for conformance to the 1705.5 specifications. 3. Installation of Masonry 1,4 Inspect placement for conformance to the specifications. 1705.5 4. Reinforcement Installation 1 Inspect reinforcing steel for size, quantity condition and placement 1705.5 for conformance to SER approved submittals and contract documents.Inspect welding of reinforcement and review welder's certifications. 5. Grouting Operations 1 Inspect grouting procedures for conformance with the 1705.5 specifications.Inspect cells prior to grouting. 6. Weather Protection___ __ I _ -Inspect-protection for cold and hot weather for conformance with 1705.5 the specifications. 7. Evaluation of Masonry 1,4 Verify strength in accordance with the specifications. Strength" 1705.5 8. Anchors and Ties1b 1, 4 Inspect anchorage of masonry to other construction for 1705.5 conformance to the contract documents. 9. Other SEC/CT Form 101CT • Statement of Special Inspections • ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 6 of 10 Structural Steel Project: The Shops at Evergreen Walk Item Agent No. Scope (Qualif,) 1 Fabricator Certification/ 1. 4 Review each Fabricators quality control procedure Quality Control Procedures 1705.2; 1705.3.1 2. Material Certification 1,4 Review for conformance to the specifications 19. 1705.3.2 3. Open Web Steel Joists 1. 4 Inspect for size,placement, bridging, bearing and connection to structure, visually inspect all welds of a minimumof 5%of the joists, randomly selected. 4. Bolting 1 Test and inspect bolted connections in accordance with 1705.3.3.1 specification. Verify bolt size and grade. 5. Welding 1 Check welder qualifications. Visually inspect fillet welds and test 1705.3.3.2 full penetration field welds in accordance with specifications. 6. Sheaf Connectors__ L__— Inspect for size and placement. Test for proper weld attachment. 7. Structural Details 1,4 Inspect for size,grade of steel, camber, installation and 1705.3.3.3 connection details. 8. Metal Deck 1.4 Verify gage, width and type. Inspect placement laps, welds sidelap attachment and screws or other mechanical fasteners. Check welder qualifications. 9. Other SEC/CT Form 101CT 9 Statement of Special Inspections 9 ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 7 of 10 Cold-Formed Steel Framing Project: The Shops at Evergreen Walk Item Agent No. Scope (Quallf.) 1. Member Sizes 1,4 Inspect and verify members for size in accordance to the SER approved submittals and contract documents. 2. Material Thickness 1,4 Inspect gage, width and material thickness in accordance SER approved submittals and contract documents. 3. Material Properties 1 Review materials properties in the accordance to the SER approved submittals and contract documents. 4. Mechanical Connections I Inspect for size and placement and grade and connection to framing structure. 5. Welding I Check welder qualifications. Visually inspect fillet welds in accordance with specifications. 6. Framing Details 1, 4 Inspect members for size, grade of steel, installation and connection details. 7.Other SEC/CT Form 101CT . Statement of Special Inspections • OSEC/CT 1999 Schedule of Special Inspection Services Sheet 8 of 10 Spray Applied Fire Resistant Material Project: The Shops at Evergreen Walk Item Agent No. Scope (Qualif.) 1 Material Specifications 2 Review manufacturer's material specification for conformance to the contract documents and that the material can obtain the required rating in the thickness specified. 2. Laboratory Tested Fire I Review manufacturers test data for conformance with Resistance Design specifications. 3. Schedule of Thickness 1 Review manufacturer's schedule of thickness for required fire ratings of structural elements. 4. Surface Preparation 2 Inspect surfaces to receive fire proofing for conformance with 1705.12.1 approved fire resistance design and the manufacturer's written instructions.prior to the application of specified material. 5. Application 2 Verify the application is in accordance with the approved 1705.12.2 manufacturer's written instructions. 6. Curing and Ambient Condition 2 Verify the substrate is not below the minimum ambient 1705.12.2 temperature before and after the application as specified in the approved manufacturer's written instructions. Verify the area of application is ventilated during and after the application. 7. Thickness 2 Verify the thickness of sprayed fire resistive material is not less 1705.12.3 than the thickness required by the approved fire resistance design. Sample shall be selected in accordance with BOCA Section 1705.12.3.1 and 1705.12.3.2. 8. Density 2 Verify the density of sprayed fire resistivematerial is not less than 1705.12.4 the thickness required by the approved fire resistance design. Sample shall be selected in accordance with BOCA Section 1705.12.3.1 and 1705.12.3.2. 9. Bond Strength 2 Verify the cohesiveladhesfve band strength of sprayed fire resistive 1705.12.5 material is not less than the bond strength required by the approved fire resistance design. The cohesiveladhesive bond strength sample shall be selected in accordance with BOCA Section 1705.12.3.1 and 1705.12.3.2. 10. Other 2 SEC/CT Form 101 CT Statement of Special Inspections • ©SEC/CT 1999 Schedule of Special Inspection Services Sheet 9 of 10 Exterior Insulation&Finish Systems(Eln) Project: The Shops at Evergreen Walk Item Agent No. Scope (Qualif.) 1. Material Submittals Architect Verification samples:representative samples of each material that is to be exposed in the finished work,showing full range of color and finish variations expected. 12X12 finish sample of each type and color selected on I"think insulation board. 2. Condition of Substrate 1 Conduct periodic field review of substrate surface to establish 1705.13 conformance with contract and manufacturer's specifications. Report in writing to the Architect any variations,discrepancies and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1 Conduct periodic field review of liquid membrane and insulation Board board to establish conforance with contract and manufacturer's 1705.13 specifications. Report in writing to the Architect any variations, discrepancies and conditions that prevent satisfactory application of the work. 4. Application of Coatings I Conduct periodic field review of basecoat and finish coats to 1705.13 establish conformance with contract and manufacturer's specifications. Report in writing to the Architect any variations, discrepancies and conditions that prevent satisfactory application of the work 5. Application of Mesh 1 Conduct periodic field review of reinforcing mesh to establish 1705.13 conformance with contract and manufacturer's specifications. Report in writing to the Architect any variations,discrepancies and conditions that prevent satisfactory application of the work. 6. --Ambient Condition and Curing— 1-- -Conductperiodic field review to establish conformance with 1705.13 contract and manufacturer's specifications. Review construction managers daily weather log. Report in writing to the Architect any variations,discrepancies and conditions that prevent satisfactory application of the work. 7. Flashing and Joint Details I Conduct periodic field review to establish conformance with 1705.13 contract and manufacturer's specifications. Report in writing to the Architect any variations,discrepancies and conditions that prevent satisfactory application of the work. 8. Sealants/Caulks I Conduct field review of surface to receive sealant prior to 1705.13 installation and report in writing any surfaces that are not suitable for application of specified materials. lit accordance with ASTM C804 and or ASTM C790 9. Other Manuf Rep Bi-weekly inspections made by a representative of E1FS manufacturer to ascertain that the system has been installed according to the applicable manufacturer's specifications and details.Submit signed inspection reports. SEC/CT Form 101CT . Statement of Special Inspections • OSEC/CT 1999 Schedule of Special Inspection Services Sheet 10 of 10 References Project: The Shops at Evergreen 6Valk 1 ACI 318-95, Building Code Requirements for Structural Concrete, Chapter 3. 2. ACI 318-95, Building Code Requirements for Structural Concrete, §7.4, 7.5. 7.6 and 7.7. 3. ACI 318-95, Building Code Requirements for Structural Concrete, § 18.18. 4. ACI 318-95, Building Code Requirements for Structural Concrete, Chapter 4 and§5.2, 5.3, 5.4 and 5.8. 5. ACI 318-95, Building Code Requirements for Structural Concrete, §5.9 and 5.10. 6. ACI 318-95, Building Code Requirements for Structural Concrete, §5.6. 7. ACI 318-95, Building Code Requirements for Structural Concrete, §5.11, 5.12 and 5.13. 8. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, §2.3. 9. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, §2.6. 10. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, §3.2. 11 ACI 530/ASCE 5/TMS 402—95, Building Code Requirements for Masonry Structures, Chapter 8. 12. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, §3.5. 13. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, § 1.8. 14. ACI 530.1 /ASCE 6/TMS 602—95, Specifications for Masonry Structures, § 1.4. 15. ACI 530/ASCE 5/TMS 402—95, Building Code Requirements for Masonry Structures, §4.2 and 5.14, 16. AISC ASD—89, Specification for Structural Steel Buildings—Allowable Stress Design and Plastic Design, §A3.4 and A3.6. 17. AISC LRFD—93, Load and Resistance Factor Design Specification for Structural Steel Buildings, §A3.3 and A3.5. 18. ASTM A6—95c, Specification for General Requirements for Rolled Steel Plates, Shapes, Sheet Piling, and Bars for Structural Use. 19. ASTM A568—95,-Specification for-Steel Sheet,-Carbon and High-Strength, Low-Alloy, Hot-Rolled and Cold Rolled, General Requirements For. 20. RCSC-85 (88), Specification for Structural Joints Using A325 or A490 Bolts, §9. 21. AWS D1.1 —92, Structural Welding Code—Steel,§6. 22. AWS D1.1 —92, Structural Welding Code—Steel, §7.8. SEC/CT Form 101CT • Statement of Special Inspections • ©SEC/CT 1999 _ 160 Federal Street,5th Floor Boston,MA 02110 USA 617-737-0040 617-737-0042 Fax RobertJ.McNamara,P.E. McNamara/Salvia,Inc. Joseph A.Salvia,P.E. Consulting Engineers March 30,2005 Christopher J.Dougan Chief Building Inspector Town of South Windsor 1540 Sullivan Avenue South Windsor,CT 06074 RE: The Shops at Evergreen Walk—South Windsor,CT Statutory Completion Certification—Building 100 Permit No.30316 Mc1Sal Project N°22109.00 Dear Mr.Dougan, In our professional opinion we affirm that the completed construction of the base building referenced above (exclusive of tenant improvements which are not the subject of this certification)is in substantial compliance with the approved plans and design specifications.