1.8 - Specs Att 3 - SECTION 01 45 35 Statement of SI Tem.xlsx

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Y1DZ--EHRM Training and Administrative Support Space B24 Construction - St Louis, Jefferson Barracks 657-21-703JB
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36C77622B0052
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This document contains a statement of special inspections and schedule of special inspections template for a construction project to renovate the first floor of Building 24 at the Jefferson Barracks VA Medical Center in St. Louis, Missouri to provide training and administrative support space for the Environmental Health Risk Management activation. The project involves demolishing existing structures and constructing the new space. A special inspector of record is required and their contact information is included. The document identifies lateral force resisting systems and designated seismic systems for the structure. Upon project completion, the registered design professional in responsible charge must perform a final walkdown inspection of designated seismic systems and submit a report documenting inspections and collection of compliance certificates.

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Sheet1

Project:P234 - Maintenance HangarUSER NOTES (Not intended to print)
Location:Anytown, VA
Project #:
Craven, Curtis L CIV NAVFAC LANT, CI: Can be a contract and task order number or other identifiying database identification number such as an Eprojects # (navy)12345678
Date:4/10/17

STATEMENT OF SPECIAL INSPECTIONS < Edit Blue text/cells only

Project Seismic Design Category:ESPECIAL INSPECTOR OF RECORD (SIOR) DETERMINATION
Project Risk Category:IV
Project Design Wind Speed (mph):100< The Special Inspector of Record (SIOR) is a DOD mandate. Enter the requested data to determine whether an SIOR is required or is not required.
Number of Stories:2
Structure Height Above Grade (ft):70
Hazardous Occupancy or attached to such?NoGroup H Occupancies (2015 IBC, Section 415)
Special Inspector of Record (SIOR)
A Special Inspector of Record (SIOR)ISrequired (per UFGS 01 45 35, Section 1.3.8)
SIOR Name (Registered Professional):John Doe P.E.< For DB contracts insert the SIOR contact information. For DBB contracts enter, "Contractor to provide prior to construction start".
Professional Registration Number:C222222
Consulting Firm Name (if any):ABC Structural Consulting< The SIOR must be a registered professional engineer, and must not be an employee of the General Contractor, or an employee of a Sub-Contractor performing construction for this project.
SIOR Office AND Mobile Phone Number:1234567895 (Mobile), 123456789 (Office)
Lateral Force Resisting System (LFRS)LATERAL FORCE RESISTING SYSTEM IDENTIFICATION
2015 IBC 1704.3.2 and 1704.3.3
Following is a listing of critical main wind/seismic force resisting systems for this structure. Carefully inspect these elements as part of the roles and responsiblities of the Special Inspector (reference the Schedule of Special Inspections for inspection checklists).
Vertical LFRS ElementsNotes
Ordinary Concentric Braced FramesNorth - South Direction Only, See Plan
Special Concentric Braced FramesLettered Gridline only, see plan for call out
Ordinary Steel Moment resisting Frames (SMRF)Both orthoginal Directions, See plan for call out
Ordinary Reinforced Concrete ShearwallsSee Key Notes
Concrete Grade Beams Resisting Lateral LoadsOffice Portion Only, see plan key notes
Ordinary Reinforced Masonry Shear WallsHigh Bay, Numbered Gridlines only, see plan
OSB Sheathed Shear Walls (nailing, sill bolting, Etc)See schedule on plan
Shear Wall Hold DownsIdentified on Plan & in Detail Sheet X.XX
Horizontal LFRS ElementsNotes
Continuous Roof TiesSee Key Notes on Roof Plan
Collector ElementsIdentified on plan with key notes
Concrete over metal deck2nd floor and roof
Metal Roof Deck & Related Fastening SystemSee Roof Plan
Out of Plane Wall ConnectionsSee Structural Details XX & XX
Diaphragm Cross Rod BracingSee Roof Plan for locations
Cast in Place Concrete Floor and Roof DiaphragmsSee sheet XX for details and rebar schedule
Special Force Transfer ConnectionSee Detail X on Sheet X.XX
Statement of Special Inspections Page 1 of 2
Project:P234 - Maintenance HangarDESIGNATED SEISMIC SYSTEMS (DSS)
Location:Anytown, VAThis section identifies whether Designated Seismic Systems apply to this project or do not apply. Additionally, and where DSS apply, some explanation is provided below for what a Designated Seismic System is for this specific project.
