25054_SIForm_Reg13MemorialSch_MiddlefieldCT_031726.pdf

Statement of Special Inspections

Project:

WeWesle yan University

Renovations & Additions to Regional School District #13

Location: 124 Hubbard Street, Middlefield, CT

Owner: CT Regional Board of Education

Design Professional in Responsible Charge: GM2 Associates, Inc.

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 encompasses the following disciplines:

X 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: Individual reports will be reviewed by S.I.

Coordinator and then submitted to the Building

Official monthly.

or per attached schedule.

Prepared by:

Design Professional Seal

Christopher H. Zajda (type or print name)

3/17/2026

Signature Date

Owner’s Authorization:

Building Official’s Acceptance:

Signature Date Signature Date

CASE Form 101 • Statement of Special Inspections • ©CASE 2004

Schedule of Inspection and Testing Agencies

This Statement of Special Inspections / Quality Assurance Plan include the following building systems:

X Soils and Foundations Spray Fire Resistant Material X Cast-in-Place Concrete Wood Construction Precast Concrete Exterior Insulation and Finish System X Masonry Mechanical & Electrical Systems X Structural Steel Architectural Systems X Cold-Formed Steel Framing Special Cases

Special Inspection Agencies Firm Address, Telephone, e-mail

1. Special Inspection Coordinator

GM2 Associates, Inc.

750 Old Main St – Suite 202

Rocky Hill, CT 06067

(860) 436-4336 czajda@gm2inc.com

2. Inspector TBD

TBD

3. Inspector

4. Testing Agency TBD

TBD

5. Testing Agency

6. Geotechnical Engineer

Down to Earth Consulting, LLC 27 Siemon Company Drive #363W

Watertown, CT 06795

(203) 683-4155

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.

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

Soils and Foundations Page 4 of 8

Item Agency #

(Qualif.)

Scope Inspection Frequency

1. Shallow Foundations 6

PE/GE

Inspect removal of unsuitable material and preparation of subgrade prior to placement of controlled fill and/or prior to placement of new concrete footings

C

2. Controlled Structural Fill 4

NICET-ST

or

NICET-GET

Perform sieve tests (ASTM D422 & D1140) and modified

Proctor tests (ASTM 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. Deep Foundations

N/A

4. Load Testing

N/A N/A

5. Other:

P: Periodic Inspections

C: Continuous

Cast-in-Place Concrete Page 5 of 8

1. Mix Design 2, 4

ACI-CCI

ICC-RCSI

Review concrete batch tickets and verify compliance with approved mix design. Verify that water added at the site does not exceed that allowed by the mix design.

2. Material Certification

2, 4

ACI-CCI

Review data and documentation providing evidence of conformance to quality standards of materials used in mix design.

3. Reinforcement Installation

1, 2 or 4

ACI-CCI

ICC-RCSI

Inspect size, spacing, cover, positioning and grade of reinforcing steel. Verify that reinforcing bars are free of form oil or other deleterious materials. Inspect bar laps and mechanical splices. Verify that bars are adequately tied and supported on chairs or bolsters

P

(once a day during installation)

4. Formwork 1, 2 or 4

ACI-CCI

ICC-RCSI

Inspect formwork geometry, stability and anchorage/ties.

Review that it conforms to design plans, specifications, and drawings.

P

(once a day

5. Welding of Reinforcing

6. Anchor Rods 1 or 2

ACI-CCI

ICC-RCSI

Inspect size, positioning and embedment of anchor rods.

Inspect concrete placement and consolidation around anchors.

7. Concrete Placement

ACI-CCI

ICC-RCSI

Inspect placement of concrete. Verify that concrete conveyance and depositing avoids segregation or contamination. Verify that concrete is properly consolidated. Conduct concrete mix tests every 50 cubic yards for each successive pour to ensure concrete meets project specifications

8. Sampling and Testing of Concrete

2, 4

ACI-CFTT

ACI-STT

Test concrete compressive strength (ASTM C31 & C39), slump (ASTM C143), air-content (ASTM C231 or C173) and temperature (ASTM C1064). Prepare and test 3 cylinders every 50 cubic yards of each successive pour

Review test reports.

9. Curing and Protection

ACI-CCI

ICC-RCSI

Inspect curing, cold weather protection and hot weather protection procedures periodically.