(CT General Statues,Sec 29-276b 10) The above represents an expression of the professional opinion of the undersigned,and is made to the best of the undersigned's knowledge,information and belief,based upon the undersigned's performance of services under the Architect's agreement for architectural services with the owner of the project referenced above,in accordance with generally accepted practice.As such,the opinions expressed herein constitute neither a guarantee nor warranty,expressed or implied. Very truly yours, McNamar /Salvia,Inc. )ief ph A.Salvia,P.E. Executive Officer �q CONIy WO. T . D�� : e o. 11102 4 ISTEa��,,�`�tr�'' JASImr T—nnfR—thWmd—rnc;ni—I TR The Shnns at Fvarnreen Walk—Rtntonry rmmnletmn rerhfiratmn SITE COMPLIANCE CHECKLIST 160 TOWN of SOUTH WINDSOR, CONNECTICUT 101 EVERGREEN WAY LOT_# Reviewed By (Engineering) HOAR CONSTRUCTION Date Reviewed o �g /Denied 2 METROPLEX DRIVE,BIRMINGHAM,AL Reviewed By nning) BP_#_30316_ Ph_# 205-423-2230 Date Rev: e L/ IPP:50F. Denied Date Submitted 12/31/03 ***** FOR B DING PER * In accordance with the Zoning and/or Subdivision Regulations, prior to the building of any structure on a lot, a Topographic Plot Plan shall be submitted for approval The minimum requirements shall include: Approved Denied N/A 1. Name, address & phone number of owner/applicant Y 2 Name, address & phone number of plan preparer 3 Zoning Information - i.e zone, open space, floodway, street address 4. Plot Plan at 1" = 40' scale a. Subdivision reference, abutting properties, etc b. Easements of record y c Lot description, bearings, building lines, distances, area, etc. d. Contours, existing & proposed, 1 or 2 ft interval where appropriate y e Building location with dimensions Elevations of proposed finish floor, garage / floor & centerline of road at driveway +/ f. Elevations of gravity drainage systems, sanitary & foundation drain at the house and the street g. Tentative utility location (gas, water, electric, septic system, etc ) ViA,( h. Title block with name and address of re arer P P date, appropriate certification, live seal and live signature consistent with the Board of Registration requirements. (P.E. & L.S.) 5 Sedimentation and erosion control 6A Special Planning & Zoning, Inland/Wetlands considerations (Plans on file w/Town Clerk) COMMENTS: JVfix47r- Size Rµ c1 LCI C-X�L-+ af� ��v��-�t►� /�.t�.Q C?'► 11 I Q� SC u '- j it'L,�G� � z'4 jk+ts tAN 1 G RECEIVED FEB 0 2 2004 SOUTHMINDSOR ENGINEERING DEPT. April 13,2004 PLUMBING DESIGN AFFIDAVIT To the Building Commissioner of South Windosr, CT. Re: The Shops at Evergreen Walk Building South Windsor, CT (Address) I certify that to the best of my knowledge,information and belief,the plans and computations are in accordance with the requirements for the Connecticut State Building Code and al;se , ertinent laws and ordinances. o f CONty"11 Z ifs0off � �2\a ff Kevin T. Je4 .E. o NO.5337T I�oo11�.c�,S��CENSE Engineer—Connecticut Reg.No. 22544 1�k%\Io"A = AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington,MA 02421 Phone: 781-372-3000 Fax: 781-372-3100 G:1Projects\2003-Boston\Evergreen Walk 3-181-000-05Wffidavits\Designklesign afiplum.doc ;1 ` ; C�� April 13,2004 ELECTRICAL DESIGN AFFIDAVIT To the Building Commissioner of South Windosr,CT. Re: The Shops at Evergreen Walk Building South Windsor, CT (Address) I certify that to the best of my knowledge, information and belief,the plans and computations are in accordance with the requirements for the Connecticut State Building Code and all of rtinent laws and ordinances. of CONC�1 • >� r � � 2 '►PI 000 Kevin T. Jen n,P.E. `N0.533�O BENS 1,% \/o Engineer—Connecticut Reg.No. 22544 AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington,MA 02421 Phone: 781-372-3000 Fax: 781-372-3100 G:\Projects\2003-Boston\Evergreen Walk 3-181-000-05\Affidavits\Designldesign aff elec.doc JAN-05-2004 02:34PM FROM-HOAR CONSTRUCTION 205-423-2323 T-207 P.003/003 F-741 :..• /•1� YVR CMMC•iQ1Iw.. . ....... /•..• .vf-.,..•••••�•.�.M.../..V w••..:��.�w.»..•w e~i�••�w• �� •'J�•rw: // 7/Y�ICL THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION alAUlrcltAll ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NCl:plfi. SfIDEIS AND IVIILIALS HOLDER, THIS CERTIFICATE DOES HOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORflED BY THE POLICIES BELOW. A.O. ucx 1025$ 1 _ COMPANIES AFFOROING OVERAGE HIAIIINGHAM AL 35202.0265 COWANY 4205) 252-9871 1 A ST. PAUL FIRE 11 YIIRINE COWANY Hoer Consirvctlen. LLC fa _ wasicHFSTER FIRE INS CO P, 0. Boa EW400 Ct)►,Q>ANY ' / Birminghw. AL 9520-0400 C ACIS INSURANCE cirinNY y CALIPANY D LANDMARK AMMICAN 199. CO. y.•.•! 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"AII.C; UAUk 51 C:..C;Lm >'ffR:t]�lu i>L„ADV b"M i_ i 10W.000 OWNEIT^.i coNtllACIOFI r rlaol I EACH QCCVRFNC[ f� �1:000.000 700.00a i IF MW W(Any one parson) IS 5,000 A AUTOIAO9LrLUAU LTTY t q;0680170 10/Of/0] 10/01/04 ANY AUTO corMapaca .E Loot s Ix +E :.rt+cl __ 1:oco,aoo ALL UWNhU AUIO� 1 DC1D71Y INMY _ •— SCrtUL&ED ALIlD9 j(ew Pef'-on) S I>< NIRF11 AUT02 1 IHCXJIIY M41URY _ _ •-•• X NJN-0WId:D AIJTGG (F'Itt aaaidar,ll t PrICTCRrY wlMAtsE I= 1 1 GAILAGS LIABLTTr I ;AUTO CM.Y.rA ACCIDBNI : ANT 141TO r,C TI JA oTNR N AVIo tNA.Y: i EACH Acc;c-cNT t AGi(F'+EWI['i t 8 �cEssuAstlm tUN7739780 t0I01103 I tOro11a4 L'AUa oeeua+eNet Is 25,0W.On0 X u1.xIA1:LI.A roNM AfXI1 MTT: - is Odd. cc G11CA IHAH i!d[O1�LLA 1'kBLA 1 ._.— __ •.....,..-.n.•... S t WanxeMCOMPSNIATMU&ND J ICCDO]00 J1/NCR0300130 6/07/03 1 4107/Ot C I,TAIU- I CAM .L�ottY.u�aI;1�J.tH._ •._. t:MPL0Y8/10'LIAtiR.RY I � :.•+.:...:.�-.� t1 EACH ACCWWI _5 600.000 TINE PROPR1F10A/ � I ... PAR1rCFOfCItl;G1TIV[ I 5 F.I n1.4FAXk+*ICY I tMI is 00.000 OI'rlr:[�11 Atli: C><IX EL DIRA'2:-EA ELI.OVEE Is E00,000 OTHcn 1 I 0 CentreCtors Egvlpmoni LHQ321151 10/01/03 10/01/04 0"ad*quip, an Fit• with Company Leesod/Ranted: SS00.000 Per ItAn St.000.W11 cgs Rc%Q011PTIQN OF UPPRAT10NeA0OATpNaryGHILLgusrLGIAL TY�Me Job Barra: The Shops at Evergroon Walk'. Jab Location: Sovth Windsor, CT, Job Rowber 3316 •::ClAI1FC•AT�FfbCtSEEi :^... ....w......w,!.......'...�.w:�._ e.;. ^•;:;:•:;:�• 1:. .r.�,� r._�rjsw^^.'.::::�.::.,.y.,....� .. . .. .. ,{.,.•..�.•,,„.,.•..,.....,x��.,_•r,...•../.yS•N,�f•/...;I�•�%Mi•.v�aNcE�W►�Ionl.�•._ ... _^:��_ «....:�%s.� ..._ . ... ...n... $11OU10 AN OF THE ABOVQ DENC14MM POLICIES iS CANC CIED 917011E TNC Town of South WIAjtor CXPIRATION OA;TNCIIEOF,TH9 I"UINa COMPANY NIAL ENDEAVOR To MAIL IS40 Sullivan Avenva 30 DAVI WRITTEN NOTICETO Tug vr71TIFICATtHO60CR NAMED TOIHELUT, Sovib Illndsor, CT 05074 ;aFAILURB TO MAIL SUCH NOYICC ttIIAIJ.IWOlB NO OBLIGATION On LIAOILITT OR ANY KIND UPON THE COMPANY, ITS ACI:NTB OR REPR£61NTATIVL3, ...........I.,.,., .. .„r�t::t:'tY....n-n.n.n......w.......n. n.y.y... . .__,,„AUwit(OR wit-aAgi, TIY. B. Ilsruld S E1edr091ah IcORrs•2�•�•t•1taE!).: ... _.:..... ;:►•• :;,•;.��.•n �... .,•: r ..,:.>.. _ ..,.- ../..•.•.. :�=; :�.�.•.:.,......�:IC'C.DIi17:C:AR60fi7i71GfJ"1:486 CERTIFICATE: 020/Call 0 Mtt2 August 20, 2004 MECHANICAL DESIGN AFFIDAVIT To the Building Commissioner of South Windosr, CT. Re: Evergreen Walk Life Safety Vacant Spaces South Windsor,CT (Address) I certify that to the best of my knowledge, information and belief,the plans and computations are in accordance with the requirements for the Connecticut State Building Code and all other pertinent laws and ordinances. A. r;•.%%.. Daniel A. Campia ;r- 3 ti Engineer—Connecticut Reg. No. 14987 ^n::r:raurn«�tom" AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington, MA 02421 Phone: 781-372-3000 Fax: 781-372-3100 G:\Pr6jects\2003-Boston\Evergreen Walk 3-181-000-05\Affidavits\Design\design aff mechanical 8-20-04.doc August 20, 2004 FIRE PROTECTION DESIGN AFFIDAVIT To the Building Commissioner of South Windosr, CT. Re: Evergreen Walk Life Safety Vacant Spaces South Windsor, CT (Address) I certify that to the best of my knowledge, information and belief,the plans and computations are in accordance with the requirements for the Connecticut State Building Code and all other pertinent laws and ordinances. n�opnWr,;r,r,•r A. i N. Daniel A. ampla `�Engineer—Connecticut Reg.No. 14987 Vt♦iy�/�NMi�Mw d�'li AHA Consulting Engineers, Inc. 10 Maguire Road, Suite 310 Lexington, MA 02421 Phone: 781-372-3000 Fax: 781-372-3100 G:\Projects\2003-Boston\Evergreen Walk 3-181-000-05\AffidavitsM)esign\design aff FP 8-20-04.doc Statement of Special Inspections oil [ i U 1 i(z south Windsor BUILDING DEPARTMENT Project: The Shops at Evergreen Walk;Building A/100 Location: South Windsor, CT Owner: Poag&McEwen Lifestyle Centers Design Professional in Responsible Charge: William E. Gaugler, P.E. (Soils&Foundations, Cast-in- Place Concrete, and Structural Steel Only) Jaynes B. Heller(Architectural Systems) This Statement of Special Inspections.is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of Special Inspection services applicable to this project as well as the name of the Special Inspection Coordinator and the identity of other approved agencies to be retained for conducting these inspections and tests. This Statement of Special Inspections encompass the following disciplines: ® Structural ❑ Mechanical/Electrical/Plumbing ® Architectural ❑ Other: The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to the Building Official and the Registered Design Professional in Responsible Charge. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected,the discrepancies shall be brought to the attention of the Building Official and the Registered Design Professional in Responsible Charge. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official and the Registered Design Professional in Responsible Charge. A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: MONTHLY or❑ per attached schedule. Prepared by: ••.111"""•e", James B. Heller ,.•••'��.••'•e•�''•• C�i�': (type or print name) 6► No.6030, 12108106 .,"RED ARC ••� kwnef Date ''•�. �� 4"St,• Design Proessional Seal or_ ization: Building Official's Acceptance: Si na ure ate Signature Date CASE Form 10i Statement of Special Inspections 9 ©CASE 2004 c r I Page 1 of 12 Schedule of Inspection and Testing Agencies This Statement of Special Inspections/Quality Assurance Plan includes the following building systems: ® Soils and Foundations ❑ Spray Fire Resistant Material ® Cast-in-Place Concrete ❑ Wood Construction ❑ Precast Concrete ® Exterior Insulation and Finish System ® Masonry ❑ Mechanical & Electrical Systems ® Structural Steel ® Architectural Systems ❑ Cold-Formed Steel Framing ❑ Special Cases Special Inspection Agencies Firm Address,Telephone,e-mail 1. Special Inspection Ryan Roy, P.E. 114 JVoodlaivn Road Coordinator JGI Eastern, Inc. Berlin, CT 06037 2. Inspector JGI Eastern, Inc. 114[Voodlmvn Road Berlin, CT 06037 3. Inspector N/A N/A 4. Testing Agency JGI Eastern, Inc. 114 1V6od1mvn Road Berlin, CT 06037 5. Testing Agency N/A N/A 6. Other KA,Inc. 1468 W 9rh St., 9600 Cleveland, Ohio, 44113 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. CASE Form 101 • Statement of Special Inspections • ©CASE 2004 III a Page 2 of 12 Quality Assurance Plan Quality Assurance for Seismic Resistance Seismic Design Category C Quality Assurance Plan Required (Y/N) Y Description of seismic force resisting system and designated seismic systems: Seismic Force Resisting System: Ordinary Steel Moment Frames Quality Assurance for Wind Requirements Basic Wind Speed (3 second gust) 95 mph Wind Exposure Category C Quality Assurance Plan Required (Y/N) N Description of wind force resisting system and designated wind resisting components: N/A Statement of Responsibility Each contractor responsible for the construction or fabrication of a system or component designated above must submit a Statement of Responsibility. CASE Form 101 9 Statement of Special Inspections 9 ©CASE 2004 Page 3 of 12 Qualifications of Inspectors and Testing Technicians The qualifications of all personnel performing Special Inspection and testing activities are subject to the approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if requested. Key for Minimum Qualifications of Inspection Agents: When the Registered Design Professional in Responsible Charge deems it appropriate that the individual performing a stipulated test or inspection have a specific certification or license as indicated below, such designation shall appear below the Agency Number on the Schedule. PE/SE Structural Engineer—a licensed SE or PE specializing in the design of building structures PE/GE Geotechnical Engineer—a licensed PE specializing in soil mechanics and foundations EIT Engineer-In-Training—a graduate engineer who has passed the Fundamentals of Engineering examination American Concrete Institute(ACI)Certification ACI-CFTT Concrete Field Testing Technician—Grade 1 ACI-CCI Concrete Construction Inspector ACI-LTT Laboratory Testing Technician—Grade 1&2 ACI-STT Strength Testing Technician American Welding Society(AWS)Certification AWS-CWI Certified Welding Inspector AWS/AISC-SSI Certified Structural Steel Inspector American Society of Non-Destructive Testing (ASNT)Certification ASNT Non-Destructive Testing Technician—Level II or III. International Code Council (ICC)Certification ICC-SMSI Structural Masonry Special Inspector ICC-SWSI Structural Steel and Welding Special Inspector ICC-SFSI Spray-Applied Fireproofing Special Inspector ICC-PCSI Prestressed Concrete Special Inspector ICC-RCSI Reinforced Concrete Special Inspector National Institute for Certification in Engineering Technologies (NICET) NICET-CT Concrete Technician—Levels I, II, III & IV NICET-ST Soils Technician-Levels I, II, III & IV NICET-GET Geotechnical Engineering Technician-Levels I, II, III & IV Exterior Design Institute(EDI)Certification EDI-EIFS EIFS Third Party Inspector Other CASE Form 101 • Statement of Special Inspections • ©CASE 2004 r Soils and Foundations Page 4 of 12 Item Agency# Scope (Qualif.) 1. Site Preparation #1,2,4 Inspect the site prior to fill placement and verb that the site has been prepared in accordance with the approved Geotechnical PE/GE Report. 2. Controlled Structural Fill #2,4 Perform sieve tests(ASTAf D422&DI140)and modified Proctor tests(ASTAf D1557)of each source of fill material. Inspect placement, lift thickness and compaction of controlled fill. Test density of each lift of fill by nuclear methods(ASTAf D2922) Verb extent and slope offill placement. 3. Shallow Foundations #1,24 Inspect soils below footings for adequate bearing capacity and consistency with geotechnical report. Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Cast-in-Place Concrete Page 5 of 12 Item Agency# Scope (Qualif.) 1. Mix Design #1,2 Review concrete batch tickets and verb compliance with approved mix design. Verb that water added at the site does not ACI exceed that allowed by the mix design. 2. Reinforcement Installation #1,2,4 Inspect size,spacing, cover,positioning and grade ofreinforcing steel. Verb that reinforcing bars are free of form oil or other ACI deleterious materials. Inspect bar laps and mechanical splices. Verb that bars are adequately tied and supported on chairs or bolsters 3. Welding of Reinforcing 94 Visually inspect all reinforcing steel welds. Verb weldability of reinforcing steel. Inspect preheating of steel when required. Provide continuous inspection of welding of any shear A{VS-CIVI reinforcement(stirrups or ties). 4. Anchor Rods 91,2,4 Inspect size,positioning and embedment of anchor rods. Inspect concrete placement and consolidation around anchors. 5. Concrete Placement #1,2,4 Inspect placement ofconcrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI concrete is properly consolidated. 6. Sampling and Testing of #4 Test concrete compressive strength(ASTMC31 &C39),slump Concrete (ASTAf C143), air-content(ASTAf C231 or C173)and temperature ACI-CFTT (ASTM C1064). ACI-STT 7. Curing and Protection #1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI CASE Form 101 9 Statement of Special Inspections 9 ©CASE 2004 I Precast Concrete Page 6 of 12 Item Agency# Scope (Qualif.) 1 Plant Certification/Quality 1,2,4 Review plant operations and quality control procedures. Control Procedures ACI-CCI ❑ Fabricator Exempt 2. Mix Design 1,2,4 Inspect concrete batching operations and verb compliance with approved mix design ACI-CCI 3. Material Certification N/A N/A 4. Reinforcement Installation 1,2,4 Inspect size,spacing,position and grade ofreinforcing steel. Verb that reinforcing bars are free of form oil or other ACI-CCI deleterious materials. 5. Prestress Operations 1,4 Inspect placement, stressing,grouting and protection of prestressing tendons PCI 6. Connections/Embedded A1!4 N!1 Items 7. Formwork Geometry N/A N/A 8. Concrete Placement 1,2,4 Inspect placement of concrete. Verb that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI-CCI concrete is properly consolidated 9. Sampling and Testing of 1,2,4 Test concrete compressive strength(ASTAI C31&C39), slump Concrete (ASTM C143),air-content(ASTM C231 or C173)and temperature ACI-CFTT (ASThf 0064). ACI-STT 10. Curing and Protection 1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI 11. Erected Precast Elements 1,2,4 Inspect erection ofprecast concrete including member configuration, connections, welding and grouting. PE 12. Other: N/A N/A CASE Form 101 • Statement of Special Inspections 9 ©CASE 2004 Masonry Required Inspection Level: ❑ 1 ❑2 Page 7 of 12 Item Agency# Scope (Qualif.) 1. Material Certification N/A N/A 2. Mixing of Mortar and Grout 2,4 Inspect proportioning, mixing and retempering ofmortar and grout. 3. Installation of Masonry 2,4 Inspect size, layout, bonding and placement of masonry units. 4. Mortar Joints 2,4 Inspect construction of mortar joints including tooling and filling of head joints. 5. Reinforcement Installation 1,2,4 Inspect placement,positioning and lapping ofreinforcing steel. AIVS-CIVI Inspect welding ofreinforcing steel. 6. Prestressed Masonry 2,4 Inspect placement, anchorage and stressing ofprestressing bars. 7. Grouting Operations 2,4 Inspect placement and consolidation ofgrout. Inspect masonry clean-outs for high-lift grouting. 7. Weather Protection 2,4 Inspect cold weather protection and hot weather protection procedures. Verb that wall cavities are protected against precipitation. 9. Evaluation of Masonry 1,2,4 Test compressive strength of mortar and grout cube samples Strength (ASTM C780). Test compressive strength of masonry prisms(ASTIpf C1314). 10. Anchors and Ties 2,4 Inspect size, location, spacing and embedment ofdowels, anchors and ties. 11. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Structural Steel Page 8 of 12 Item Agency# Scope (Qualiy.) 1 Fabricator Certification/ #1,2,4 Review shop fabrication and quality control procedures. Quality Control Procedures ❑Fabricator Exempt AIVSIAISC 2. Material Certification #1,2,4 Review certified mill test reports and identification markings on structural steel„ high-strength bolts, nuts and welding electrodes A IVS/AISC 3. Open Web Steel Joists 91,2,4 Inspect installation,field welding and bridging ofjoists. A If S-RISC 4. Bolting #2,4 Inspect installation and tightening ofhigh-strength bolts. Verb that splines have separated from tension control bolts. Verb AIVS,1ISC proper tightening sequence. Continuous inspection of bolts in slip- critical connections. 5. Welding #2,4 Visually inspect all welds. Inspect pre-heat,post-heat and surface Y P preparation between passes. Verb si_e and length of fillet welds. AfVS-Clf7 Continuous inspection of Complete and Partial Penetration Groove IVelds, Afultipass fillet welds and fillet welds greater than 5116" ASNT Ultrasonic testing of all full penetration welds. 6. Shear Connectors #2,4 Inspect size, number,positioning and welding ofshear connectors. Inspect suds for full 360 degree flash. Ring test all shear AfVSIAISC connectors with a 3 lb hammer. Bend test all questionable studs to 15 degrees. 7. Structural Details #1,2,4 Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details. PE 8. Metal Deck #2,4 Inspect welding and side-lap fastening of metal roof and floor deck. A fVS-CIVI CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Cold-Formed Steel Framing Page 9 of 12 Item Agency# Scope (Qualif.) 1 Member Sizes 1,2,4 Visual inspection of the erected light gauge framing to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each connection. 2. Material Thickness 1,2,4 Verb that the material thickness is in conformance with the contract documents 3. Material Properties 1,4 Review material certification submittals to verb conformance with design specifications 4. Mechanical Connections 1,2,4 Inspect 25%of threaded fasteners connections at the site 5. Welding 1,2,4 Review welder qualifications if needed AIVS'CIV I 6. Framing Details 1,2,4 Visual inspection of the coldformed steel frame to verify compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each locations 7. Trusses N/A N/A 8. Permanent Truss Bracing N/A N/A 9. Other. N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Wood Construction Page 10 of 12 Item Agency# Scope (Qualif.) 1. Fabricator Certification/ N/A N/A Quality Control Procedures ❑ Fabricator Exempt 2. Material Grading N/A N/A 3. Connections NIA N/A 4. Framing and Details NiA NIA 5. Diaphragms and Shearwalls 1,2,4 Inspect size, configuration, blocking and fastening ofsheanvalls and diaphragms. Verb panel grade and thickness. 6. Prefabricated Wood Trusses N/A N/A 7. Permanent Truss Bracing N/A N/A 8. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Exterior Insulation&Finish Systems(EIFS) Page 11 of 12 Item Agency# Scope (Qualif.) 1 Material Submittals 6 verification samples:representative samples of each material that is to be used to be exposed in the finished work,showing full range of color and finish variations expected. 12x12 finish sample of each type and color selected on I"thick insulation board 2. Condition of Substrate 1,2,4 Conduct periodicfield review ofsubstrate surface to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1,2,4 Conduct periodic field review of liquid membrane and insulation Board board to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 4. Application of Coatings 1,2,4 Conduct periodic field review of basecoat and finish coat to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 5. Application of Mesh 1,2,4 Conduct periodic field review of reinforcing mesh to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 6.Ambient Condition and Curing 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Review construction manager's daily weather log. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 7. Flashing and Joint Details 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 8. Sealants/Caulks 1,2,4 Conduct field review ofsurface to receive sealant prior to installation and report any surfaces that are not suitable for application of specified materials in accordance with ASTA1 C804, and or ASTU C790. 9. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 • Architectural Systems Page 12 of 12 Item Agency# Scope (Qualif.) 1. Wall Panels&Veneers N/A N/A 2. Suspended Ceilings N/A N/A 3. Access Floors N/A N/A 4. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Statement of Special Inspections Project: The Shops at Evergreen TValk,Building B/200 Location: South Windsor, CT Owner: Poag&McEiven Lifestyle Centers Design Professional in Responsible Charge: William E. Gaugler, P.E. (Soils&Foundations, Cast-in- Place Concrete, and Structural Steel Only) James B.Heller(Architectural Systems) This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of Special Inspection services applicable to this project as well as the name of the Special Inspection Coordinator and the identity of other approved agencies to be retained for conducting these inspections and tests. This Statement of Special Inspections encompass the following disciplines: ® Structural ❑ Mechanical/Electrical/Plumbing ® Architectural ❑ Other: The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to the Building Official and the Registered Design Professional in Responsible Charge. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected,the discrepancies shall be brought to the attention of the Building Official and the Registered Design Professional in Responsible Charge. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official and the Registered Design Professional in Responsible Charge. A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: MONTHLY or❑ per attached schedule. Prepared by: %%l"'er•#,, '•. CONNF James B. Heller �.•�,'t�.••S60060%•C��'% (type or print name) y J•�P �9' C'.• No.6483 •.'�V•` • • �• 12/08/06 ,•''•,`� A,' FgEQ ARG �.•`� Signat Date ••'•�� N``, Design aWAsional Seal Ow er' ut zation: Building Official's Acceptance: Sig e D to Signature Date r 1 CASE Form 10i Statement of Special Inspections • ©CASE 2004 r . It!ti,r.1, iA r. elf "dlifll ii+l►t Page 1 of 12 Schedule of Inspection and Testing Agencies This Statement of Special Inspections/Quality Assurance Plan includes the following building systems: ® Soils and Foundations ❑ Spray Fire Resistant Material ® Cast-in-Place Concrete ❑ Wood Construction ❑ Precast Concrete ® Exterior Insulation and Finish System ® Masonry ❑ Mechanical& Electrical Systems ® Structural Steel ® Architectural Systems ❑ Cold-Formed Steel Framing ❑ Special Cases Special Inspection Agencies Firm Address,Telephone, e-mail 1 Special Inspection Ryan Roy, P.E. 114 Woodlmvn Road Coordinator JGI Eastern, Inc. Berlin, CT 06037 2. Inspector JGI Eastern, Inc. 114 Woodlmvn Road Berlin, CT 06037 3. Inspector N/A N/A 4. Testing Agency JGI Eastern, Inc. 114 ff'oodlmvn Road Berlin, CT 06037 5. Testing Agency N/A N/A 6. Other KA, Inc. 1468 W 9'"St., #600 Cleveland, Ohio, 44113 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. CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Page 2 of 12 Quality Assurance Plan Quality Assurance for Seismic Resistance Seismic Design Category C Quality Assurance Plan Required (Y/N) Y Description of seismic force resisting system and designated seismic systems: Seismic Force Resisting System: Ordinary Steel Moment Frames Quality Assurance for Wind Requirements Basic Wind Speed (3 second gust) 95 mph Wind Exposure Category C Quality Assurance Plan Required (Y/N) N Description of wind force resisting system and designated wind resisting components: N/A Statement of Responsibility Each contractor responsible for the construction or fabrication of a system or component designated above must submit a Statement of Responsibility. CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Page 3 of 12 Qualifications of Inspectors and Testing Technicians The qualifications of all personnel performing Special Inspection and testing activities are subject to the approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if requested. Key for Minimum Qualifications of Inspection Agents: When the Registered Design Professional in Responsible Charge deems it appropriate that the individual performing a stipulated test or inspection have a specific certification or license as indicated below, such designation shall appear below the Agency Numberon the Schedule. PE/SE Structural Engineer—a licensed SE or PE specializing in the design of building structures PE/GE Geotechnical Engineer—a licensed PE specializing in soil mechanics and foundations EIT Engineer-In-Training—a graduate engineer who has passed the Fundamentals of Engineering examination American Concrete Institute(ACI)Certification ACI-CFTT Concrete Field Testing Technician—Grade 1 ACI-CCI Concrete Construction Inspector ACI-LTT Laboratory Testing Technician—Grade 1&2 ACI-STT Strength Testing Technician American Welding Society(AWS)Certification AWS-CWI Certified Welding Inspector AWS/AISC-SSI Certified Structural Steel Inspector American Society of Non-Destructive Testing (ASNT) Certification ASNT Non-Destructive Testing Technician—Level II or III. International Code Council (ICC)Certification ICC-SMSI Structural Masonry Special Inspector ICC-SWSI Structural Steel and Welding Special Inspector ICC-SFSI Spray-Applied Fireproofing Special Inspector [CC-PCSI Prestressed Concrete Special Inspector ICC-RCSI Reinforced Concrete Special Inspector National Institute for Certification in Engineering Technologies (NICET) NICET-CT Concrete Technician—Levels I, II, III &IV NICET-ST Soils Technician-Levels I, II, III & IV NICET-GET Geotechnical Engineering Technician-Levels I, II, III & IV Exterior Design Institute(EDI)Certification EDI-EIFS EIFS Third Party Inspector Other CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Soils and Foundations Page 4 of 12 Item Agency# Scope (Qualif.) 1. Site Preparation #1,2,4 Inspect the site prior to fill placement and verify that the site has been prepared in accordance with the approved Geolechnical PE/GE Report. 2. Controlled Structural Fill #2,4 Perform sieve tests(ASTH D422&D1140)and modified Proctor tests(ASTAI D1557)of each source of fill material. Inspect placement, lift thickness and compaction of controlled fill. Test density of each lift of fill by nuclear methods(ASTM D2922) Verify extent and slope of fill placement. 3. Shallow Foundations 91,24 Inspect soils below footings for adequate bearing capacity and consistency with geotechnical report. Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Cast-in-Place Concrete Page 5 of 12 Item Agency# Scope (Qualif.) 1 Mix Design #1,2 Review concrete batch tickets and verify compliance with ' approved mix design. Verify that water added at the site does not ACI exceed that allowed by the mix design. 2. Reinforcement Installation #1,2,4 Inspect size,spacing, cover,positioning andgrade ofreinforcing steel. Verify that reinforcing bars are free ofform oil or other ACI deleterious materials. Inspect bar laps and mechanical splices. Verb that bars are adequately tied and supported on chairs or bolsters 3. Welding of Reinforcing #4 Visually inspect all reinforcing steel welds. Verify weldability of reinforcing steel. Inspect preheating of steel when required. Provide continuous inspection of welding of any shear AJ S-C{VI reinforcement(stirrups or ties). 4. Anchor Rods #1,2,4 Inspect size,positioning and embedment ofanchor rods. Inspect concrete placement and consolidation around anchors. 5. Concrete Placement #1,2,4 Inspect placement of concrete. Verb that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI concrete is properly consolidated. 6. Sampling and Testing of #4 Test concrete compressive strength(ASTAf C31 & C39),slump Concrete (ASTd1 C143), air-content(ASTHC231 or C173)and temperature ACI-CFTT (ASTbf C1064). ACI-STT 7. Curing and Protection #1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Precast Concrete Page 6 of 12 Item Agency# Scope (Qualif.) 1. Plant Certification I Quality 1,2,4 Review plant operations and quality control procedures. Control Procedures ACI-CCI ❑ Fabricator Exempt 2. Mix Design 1,2,4 Inspect concrete batching operations and verb compliance with approved mix design ACI-CCI 3. Material Certification N/A N/A 4. Reinforcement Installation 1,2,4 Inspect size,spacing,position and grade of reinforcing steel. Verify that reinforcing bars are free of form oil or other ACI-CCI deleterious materials. 5. Prestress Operations 1,4 Inspect placement,stressing, grouting and protection of prestressing tendons PCI 6. Connections I Embedded NIA NA Items 7. Formwork Geometry N/A N/A 8. Concrete Placement 1,2,4 Inspect placement of concrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verify that ACI-CCI concrete is properly consolidated. 9. Sampling and Testing of 1,2,4 Test concrete compressive strength(ASTAI C31 &C39),slump Concrete (ASTAt C143), air-content(ASTM C231 or C173)and temperature ACI-CF7T (ASTAi C1064). ACI-STT 10. Curing and Protection 1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI 11. Erected Precast Elements 112,4 Inspect erection ofprecast concrete including member configuration, connections, welding and grouting. PE 12. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Masonry Required Inspection Level: ❑ 1 ❑2 Page 7 of 12 Item Agency# Scope (Qualif.) 1. Material Certification N/A N/A 2. Mixing of Mortar and Grout 2,4 Inspect proportioning, mixing and retempering of mortar and grout. 3. Installation of Masonry 2,4 Inspect size, layout, bonding and placement of masonry units. 4. Mortar Joints 1,4 Inspect construction of mortar joints including tooling and filling of head joints. 5. Reinforcement Installation 1,2,4 Inspect placement,positioning and lapping of reinforcing steel. AIVS-CIVI Inspect welding of reinforcing steel. 6. Prestressed Masonry 2,4 Inspect placement, anchorage and stressing ofprestressing bars. 7. Grouting Operations 1,4 Inspect placement and consolidation ofgrout. Inspect masonry clean-outs for high-lift grouting. 7. Weather Protection 2,4 Inspect cold weather protection and hot weather protection procedures. Verify that wall cavities are protected against precipitation. 9. Evaluation of Masonry 1,2,4 Test compressive strength ofmortar and grout cube samples Strength (ASTMC780). Test compressive strength of masonry prisms(ASTNf C1314). 10. Anchors and Ties 2,4 Inspect size, location, spacing and embedment of dowels, anchors and ties. 11 Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Structural Steel Page 8 of 12 Item Agency# Scope (Qualif.) 1. Fabricator Certification/ #1,2,4 Review shopfabrication and quality control procedures. Quality Control Procedures ❑ Fabricator Exempt AIVS/AISC 2. Material Certification #1,2,4 Review certified mill test reports and identification markings on structural steel„ high-strength bolts, nuts and welding electrodes A IVS/AISC 3. Open Web Steel Joists #1,2,4 Inspect installation,field welding and bridging ofjoists. A{VS-AISC 4. Bolting #2,4 Inspect installation and tightening ofhigh-strength bolts. Verb that splines have separated from tension control bolts. Verify AI VS,:41SC proper tightening sequence. Continuous inspection of bolts in slip- critical connections. 5. Welding #2,4 Visually inspect all welds. Inspect pre-heat,post-heat and surface preparation between passes. Verify size and length of fillet welds. A tVS-ClVI Continuous inspection of Complete and Partial Penetration Groove Welds, Alultipass fillet welds and fillet welds greater than 5116" ASNT Ultrasonic testing of all full penetration welds. 6. Shear Connectors #2,4 Inspect size, number,positioning and welding ofshear connectors. Inspect suds for full 360 degree flash. Ring test all shear AIVS/AISC connectors with a 3 lb hammer. Bend test all questionable studs to 15 degrees. 7. Structural Details #1,2,4 Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details. PE 8. Metal Deck #2,4 Inspect welding and side-lap fastening of metal roof andfloor deck. A IVS-CWI CASE Form 101 • Statement of Special Inspections 9 ©CASE 2004 Cold-Formed Steel Framing Page 9 of 12 Item Agency# Scope (Qualif.) 1 Member Sizes 1,2,4 Visual inspection of the erected light gauge framing to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application of joint details at each connection. 2. Material Thickness 1,2,4 Verify that the material thickness is in conformance with the contract documents 3. Material Properties 1,4 Review material certification submittals to verify conformance with design specifications 4. Mechanical Connections 1,2,4 Inspect 25%ofthreadedfasteners connections at the site 5. Welding 1,2,4 Review welder qualifications if needed A iVSIC{VI 6. Framing Details 1,2,4 Visual inspection of the cold formed steel frame to verify compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each locations 7. Trusses N/A N/A 8. Permanent Truss Bracing N/A N/A 9. Other: N/A N/A CASE Form 101 Statement of Special Inspections • ©CASE 2004 Wood Construction Page 10 of 12 Item Agency# Scope (Qualif.) 1. Fabricator Certification/ N/A N/A Quality Control Procedures ❑ Fabricator Exempt 2. Material Grading N/A N/A 3. Connections N/A N/A 4. Framing and Details W4 N44 5. Diaphragms and Shearwalls 1,2,4 Inspect size, configuration, blocking andfasteningofshearwalls and diaphragms. Verb panel grade and thickness. 6. Prefabricated Wood Trusses N/A N/A 7. Permanent Truss Bracing N/A N/A 8. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Exterior Insulation&Finish Systems(EIFS) Page 11 of 12 Item Agency# Scope (Qualif.) 1 Material Submittals 6 Verification samples:representative samples of each material that is to be used to be exposed in the finished work,showing full range of color and finish variations expected. 12x12 finish sample of each type and color selected on I"thick insulation board. 2. Condition of Substrate 1,2,4 Conduct periodicfield review ofsubstrate surface to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1,2,4 Conduct periodic field review of liquid membrane and insulation Board board to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 4. Application of Coatings 1,2,4 Conduct periodic field review of basecoal and finish coat to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 5. Application of Mesh 1,2,4 Conduct periodic field review of reinforcing mesh to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 6.Ambient Condition and Curing 1,2,4 Conduct periodicfield review to establish conformance with contract and manufacturers specifications. Review construction manager's daily weather log. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 7. Flashing and Joint Details 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 8. Sealants/Caulks 1,2,4 Conduct field review ofsurface to receive sealant prior to installation and report any surfaces that are not suitable for application of specified materials in accordance with ASTA1 C804, and or ASTM C790. 9. Other: N/A N/A CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Page Architectural Systems Pa g Item Agency# Scope (Qualif.) 1. Wall Panels&Veneers N/A N/A 2. Suspended Ceilings NM N/A 3. Access Floors N/A N/A 4. Other: N/A N/A CASE Form 101 9 Statement of Special Inspections ©CASE 2004 1 Statement of Special Inspections �. �j�i BUILDING UEPAR Project: The Shops at Evergreen Walk;Building C/300 Location: South Windsor, CT Owner: Poag&McEwen Lifestyle Centers Design Professional in Responsible Charge: William E. Gaugler,P.E. (Soils&Foundations, Cast-in- Place Concrete, and Structural Steel Only) James B.Heller(Architectural Systems) This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of Special Inspection services applicable to this project as well as the name of the Special Inspection Coordinator and the identity of other approved agencies to be retained for conducting these inspections and tests. This Statement of Special Inspections encompass the following disciplines: ® Structural ❑ Mechanical/Electrical/Plumbing ® Architectural ❑ Other: The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to the Building Official and the Registered Design Professional in Responsible Charge. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected, the discrepancies shall be brought to the attention of the Building Official and the Registered Design Professional in Responsible Charge. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official and the Registered Design Professional in Responsible Charge. A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: MONTHLY or❑ per attached schedule. Prepared by: •�+N+++++��,,, .�``�pf CONtyF'••. James B. Heller �.•`��•.•5 B'HF.•Cl�'•� (type or print name) • �� • 64. r4 �1� No.Cr183 •.••((� e 12108106 '•••. ..... •. FRED ARC Signat a Date •, '••i, •,.•• , Design�f6l��sJonal Seal Own r' A orizat�on: Building Official's Acceptance: Sig t to Date Signature Date CASE Form l01 Statement of Special Inspections . ©CASE 2004 !• �� .e..e, '" � f, ' � '" +.'.5ut44• . i��f r1 r4 f•f'\ .tr+ ,fit �4 •; t 'I�� •,��.�1a�w 1{� Page 1 of 12 Schedule of Inspection and Testing Agencies This Statement of Special Inspections/Quality Assurance Plan includes the following building systems: ® Soils and Foundations ❑ Spray Fire Resistant Material ® Cast-in-Place Concrete ❑ Wood Construction ❑ Precast Concrete ® Exterior Insulation and Finish System ® Masonry ❑ Mechanical& Electrical Systems ® Structural Steel ® Architectural Systems ❑ Cold-Formed Steel Framing ❑ Special Cases Special Inspection Agencies Firm Address,Telephone,e-mail 1. Special Inspection Ryan Roy, P.E. 114 Woodlcnvn Road Coordinator JGI Eastern, Inc. Berlin, CT 06037 2. Inspector JG1 Eastern, Inc. 114 If'oodlawn Road Berlin, CT 06037 3. Inspector N/A N/A 4. Testing Agency JGI Eastern, Inc. 114 [Voodlawn Road Berlin, CT 06037 5. Testing Agency N/A N/A 6. Other KA, Inc. 1468 W 9`h St., #600 Cleveland, Ohio, 44113 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. CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Page 2 of 12 Quality Assurance Plan Quality Assurance for Seismic Resistance Seismic Design Category C Quality Assurance Plan Required (Y/N) Y Description of seismic force resisting system and designated seismic systems: Seismic Force Resisting System: Ordinary Steel Moment Frames Quality Assurance for Wind Requirements Basic Wind Speed (3 second gust) 95 mph Wind Exposure Category C Quality Assurance Plan Required (Y/N) N Description of wind force resisting system and designated wind resisting components: N/A Statement of Responsibility Each contractor responsible for the construction or fabrication of a system or component designated above must submit a Statement of Responsibility. CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Page 3 of 12 Qualifications of Inspectors and Testing Technicians The qualifications of all personnel performing Special Inspection and testing activities are subject to the approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if requested. Key for Minimum Qualifications of Inspection Agents: When the Registered Design Professional in Responsible Charge deems it appropriate that the individual performing a stipulated test or inspection have a specific certification or license as indicated below, such designation shall appear below the Agency Number on the Schedule. PE/SE Structural Engineer—a licensed SE or PE specializing in the design of building structures PE/GE Geotechnical Engineer—a licensed PE specializing in soil mechanics and foundations EIT Engineer-In-Training—a graduate engineer who has passed the Fundamentals of Engineering examination American Concrete Institute(ACI)Certification ACI-CFTT Concrete Field Testing Technician—Grade 1 ACI-CCI Concrete Construction Inspector ACI-LTT Laboratory Testing Technician—Grade 1&2 ACI-STT Strength Testing Technician American Welding Society (AWS)Certification AWS-CWI Certified Welding Inspector AWS/AISC-SSI Certified Structural Steel Inspector American Society of Non-Destructive Testing (ASNT) Certification ASNT Non-Destructive Testing Technician—Level II or III. International Code Council (ICC)Certification ICC-SMSI Structural Masonry Special Inspector ICC-SWSI Structural Steel and Welding Special Inspector ICC-SFSI Spray-Applied Fireproofing Special Inspector ICC-PCSI Prestressed Concrete Special Inspector ICC-RCSI Reinforced Concrete Special Inspector National Institute for Certification in Engineering Technologies(NICET) NICET-CT Concrete Technician—Levels I, II, III & IV NICET-ST Soils Technician-Levels I, II, III & IV NICET-GET Geotechnical Engineering Technician-Levels I, II, III & IV Exterior Design Institute(EDI)Certification EDI-EIFS EIFS Third Party Inspector Other CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Soils and Foundations Page 4 of 12 Item Agency# Scope (Qualif.) 1 Site Preparation 41,2,4 Inspect the site prior to fill placement and verify that the site has been prepared in accordance with the approved Geotechnical PE/GE Report. 2. Controlled Structural Fill #2,4 Perform sieve tests(ASTAf D422& D1140)and modified Proctor tests(ASTAf D1557)ofeach source gffill material. Inspect placement, lift thickness and compaction of controlled fill. Test density of each lift of fill by nuclear methods(ASTAf D2922) Verify extent and slope offill placement. 3. Shallow Foundations #1,24 Inspect soils below footings for adequate bearing capacity and consistency with geotechnical report. Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill CASE Form 101 9 Statement of Special Inspections 9 ©CASE 2004 Cast-in-Place Concrete Page 5 of 12 Item Agency# Scope (Qualif.) 1. Mix Design 91,2 Review concrete batch tickets and verb compliance with approved mix design. Verify that water added at the site does not ACI exceed that allowed by the mix design. 2. Reinforcement Installation #1,2,4 Inspect size,spacing, cover,positioning and grade ofrei forcing steel. Verb that reinforcing bars are free ofform oil or other ACI deleterious materials. Inspect bar laps and mechanical splices. Verify that bars are adequately tied and supported on chairs or bolsters 3. Welding of Reinforcing 44 Visually inspect all reinforcing steel welds. Verify weldability of reinforcing steel. Inspect preheating of steel when required. Provide continuous inspection of ivelding of any shear A I i S-C{VI reinforcement(stirrups or ties). 4. Anchor Rods #1,2,4 Inspect size,positioning and embedment of anchor rods. Inspect concrete placement and consolidation around anchors. 5. Concrete Placement #1,2,4 Inspect placement of concrete. Verb that concrete conveyance and depositing avoids segregation or contamination. Verify that ACI concrete is properly consolidated. 6. Sampling and Testing of #4 Test concrete compressive strength(ASTAf C31 &C39), slump Concrete (ASTAf CI43),air-content(ASTAf C231 or C173)and temperature ACI-CF7T (ASTAf 0064). ACI-STT 7. Curing and Protection #1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI CASE Form 101 • Statement of Special Inspections 9 OCASE 2004 Precast Concrete Page 6 of 12 Item Agency# Scope (Quaiyif.) 1 Plant Certification I Quality 1,2,4 Review plant operations and quality control procedures. Control Procedures ACI-CCI ❑ Fabricator Exempt 2. Mix Design 1,2,4 Inspect concrete batching operations and verb compliance with approved mix design ACI-CCI 3. Material Certification N/A NIA 4. Reinforcement Installation 1,2,4 Inspect size, spacing,position and grade ofreinforcing steel. Verb that reinforcing bars are free of form oil or other ACI-CCI deleterious materials. 5. Prestress Operations 1,4 Inspect placement, stressing,grouting and protection of prestressing tendons PCI 6. Connections I Embedded A1!4 NIA Items 7. Formwork Geometry N/A N/A 8. Concrete Placement 1,2,4 Inspect placement of concrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI-CCI concrete is properly consolidated 9. Sampling and Testing of 1,2,4 Test concrete compressive strength(ASTAf C31 &C39), slump Concrete (ASTAf C143), air-content(ASTM C231 or C173)and temperature ACI-= (ASTAf C1064). ACI-STT 10. Curing and Protection 1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI 11. Erected Precast Elements 1,2,4 Inspect erection ofprecast concrete including member configuration, connections,welding and grouting. PE 12. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Masonry Required Inspection Level: ❑ 1 ❑2 Page 7 of 12 Item Agency# Scope (Qualif.) 1. Material Certification N/A N/A 2. Mixing of Mortar and Grout 2,4 Inspect proportioning, mixing and retempering of mortar and grout. 3. Installation of Masonry 2,4 Inspect size, layout, bonding and placement ofmasonry units. 4. Mortar Joints 2,4 Inspect construction of mortar joints including tooling and filling of head joints. 5. Reinforcement Installation 1,2,4 Inspect placement,positioning and lapping of reinforcing steel. A ITS-CIG7 Inspect welding of reinforcing steel. 6. Prestressed Masonry 2,4 Inspect placement, anchorage and stressing of prestressing bars. 7. Grouting Operations 2,4 Inspect placement and consolidation ofgrout. Inspect masonry clean-outs for high-lift grouting. 7. Weather Protection 2,4 Inspect cold weather protection and hot weather protection procedures. Verb that wall cavities are protected against precipitation. 9. Evaluation of Masonry 1,2,4 Test compressive strength ofmortar and grout cube samples Strength (ASTM C780). Test compressive strength of masonry prisms(ASTM C1314). 