Project #:12345678
Date:4/10/17
Designated Seismic Systems (DSS)
(2015 IBC 1705.13.3.4) (ASCE 7-10, 13.2.2, C13.2.2) (UFC 3-310-04, 2-11.2 & 2-13.2.2)
Non-structural 'Designated Seismic Systems' (DSS) must remain operable and contain hazardous substances following a design earthquake. Accordingly, all Designated Seismic Systems must be listed below and must be certified by the manufacturer to remain both operable and/or to contain hazardous substances after a design earthquake per UFC 3-301-01, Section 2-13.2.2. Submit said Certificates of Compliance to the Contracting Officer for each DSS after they have been reviewed and accepted by the EOR/DOR. Additionally, the below listed Designated Seismic Systems must be carefully inspected by the Special Inspector according to the requirements noted in the Schedule of Special Inspections, Section AA.< Designated Seismic Systems APPLY to this project. List all Designated Seismic Systems in the blue tables below. Some DSS suggestions are already populated, delete or keep as necessary.
ELECTRICAL Designated Seismic Systems (DSS) Requiring a Certificate of ComplianceDSS for this project are nonstructural components with an importance factor of 1.5 AND with the following project conditions (UFC 3-310 SECTION 2-11.2) (ASCE 7-10, 13.1.3):
1.DSS Emergency or Standby Power System
2.DSS Component XX
3.DSS Component XX1. The component is required to function for life-safety purposes after an earthquake, including fire sprinkler systems and egress stairways (RC I thru V + SDC C thru F).
4.DSS Component XX
5.DSS Component XX
If additional space is required, append an additional sheet listing the remaining DSS2. The component conveys, supports, or otherwise contains toxic, highly toxic, or explosive substances where the quantity of the a material excees a threshold quantity established by the authority having jurisdiction and is sufficient to pose a threat to the public if released (RC I thru V + SDC C thru F).
MECHANICAL/PLUMBING Designated Seismic Systems (DSS) Requiring a Certificate of Compliance
1.DSS Gas lines and associated fittings, anchorage, & flexible Connections
2.DSS Component XX
3.DSS Component XX
4.DSS Component XX3. The component is in, or attached to, a Risk Category IV or V structure, and it is needed for continued operation of the facility, or its faiure could impair the continued operation of the facility (RC IV thru V + SDC C thru F).
5.DSS Component XX
6.DSS Component XX
If additional space is required, append an additional sheet listing the remaining DSS
OTHER Designated Seismic Systems (DSS) Requiring a Certificate of Compliance4. The component conveys, supports, or otherwise contains hazardous substances and is attached to a structure, or portion thereof, classified by the authority having jurisdiction as a hazardous occupancy (RC I thru V + SDC C thru F).
1.DSS Building egress stair systems
2.DSS Building fire sprinkler systems
3.DSS Component XX
4.DSS Component XX
5.DSS Component XX
6.DSS Component XX
Final Walk Down Inspection and ReportFINAL WALK DOWN INSPECTION AND REPORT FOR NON-STRUCTURAL DSS
(UFC 3 301 01 SECTION 2-2.4.3)
Designated Seismic Systems shall receive a final walk-down inspection by the Registered Design Professional in Responsible Charge< A non-structural DSS final walk down inspection applies to this project
Final Walk Down Report, Prepared by the Registered Design Professional in Responsible Charge, Must Include:
1. Record observations of Final Walk Down Inspection
2. Document that Inspections were performed in accordance with the Schedule of Special Inspections< …Certificates of compliance documenting that the requirements are met shall be submited to the buidling offical (2015 IBC 1704.5 & 1705.13.3) and shall be maintained in a file identified as "Equipment Certification Documentation". This file shall be part of the final project O&M Manual
3. Document that all Designated Seismic Systems are installed according to construction/manufacturer document requirements, and that Compliance Certificates have been collected (UFC 03 301 01, 2-13.2.2.1).
Statement of Special Inspections Page 2 of 2
NEXT: COMPLETE THE SCHEDULE OF SPECIAL INSPECTIONS TEMPLATE.
Edit, print, and append the Schedule of Special Inspections Template to this Statement of Special Inspections and insert both at the back of the project Special Inspections Specification 01 45 35.

Example entries are provided, replace/delete as necessary

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