Best practices book - Flipbook - Page 114
BEST PRACTICES | 105
Building Permit #:
Owner Name:
Fax #:
Company Address:
Date:
Architect/Engineer Signature:
Effective 042017
BEST PRACTICES | 105
4.1.0560
• Special Inspections Categories: Please select all the categories that apply to your Project by checking the appropriate boxes below and enter the name of each individual
responsible for the special inspections you have checked in the space provided to the right of each category.
structures are in Seismic Design Category B. However; "Essential Facilities" will be in Seismic Design Category C, unless structural calculation shows otherwise.
• Note: This form is intended for buildings or structures that are assigned a Seismic Design Category A, B or C. In Rochester Hills, Michigan, most buildings and
of the calibration of each piece of equipment used in the testing.
the project. This includes information about the Accreditation of the Testing Lab, names and qualifications of each designated Laboratory Technician, and verification
and Fabricator Shop. Information shall also be provided outlining the qualifications of any Testing Labs (soils, concrete, masonry, steel, and others) being used for
firm listed. This should include all current Education, Experience, Certifications and Accreditations required for each Special Inspector, Special Inspection Agency
minimum qualification standards (Sections 1701, 1702, 1703, 1704 and 1705). Please provide the appropriate documents that verify the qualifications of each individual or
under "Special Inspection and Program" at www.rochesterhills.org. Each party involved with the Special Inspection and Testing process shall meet these
• Provide Qualifications: Please refer to the "MINUMUM QUALIFICATIONS FOR SPECIAL INSPECTORS", posted on the Building Department website
approved plans that shall be on site for all inspections.
approval by the Building Department prior to the issuance of the Building Permit (Sections 107.1, 1704.2.3, 1704.3 and 1705). This form will be attached to the approved
• Complete Form: The Registered Design Professional (Architect/Engineer) shall complete this form and submit it with the Building Permit Application for review and
INSTRUCTIONS:
E-Mail Address:
Architect/Engineer Name:
Cell Phone #:
Telephone #:
Company Name:
FORM PREPARED BY:
Architect/Engineer Name:
Project Address:
Project Name:
PROJECT INFORMATION:
MICHIGAN BUILDING CODE 2015 (MBC 2015)
Revised September 21, 2017
CITY OF ROCHESTER HILLS BUILDING DEPARTMENT
STATEMENT OF SPECIAL INSPECTIONS