10. Anchors and Ties 2,4 Inspect size, location, spacing and embedment ofdowels, anchors and ties. 11. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Structural Steel Page 8 of 12 Item Agency# Scope (Qualif.) 1. Fabricator Certification/ #1,2,4 Review shop fabrication and quality control procedures. Quality Control Procedures ❑ Fabricator Exempt AIiSIAISC 2. Material Certification #1,2,4 Review certified mill test reports and identification markings on structural steel„ high-strength bolts, nuts and welding electrodes A IVS/AISC 3. Open Web Steel Joists #1,2,4 Inspect installation,field welding and bridging ofjoists. A IVS-R ISC 4. Bolting #2,4 Inspect installation and tightening of high-strength bolts. Verify that splines have separated from tension control bolts. Verify f II S,IISC proper tightening sequence. Continuous inspection of bolts in slip- critical connections. 5. Welding 42,4 Visually inspect all welds. Inspect pre-heat,post-heat and surface preparation between passes. I'erify size and length offillet tiwelds. AWS-CII7 Continuous inspection of Complete and Partial Penetration Groove Welds, dlultipass fillet welds and fillet welds greater than 5116" ASNT Ultrasonic testing of all full-penetration welds. 6. Shear Connectors #2,4 Inspect size, number,positioning and welding ofshear connectors. Inspect suds for full 360 degree flash. Ring test all shear AII'SIAISC connectors with a 3 lb hammer. Bend test all questionable studs to 15 degrees. 7. Structural Details #1,2,4 Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details. PE 8. Metal Deck #2,4 Inspect welding and side-lap fastening of metal roof and floor deck. AWS-CWI CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Cold-Formed Steel Framing Page 9 of 12 Item Agency# Scope (Qualit) 1 Member Sizes 1,2,4 Visual inspection of the erected light gauge framing to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each connection. 2. Material Thickness 1,2,4 Verb that the material thickness is in conformance with the contract documents 3. Material Properties 1,4 Review material certification submittals to verify conformance with design specifications 4. Mechanical Connections 1,2,4 Inspect 25%of threaded fasteners connections at the site 5. Welding 1,2,4 Review it-elder qualifications if needed AifS/CIt7 6. Framing Details 1,2,4 Visual inspection of the cold formed steel frame to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each locations 7. Trusses N/A N/A 8. Permanent Truss Bracing N/A N/A 9. Other: N/A N/A CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Wood Construction Page 10 of 12 Item Agency# Scope (Qualif.) 1 Fabricator Certification/ NIA N/A Quality Control Procedures ❑ Fabricator Exempt 2. Material Grading NIA NIA 3. Connections NSA NIA 4. Framing and Details AT 4 NIA 5. Diaphragms and Shearwalls 1,2,4 Inspect size, configuration, blocking andfastening ofsheanvalls and diaphragms. Verb panel grade and thickness. 6. Prefabricated Wood Trusses NIA NIA 7. Permanent Truss Bracing NIA NIA 8. Other: NIA NIA CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Exterior Insulation&Finish Systems(EIFS) Page 11 of 12 Item Agency# Scope (Qual fl 1 Material Submittals 6 Verification samples:representative samples of each material that is to be used to be exposed in the finished work, showing frill range of color and finish variations expected. 12xl2 finish sample of each t}pe and color selected on I"thick insulation board. 2. Condition of Substrate 1,2,4 Conduct periodicfield review ofsubstrate surface to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1,2,4 Conduct periodic field review of liquid membrane and insulation Board board to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 4. Application of Coatings 1,2,4 Conduct periodic field review of basecoat and finish coat to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 5. Application of Mesh 1,2,4 Conduct periodic field review of reinforcing mesh to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 6.Ambient Condition and Curing 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Review construction manager's daily weather log. Report discrepancies and variations and conditions that prevent satisfactory application of the work 7. Flashing and Joint Details 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 8. Sealants/Caulks 1,2,4 Conduct field review ofsurface to receive sealant prior to installation and report any surfaces that are not suitable for application of specified materials in accordance with ASTAI C804, and or ASTA1 C790. 9. Other: N/A N/A CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Architectural Systems Page 12 of 12 Item Agency# Scope (Qualif.) 1. Wall Panels&Veneers N/A N/A 2. Suspended Ceilings N/A N/A 3. Access Floors N/A NIA 4. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 , Statement of Special Inspections Pgis �w i'lat;l BUILDING DEPARTMENT Project: The Shops at Evergreen lValk;Building D/400 Location: South Windsor, CT Owner: Poag&McEwen Lifestyle Centers Design Professional in Responsible Charge: William E. Gaugler, P.E. (Soils&Foundations, Cast-in- Place Concrete, and Structural Steel Only) James B.Heller Architectural Systems) ( Y This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of Special Inspection services applicable to this project as well as the name of the Special Inspection Coordinator and the identity of other approved agencies to be retained for conducting these inspections and tests. This Statement of Special Inspections encompass the following disciplines: ® Structural ❑ Mechanical/Electrical/Plumbing ® Architectural ❑ Other: The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to the Building Official and the Registered Design Professional in Responsible Charge. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected,the discrepancies shall be brought to the attention of the Building Official and the Registered Design Professional in Responsible Charge. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official and the Registered Design Professional in Responsible Charge. A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: MONTHLY or❑ per attached schedule. Prepared by: •��i�..,, ••�� CONK '•• James B. Heller ��•'•'��••'S 8'h••• 41A,•� (type or print name) ' *;�r ! ��'�"4 • � � J 1, L�C No.W 83 •.�t�,V ti 12108106 / ••~•NN••••a� , ' "RED ARC .•` Signatu Date 100 ,lost Design P1'df3Vsional Sea! Own IFO-d—zatt n: Building Official's Acceptance: ly f Si na ure Date Signature Date I CASE Form 101 Statement of Special Inspections 9 ©CASE 2004 ,�a,ai a e•:�..�. ice, a•a•1� r� •'��'i J• 'aJ f �:•�•�aa.�a i:� Page 1 of 12 Schedule of Inspection and Testing Agencies This Statement of Special Inspections/Quality Assurance Plan includes the following building systems: ® Soils and Foundations ❑ Spray Fire Resistant Material ® Cast-in-Place Concrete ❑ Wood Construction ❑ Precast Concrete ® Exterior Insulation and Finish System ® Masonry ❑ Mechanical& Electrical Systems ® Structural Steel ® Architectural Systems ❑ Cold-Formed Steel Framing ❑ Special Cases Special Inspection Agencies Firm Address,Telephone,e-mail 1 Special Inspection Ryan Roy, P.E. 114 Woodlawn Road Coordinator JGI Eastern, Inc. Berlin, CT 06037 2. Inspector JGI Eastern, Inc. 114 if'oodlawn Road Berlin, CT 06037 3. Inspector N/A N/A 4. Testing Agency JGI Eastern, Inc. 1/4 117oodlaivn Road Berlin, CT 06037 5. Testing Agency N/A N/A 6. Other KA,Inc. 1468;V 9'h St., #600 Cleveland, Ohio, 44113 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. CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Page 2 of 12 Quality Assurance Plan Quality Assurance for Seismic Resistance Seismic Design Category C Quality Assurance Plan Required (Y/N) Y Description of seismic force resisting system and designated seismic systems: Seismic Force Resisting System: Ordinary Steel Moment Frames Quality Assurance for Wind Requirements Basic Wind Speed (3 second gust) 95 mph Wind Exposure Category C Quality Assurance Plan Required (Y/N) N Description of wind force resisting system and designated wind resisting components: N/A Statement of Responsibility Each contractor responsible for the construction or fabrication of a system or component designated above must submit a Statement of Responsibility. CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Page 3 of 12 Qualifications of Inspectors and Testing Technicians The qualifications of all personnel performing Special Inspection and testing activities are subject to the approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if requested. Key for Minimum Qualifications of Inspection Agents: When the Registered Design Professional in Responsible Charge deems it appropriate that the individual performing a stipulated test or inspection have a specific certification or license as indicated below, such designation shall appear below the Agency Number on the Schedule. PE/SE Structural Engineer—a licensed SE or PE specializing in the design of building structures PE/GE Geotechnical Engineer—a licensed PE specializing in soil mechanics and foundations EIT Engineer-In-Training-a graduate engineer who has passed the Fundamentals of Engineering examination American Concrete Institute(ACI) Certification ACI-CFTT Concrete Field Testing Technician—Grade 1 ACI-CCI Concrete Construction Inspector ACI-LTT Laboratory Testing Technician—Grade 1&2 ACI-STT Strength Testing Technician American Welding Society (AWS)Certification AWS-CWl Certified Welding Inspector AWS/AISC-SSI Certified Structural Steel Inspector American Society of Non-Destructive Testing (ASNT)Certification ASNT Non-Destructive Testing Technician—Level II or III. International Code Council (ICC)Certification ICC-SMSI Structural Masonry Special Inspector ICC-SWSI Structural Steel and Welding Special Inspector ICC-SFSI Spray-Applied Fireproofing Special Inspector ICC-PCSI Prestressed Concrete Special Inspector ICC-RCSI Reinforced Concrete Special Inspector National Institute for Certification in Engineering Technologies (NICET) NICET-CT Concrete Technician—Levels I, II, III & IV NICET-ST Soils Technician-Levels I, ll, III&IV NICET-GET Geotechnical Engineering Technician-Levels I, II, III & IV Exterior Design Institute(EDI)Certification EDI-EIFS EIFS Third Party Inspector Other CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 A Soils and Foundations Page 4 of 12 Item Agency# Scope (Qualif.) 1. Site Preparation #112,4 Inspect the site prior to fill placement and verify that the site has been prepared in accordance with the approved Geotechnical PEIGE Report. 2. Controlled Structural Fill #2,4 Perform sieve tests(ASTM D422&DI140)and modified Proctor tests(ASTA1 D1557)of each source of fill material. Inspect placement, lift thickness and compaction of controlled fill. Test density of each lift of fill by nuclear methods(ASTAf D2922) Verify extent and slope of fill placement. 3. Shallow Foundations #1,24 Inspect soils below footings for adequate bearing capacity and consistency with geotechnical report. Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Cast-in-Place Concrete Page 5 of 12 Item Agency# Scope (Qualif.) 1. Mix Design #1,2 Review concrete batch tickets and verb compliance with approved mix design. Verify that water added at the site does not ACI exceed that allowed by the mix design. 2. Reinforcement Installation #1,2,4 Inspect size, spacing, cover,positioning and grade ofreinforcing steel. Verify that reinforcing bars are free of form oil or other ACI deleterious materials. Inspect bar laps and mechanical splices. Verify that bars are adequately tied and supported on chairs or bolsters 3. Welding of Reinforcing 44 Visually inspect all reinforcing steel welds. Verify weldability of reinforcing steel.Inspect preheating of steel when required. Provide continuous inspection of welding of any shear AWS-CIVI reinforcement(stirrups or ties). 