P

(once a day

10. Other:

Masonry Required Inspection Level: X 1 2

1. Material Certification

1 or 2

ICC-SMSI

Masonry units to be verified for each type of unit specified.

2. Mixing of Mortar and Grout

Inspect proportioning, mixing and retempering of mortar and grout. Take field samples periodically and test in accordance with ASTM C270, ASTM C780 and ASTM

C1019.

3. Installation of Masonry

1 or 2

Periodically inspect size, layout, bonding and placement of masonry units.

4. Mortar Joints

ICC-SMSI

Inspect construction of mortar joints including tooling and filling of head joints.

5. Reinforcement Installation

Inspect placement, positioning and lapping of reinforcing steel to ensure compliance with contract documents.

6. Prestressed Masonry

7. Grouting Operations

ICC-SMSI

Inspect placement and consolidation of grout. Inspect masonry clean-outs for high-lift grouting. Take field samples and lab test grout.

8. Weather Protection

1 or 2

ICC-SMSI

Inspect cold weather protection and hot weather protection procedures. Verify that wall cavities are protected against precipitation.

9. Evaluation of Masonry Strength

2,4

Take mortar and grout cubes to each 5000 sq.ft. of wall area and test compressive strength of mortar and grout cube samples (ASTM C780).

Test compressive strength of masonry prisms (ASTM

C1314).

10. Anchors and Ties

ICC-SMSI

Inspect size, location, spacing and embedment of dowels, anchors and ties.

11. Other:

Structural Steel Page 7 of 8

1. Fabricator Certification/ Quality Control Procedures

Fabricator Exempt

AWS/AISC-

SSI

ICC-SWSI

Review shop fabrication quality control certifications.

P

(one inspection)

2. Material Certification 2

AWS/AISC-

SSI

ICC-SWSI

Review certified mill test reports and identification markings on structural steel elements, high-strength bolts, nuts and welding electrodes

P

(one inspection)

3. Open Web Steel Joists 2

AWS/AISC-

SSI

ICC-SWSI

Inspect installation of field welding and bridging of joists.

4. Bolting 2

AWS/AISC-

SSI

ICC-SWSI

Inspect installation and tightening of high-strength bolts.

Verify that splines have separated from tension control bolts.

Verify proper tightening sequence. Continuous inspection of bolts in slip-critical connections.

5. Welding 2

AWS-CWI

Visually inspect all welds. Inspect pre-heat, post-heat and surface preparation between passes. Verify size and length of fillet welds.

6. Shear Connectors 2

AWS/AISC-

SSI

ICC-SWSI

Inspect size, number, positioning, and welding of 100% of shear connectors. Inspect studs for full 360 degrees flash.

Ring test all shear connectors with a 3 lb. hammer. Bend test all questionable studs to 15 degrees.

7. Structural Details 2

PE/SE

Inspect steel frame for compliance with structural drawings, including bracing, member configuration and connection details.

P

(minimum twice a week during erection)

8. Metal Deck 2

AWS-CWI

Inspections shall be in accordance with SDI QA/QC Tables

1.1 thru1.8. Verify deck gauge, width, and type. Inspect deck placement, laps, welds (floor deck only), side lap attach-ments, mechanical fasteners for roof deck, any special perimeter edge fastening, and pour-stop welds. Verify mech.

roof deck fasteners compliy with approved shop dwgs.

(minimum twice a week

9. Other:

Cold-Formed Steel Framing Page 8 of 8

1. Member Sizes 2

AWS/AISC-

SSI

ICC-SWSI

Review identification markings and certificates. P

(one inspection per delivery)

2. Material Thickness 2

AWS/AISC-

SSI

ICC-SWSI

Review identification markings. P

(one inspection per delivery)

3. Material Properties 1 or 2

AWS/AISC-

SSI

ICC-SWSI

Review data and documentation providing evidence of conformance to quality standards of materials. Review certification.

(one inspection)

4. Mechanical Connections

AWS/AISC-

SSI

ICC-SWSI

Review installation to ensure conformance with contract documents and shop drawings.

P

(minimum twice a week during installation)

5. Welding 2

AWS/AISC-

SSI

ICC-SWSI

100% visual inspection of all welds. P

(minimum twice a week during installation)

6. Framing Details 2

AWS/AISC-

SSI

ICC-SWSI

Check details for general conformance with contract documents, and review shop drawings.

P

(minimum twice a week during installation)

7. Trusses N/A

8. Permanent Truss Bracing

9. Other: