Best practices book - Flipbook - Page 152
ACKNOWLEDGMENTS
I have read and agree to comply with my responsibilities as they are outlined in the Special Inspections
and Testing Agreement.
Owner:
__________________________
Print Name
_____________________________
Signature
_________________
Date
Registered Design Professional in Responsible Charge (Project Engineer/Architect of
Record):
__________________________
Print Name /Company
_____________________________
Signature
_________________
Date
Contractor:
__________________________
Print Name /Company
_____________________________
Signature
_________________
Date
Special Inspections & Testing Agencies and/or Testing Laboratories, Independent Special
Inspectors or Testers:
__________________________
Print Name / Company
__________________________
Print Name / Company
_________________________
Print Name
(Independent Special Inspector)
_________________________
Print Name
(Independent Special Inspector)
____________________________*
Signature
____________________________*
Signature
_____________________________
Signature
_____________________________
Signature
_________________
Date
_________________
Date
_________________
Date
_________________
Date
* This signature shall be that of the responsible professional Engineer within the Special Inspection
Agency.
ACCEPTED BY THE CITY OF ROCHESTER HILLS
BUILDING DEPARTMENT
__________________________
Print Plan Reviewer Name
_____________________________
Signature
BEST
BEST PRACTICES
PRACTICES || 143
143
_________________
Date
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