4. Anchor Rods #1,2,4 Inspect size,positioning and embedment ofanchor rods. Inspect concrete placement and consolidation around anchors. 5. Concrete Placement #1,2,4 Inspect placement ofconcrete. Verb that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI concrete is properly consolidated. 6. Sampling and Testing of #4 Test concrete compressive strength(ASTMC31 &C39),slump Concrete (ASTAf C143), air-content(ASTAf C231 or C173)and temperature ACI-CFTT (ASTAf C1064). ACPSTT 7. Curing and Protection #1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Precast Concrete Page 6 of 12 Item Agency## Scope (Quaiif.) 1. Plant Certification/Quality 1,2,4 Review plant operations and quality control procedures. Control Procedures ACI-CCI ❑ Fabricator Exempt 2. Mix Design 1,2,4 Inspect concrete batching operations and verb compliance with approved mix design ACI-CCI 3. Material Certification N/A NIA 4. Reinforcement Installation 1,2,4 Inspect size, spacing,position and grade ofreinforcing steel. Verify that reinforcing bars are free of form oil or other ACI-CCI deleterious materials. 5. Prestress Operations 1,4 Inspect placement, stressing,grouting and protection of prestressing tendons PCI 6. Connections/Embedded N l A';f Items 7. Formwork Geometry N/A N/A 8. Concrete Placement 1,2,4 Inspect placement of concrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verb that ACI-CCI concrete is properly consolidated. 9. Sampling and Testing of 1,2,4 Test concrete compressive strength(ASTMC31 &C39),slump Concrete (ASTM C143), air-content(ASTAf C231 or C173)and temperature ACI-CFTT (ASTM C1064). ACI-STT 10. Curing and Protection 1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI 11. Erected Precast Elements 1,2,4 Inspect erection o recast concrete including P .fP g member configuration,connections, welding and grouting. PE 12. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Masonry Required Inspection Level: ❑ 1 ❑2 Page 7 of 12 Item Agency# Scope (Qualif.) 1 Material Certification NIA NIA 2. Mixing of Mortar and Grout 2,4 Inspect proportioning, mixing and retempering ofmortar and grout. 3. Installation of Masonry 2,4 Inspect size, layout, bonding and placement of masonry units. 4. Mortar Joints 2,4 Inspect construction of mortar joints including tooling and filling of head joints. 5. Reinforcement Installation 1,2,4 Inspect placement,positioning and lapping ofreinforcing steel. AIIS-CIVI Inspect welding ofreinforcing steel. 6. Prestressed Masonry 2,4 Inspect placement, anchorage and stressing ofprestressing bars. 7. Grouting Operations 2,4 Inspect placement and consolidation ofgrout. Inspect masonry clean-outs for high-lift grouting. 7. Weather Protection 2,4 Inspect cold weather protection and hot weather protection procedures. Verify that wall cavities are protected against precipitation. 9. Evaluation of Masonry 1,2,4 Test compressive strength of mortar and grout cube samples Strength (ASTM C780). Test compressive strength of masoruy prisms(ASTA1 C1314). 10. Anchors and Ties 2,4 Inspect size, location, spacing and embedment of dowels, anchors and ties. 11. Other: NIA NIA CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Structural Steel Page 8 of 12 Item Agency# Scope (Qualif.) 1. Fabricator Certification/ #1,2,4 Review shop fabrication and quality control procedures. Quality Control Procedures ❑ Fabricator Exempt AIVSIAISC identification markin s on 2. Material Certification #1,2,4 Reitetiv certified mill test reports andg structural steel„ high-strength bolts, nuts and welding electrodes A IVSIAISC 3. Open Web Steel Joists #1,2,4 Inspect installation,field welding and bridging ofjoists. A IVS--RISC 4. Bolting #2,4 Inspect installation and tightening of high-strength bolts. Verb that splines have separated from tension control bolts. Verb A►IS,:IISC proper tightening sequence. Continuous inspection of bolts in slip- critical connections. 5. Welding #2,4 I isually inspect all welds. Inspect pre-heat,post-heat and surface preparation between passes. Verify size and length offillet welds. AJVS-CIVI Continuous inspection of Complete and Partial Penetration Groove iVelds, Alultipass fillet welds and fillet welds greater than 5116" ASNT Ultrasonic testing of all full penetration welds. 6. Shear Connectors #2,4 Inspect size, number,positioning and welding of shear connectors. Inspect suds for full 360 degree flash.Ring test all shear A IVSIAISC connectors with a 3 lb hammer. Bend test all questionable studs to 15 degrees. 7. Structural Details #1,2,4 Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details. PE 8. Metal Deck #2,4 Inspect welding and side-lap fastening of metal roof and floor deck. A IVS-CIVI CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Cold-Formed Steel Framing Page 9 of 12 Item Agency# Scope (Qualif.) 1. Member Sizes 1,2,4 Visual inspection of the erected light gauge framing to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each connection. 2. Material Thickness 1,2,4 Verb that the material thickness is in conformance with the contract documents 3. Material Properties 1,4 Review material certification submittals to verify conformance with design specifications 4. Mechanical Connections 1,2,4 Inspect 25%of threaded fasteners connections at the site 5. Welding 1,2,4 Review welder qualifications if needed AJfS/CJf7 6. Framing Details 1,2,4 Visual inspection of the cold formed steel frame to verify compliance with details shown on the approved shop drawings, such as bracing stiffening,member locations and proper application ofjoint details at each locations 7. Trusses N/A N/A 8. Permanent Truss Bracing N/A N/A 9. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Wood Construction Page 10 of 12 Item Agency# Scope (Quallf.) 1 Fabricator Certification/ NIA N/A Quality Control Procedures ❑ Fabricator Exempt 2. Material Grading NIA NIA 3. Connections NIA NIA 4. Framing and Details W4 W4 I 5. Diaphragms and Shearwalls 1,2,4 Inspect size, configuration, blocking and fastening ofsheanvalls and diaphragms. Verb panel grade and thickness. 6. Prefabricated Wood Trusses NIA NIA 7. Permanent Truss Bracing NIA NIA 8. Other: NIA NIA CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 Exterior Insulation&Finish Systems(EIFS) Page 11 of 12 Item Agency# Scope (Qualif.) 1. Material Submittals 6 Verification samples:representative samples of each material that is to be used to be exposed in the finished work, showing full range of color and finish variations expected. 12xl2 finish sample of each t}pe and color selected on 1"thick insulation board. 2. Condition of Substrate 1,2,4 Conduct periodic field review ofsubstrate surface to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1,2,4 Conduct periodicfield review ofliquid membrane and insulation Board board to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 4. Application of Coatings 1,2,4 Conduct periodic field review of basecoat and finish coat to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 5. Application of Mesh 1,2,4 Conduct periodic field review of reinforcing mesh to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 6. Ambient Condition and Curing 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Review construction manager's daily weather log. Report discrepancies and variations and conditions that prevent satisfactory application of the work 7. Flashing and Joint Details 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work 8. Sealants/Caulks 1,2,4 Conductfield review ofsurface to receive sealant prior to installation and report any surfaces that are not suitable for application of specified materials in accordance with ASTM C804, and or ASTA1 C790. 9. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Architectural Systems Page 12 of 12 Item Agency# Scope (Qualif.) 1. Wall Panels &Veneers N/A N/A 2. Suspended Ceilings AVA NIA 3. Access Floors N/A N/A 4. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 P P Statement of Special Inspections S^Utz i',rJirr!:]t Project: The Shops at Evergreen IYalk;Building E/500 Location: South Windsor, CT Owner: Poag&McEwen Lifestyle Centers Design Professional in Responsible Charge: William E. Gaugler, P.E. (Soils&Foundations, Cast-in- Place Concrete, and Structural Steel Only) James B. Heller(Architectural Systems) This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of Special Inspection services applicable to this project as well as the name of the Special Inspection Coordinator and the identity of other approved agencies to be retained for conducting these inspections and tests. This Statement of Special Inspections encompass the following disciplines: ® Structural ❑ Mechanical/Electrical/Plumbing ® Architectural ❑ Other: The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to the Building Official and the Registered Design Professional in Responsible Charge. Discovered discrepancies shall be brought to the immediate attention of the Contractor for correction. If such discrepancies are not corrected,the discrepancies shall be brought to the attention of the Building Official and the Registered Design Professional in Responsible Charge. The Special Inspection program does not relieve the Contractor of his or her responsibilities. Interim reports shall be submitted to the Building Official and the Registered Design Professional in Responsible Charge. A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy. Job site safety and means and methods of construction are solely the responsibility of the Contractor. Interim Report Frequency: MONTHLY or❑ per attached schedule. Prepared by: �`��',�CQNf I•'�' James B. Heller .•�� •.•••••••.,FL'r''. (type or print name) No.6483 CVV 12108106 ''.�s'l'••.......••'��•.••• ARC .•`. Signatuf Date Desl hlpltll�Sgj`onal Seal Ow er' A ization: Building Official's Acceptance: Z / Sig D e Signature Date CASE Form 101 Statement of Special Inspections 9 OCASE 2004 , ,`+Ik Glle1tot 11ff frrr i tr ' •rr�Ir*l1 r;1•��♦ Page 1 of 12 Schedule of Inspection and Testing Agencies This Statement of Special Inspections/Quality Assurance Plan includes the following building systems: ® Soils and Foundations ❑ Spray Fire Resistant Material ® Cast-in-Place Concrete ❑ Wood Construction ❑ Precast Concrete ® Exterior Insulation and Finish System ® Masonry ❑ Mechanical& Electrical Systems ® Structural Steel ® Architectural Systems ❑ Cold-Formed Steel Framing ❑ Special Cases Special Inspection Agencies Firm Address,Telephone,e-mail 1. Special Inspection Ryan Roy, P.E. 114 Woodlawn Road Coordinator JGI Eastern, Inc. Berlin, CT 06037 2. Inspector JGI Eastern, Inc. 114 IVoodlmvn Road Berlin, CT 06037 3. Inspector N/A N/A 4. Testing Agency JGI Eastern, h7c. 114 IVoodlmsn Road Berlin, CT 06037 5. Testing Agency N/A N/A 6. Other KA, Inc. 1468 W 9`6 St., 4600 Cleveland, Ohio, 44113 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. CASE Form 101 9 Statement of Special Inspections 9 ©CASE 2004 Page 2 of 12 Quality Assurance Plan Quality Assurance for Seismic Resistance Seismic Design Category C Quality Assurance Plan Required (Y/N) Y Description of seismic force resisting system and designated seismic systems: Seismic Force Resisting System: Ordinary Steel Moment Frames Quality Assurance for Wind Requirements Basic Wind Speed (3 second gust) 95,nph Wind Exposure Category C Quality Assurance Plan Required (Y/N) N Description of wind force resisting system and designated wind resisting components: N/A Statement of Responsibility Each contractor responsible for the construction or fabrication of a system or component designated above must submit a Statement of Responsibility. CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Page 3 of 12 Qualifications of Inspectors and Testing Technicians The qualifications of all personnel performing Special Inspection and testing activities are subject to the approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if requested. Key for Minimum Qualifications of Inspection Agents: When the Registered Design Professional in Responsible Charge deems it appropriate that the individual performing a stipulated test or inspection have a specific certification or license as indicated below, such designation shall appear below the Agency Number on the Schedule. PE/SE Structural Engineer—a licensed SE or PE specializing in the design of building structures PE/GE Geotechnical Engineer—a licensed PE specializing in soil mechanics and foundations EIT Engineer-In-Training—a graduate engineer who has passed the Fundamentals of Engineering examination American Concrete Institute(ACI) Certification ACI-CFTT Concrete Field Testing Technician—Grade 1 ACI-CCI Concrete Construction Inspector ACI-LTT Laboratory Testing Technician—Grade 1&2 ACI-STT Strength Testing Technician American Welding Society(AWS)Certification AWS-CWI Certified Welding Inspector AWS/AISC-SSI Certified Structural Steel Inspector American Society of Non-Destructive Testing (ASNT)Certification ASNT Non-Destructive Testing Technician—Level 11 or III. International Code Council (ICC)Certification ICC-SMSI Structural Masonry Special Inspector ICC-SWSI Structural Steel and Welding Special Inspector ICC-SFSI Spray-Applied Fireproofing Special Inspector ICC-PCSI Prestressed Concrete Special Inspector ICC-RCSI Reinforced Concrete Special Inspector National Institute for Certification in Engineering Technologies(NICET) NICET-CT Concrete Technician—Levels 1, II, III & IV NICET-ST Soils Technician-Levels I, 11, III & IV NICET-GET Geotechnical Engineering Technician-Levels I, II, III &IV Exterior Design Institute(EDI)Certification EDI-EIFS EIFS Third Party Inspector Other CASE Form 101 - Statement of Special Inspections - ©CASE 2004 Soils and Foundations Page 4 of 12 Item Agency# Scope (Qualif.) 1 Site Preparation #1,2,4 Inspect the site prior to fill placement and verb that the site has been prepared in accordance with the approved Geotechnical PE/GE Report. 2. Controlled Structural Fill #2 4 Per orm sieve tests ASTAf D422& D1140 and modified Proctor f ( ) tests(ASTAf D1557)ofeach source offill material. Inspect placement,lift thickness and compaction of controlled fill. Test density of each lift offill by nuclear methods(ASTAf D2922) Verify extent and slope offill placement. 3. Shallow Foundations #1,24 Inspect soils below footings for adequate bearing capacity and consistency with geotechnical report. Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill CASE Form 101 9 Statement of Special Inspections • ©CASE 2004 w Cast-in-Place Concrete Page 5 of 12 Item Agency# Scope (Qualif.) 1 Mix Design #1,2 Review concrete batch tickets and verb compliance with approved mix design. Verify that water added at the site does not ACI exceed that allowed by the mix design. 2. Reinforcement Installation #1,2,4 Inspect size,spacing, cover,positioning and grade ofreinforcing steel. Verify that reinforcing bars are free ofform oil or other ACI deleterious materials. Inspect bar laps and mechanical splices. Verb that bars are adequately tied and supported on chairs or bolsters 3. Welding of Reinforcing #4 Visually inspect all reinforcing steel welds. Verify weldability of reinforcing steel. Inspect preheating of steel when required. Provide continuous inspection of welding of any shear AT i S-CIV I reinforcement(stirrups or ties). 4. Anchor Rods 91,2,4 Inspect size,positioning and embedment of anchor rods. Inspect concrete placement and consolidation around anchors. 5. Concrete Placement #1,2,4 Inspect placement ofconcrete. Verify that concrete conveyance and depositing avoids segregation or contamination. 6 erg that ACI concrete is properly consolidated. 6. Sampling and Testing of #4 Test concrete compressive strength(ASTMC31 & C39),slump Concrete (ASTAf C143), air-content(ASTAf C231 or C173)and temperature ACI-CF7T (ASTAf C1064). ACI-S7T 7. Curing and Protection #1,2,4 Inspect curing, cold weather protection and hot weather protection procedures. ACI-CCI CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Precast Concrete Page 6 of 12 Item Agency# Scope (Quaiif.) 1. Plant Certification/Quality 1,2,4 Review plant operations and quality control procedures. Control Procedures .ICI-CCI ❑ Fabricator Exempt 2. Mix Design 1,2,4 Inspect concrete batching operations and verify compliance with approved mix design ACI-CCI 3. Material Certification N/A N/A 4. Reinforcement Installation 1,2,4 Inspect size,spacing,position and grade ofreinforcingsteel. Verb that reinforcing bars are free ofform oil or other ACI-CCI deleterious materials. 5. Prestress Operations 1,4 Inspect placement,stressing,grouting and protection of prestressing tendons PCI 6. Connections/Embedded N./A NIA Items 7. Formwork Geometry N/A N/A 8. Concrete Placement 1,2,4 Inspect placement ofconcrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verify that ACI-CCI concrete is properly consolidated. 9. Sampling and Testing of 1,2,4 Test concrete compressive strength(ASTAf C31&C39),slump Concrete (ASTAI C143), air-content(ASTAI C231 or C173)and temperature ACI-CF7T (ASTAI C1064). ACI-SIT 10. Curing and Protection 1,2,4 Inspect curing, cold weather protection and hol weather protection procedures. ACI-CCI 11. Erected Precast Elements 1,2,4 Inspect erection ofprecast concrete including member configuration, connections, welding and grouting. PE 12. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Masonry Required Inspection Level: ❑ 1 ❑2 Page 7 of 12 Item Agency# Scope (Qualif.) 1 Material Certification N/A N/A 2. Mixing of Mortar and Grout 2,4 Inspect proportioning, mixing and retempering of mortar and grout. 3. Installation of Masonry 2,4 Inspect size, layout, bonding and placement of masonry units. 4. Mortar Joints 214 Inspect construction of mortar joints including tooling and filling of head joints. 5. Reinforcement Installation 1,2,4 Inspect placement,positioning and lapping ofreinforcing steel. A 16 S-007 Inspect welding of reinforcing steel. 6. Prestressed Masonry 2,4 Inspect placement,anchorage and stressing of prestressing bars. 7. Grouting Operations 2,4 Inspect placement and consolidation ofgrout. Inspect masonry clean-ouls for high-lift grouting. 7. Weather Protection 2,4 Inspect cold weather protection and hot weather protection procedures. Verb that wall cavities are protected against precipitation. 9. Evaluation of Masonry 1,2,4 Test compressive strength of mortar and grout cube samples Strength (ASTM C780). Test compressive strength of masonry prisms(ASTAt 0314). 10. Anchors and Ties 2,4 Inspect size, location,spacing and embedment of dowels, anchors and ties. 11. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Structural Steel Page 8 of 12 Item Agency# Scope (Qualif.) 1 Fabricator Certification/ #1,2,4 Review shop fabrication and quality control procedures. Quality Control Procedures ❑ Fabricator Exempt AIISIAISC 2. Material Certification #1,2,4 Review certified mill test reports and identification markings on structural steel„ high-strength bolts, nuts and welding electrodes A f i SiAISC 3. Open Web Steel Joists #1,2,4 Inspect installation,field welding and bridging ofjoists. A IVS-AISC 4. Bolting #2,4 Inspect installation and tightening of high-strength bolts. Veri 5, that splines have separated from tension control bolts. Verify t If SaISC proper tightening sequence. Continuous inspection of bolts in slip- critical connections. 5. Welding #2,4 Visually inspect all welds. Inspect pre-heat,post-heat and surface preparation between passes. Verify size and length of fillet irelds. AIVS-CIVI Continuous inspection of Complete and Partial Penetration Groove IVelds, Afultipass fillet welds and fillet welds greater than 5116" ASNT Ultrasonic testing of all full penetration welds. 6. Shear Connectors #2,4 Inspect size, number,positioning and welding ofshear connectors. Inspect suds for full 360 degree flash. Ring test all shear AIVS/AISC connectors with a 3 lb hammer. Bend test all questionable studs to 15 degrees. 7. Structural Details #1,2,4 Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details. PE 8. Metal Deck #2,4 Inspect welding and side-lap fastening of metal roof and floor deck. AIVS-CIVI CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Y Cold-Formed Steel Framing Page 9 of 12 Item Agency# Scope (Qualif.) 1. Member Sizes 1,2,4 Visual inspection of the erected light gauge framing to verb compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each connection. 2. Material Thickness 1,2,4 Verb that the material thickness is in conformance with the contract documents 3. Material Properties 1,4 Review material certification submittals to verb conformance with design specifications 4. Mechanical Connections 1,2,4 Inspect 25%of threaded fasteners connections at the site 5. Welding 1,2,4 Review welder qualifications if needed AIVYCIVI 6. Framing Details 1,2,4 Visual inspection of the cold formed steel frame to verify compliance with details shown on the approved shop drawings, such as bracing stiffening, member locations and proper application ofjoint details at each locations 7. Trusses N/A N/A 8. Permanent Truss Bracing N/A N/A 9. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 i M Wood Construction Page 10 of 12 Item Agency# Scope (Quaiif.) 1 Fabricator Certification/ N/A N/A Quality Control Procedures ❑ Fabricator Exempt 2. Material Grading N/A N/A 3. Connections N/A N/A 4. Framing and Details W4 NIA 5. Diaphragms and Shearwalls 1,2,4 Inspect size, configuration, blocking andfastening ofsheanvalls and diaphragms. Verb panel grade and thickness. 6. Prefabricated Wood Trusses N/A N/A 7. Permanent Truss Bracing N/A N/A 8. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Exterior Insulation&Finish Systems(EIFS) Page 11 of 12 Item Agency# Scope (Qualif.) 1. Material Submittals 6 Verification samples:representative samples of each material that is to be used to be exposed in the finished work, showing full range of color and finish variations expected. 12x12 finish sample of each type and color selected on I"thick insulation board. 2. Condition of Substrate 1,2,4 Conduct periodic field review ofsubstrate surface to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 3. Application of Foam Plastic 1,2,4 Conduct periodic field review of liquid membrane and insulation Board board to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 4. Application of Coatings 1,2,4 Conduct periodic field review of basecoat and finish coat to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 5. Application of Mesh 1,2,4 Conduct periodic field review of reinforcing mesh to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 6.Ambient Condition and Curing 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Review construction manager's daily weather log. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 7. Flashing and Joint Details 1,2,4 Conduct periodic field review to establish conformance with contract and manufacturers specifications. Report discrepancies and variations and conditions that prevent satisfactory application of the work. 8. Sealants/Caulks 1,2,4 Conduct field review ofsurface to receive sealant prior to installation and report any surfaces that are not suitable for application of specified materials in accordance with ASTM C804, and or ASTM C790. 9. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004 Architectural Systems Page 12 of 12 Item Agency# Scope (Qualif.) 1 Wall Panels&Veneers N/A N/A 2. Suspended Ceilings AIM N/A 3. Access Floors N/A N/A 4. Other: N/A N/A CASE Form 101 • Statement of Special Inspections • ©CASE 2004