014535 Special Inspections - Statement of SI.pdf

Project:

Location:

Project #:

Date:

Project:

Location:

Project #:

Date:

Project Risk Category:

Project Design Wind Speed (mph):

Number of Stories:

Structure Height Above Grade (ft):

Hazardous Occupancy or attached to such? Group H Occupancies (2015 IBC, Section 415)

Sioux Falls Boiler Plant

Sioux Falls VAMC, SD

438-22-900

1/16/2025

STATEMENT OF SPECIAL INSPECTIONS

Project Seismic Design Category:

Professional Registration Number:

Consulting Firm Name (if any):

SIOR Office AND Mobile Phone Number:

Special Inspector of Record (SIOR)

A Special Inspector of Record (SIOR) IS NOT required (per UFGS 01 45 35, Section 1.3.8)

SIOR Name (Registered Professional):

Special Concentric Braced Frames Lettered Gridline only, see plan for call out

Ordinary Steel Moment resisting Frames (SMRF) Both orthoginal Directions, See plan for call out

Ordinary Reinforced Concrete Shearwalls See Key Notes

Lateral Force Resisting System (LFRS)

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 Elements Notes

Ordinary Concentric Braced Frames North - South Direction Only, See Plan

Shear Wall Hold Downs Identified on Plan & in Detail Sheet X.XX

Horizontal LFRS Elements Notes

Continuous Roof Ties See Key Notes on Roof Plan

Concrete Grade Beams Resisting Lateral Loads Office Portion Only, see plan key notes

Ordinary Reinforced Masonry Shear Walls High Bay, Numbered Gridlines only, see plan

OSB Sheathed Shear Walls (nailing, sill bolting, Etc) See schedule on plan

Out of Plane Wall Connections See Structural Details XX & XX

Diaphragm Cross Rod Bracing See Roof Plan for locations

Cast in Place Concrete Floor and Roof Diaphragms See sheet XX for details and rebar schedule

Collector Elements Identified on plan with key notes

Concrete over metal deck 2nd floor and roof

Metal Roof Deck & Related Fastening System See Roof Plan

1/16/2025

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)

Special Force Transfer Connection See Detail X on Sheet X.XX

Statement of Special Inspections Page 1 of 2

Sioux Falls Boiler Plant

Sioux Falls VAMC, SD

438-22-900

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DESIGNATED SEISMIC SYSTEMS DO NOT APPLY TO THIS PROJECT, due to the Seismic Design Category being less than C.

ELECTRICAL Designated Seismic Systems (DSS) Requiring a Certificate of Compliance

DSS Emergency or Standby Power System

DSS Component XX

DSS Component XX

DSS Component XX

DSS Component XX

DSS Component XX

DSS Component XX

DSS Component XX

DSS Component XX

If additional space is required, append an additional sheet listing the remaining DSS

MECHANICAL/PLUMBING Designated Seismic Systems (DSS) Requiring a Certificate of Compliance

1. Record observations of Final Walk Down Inspection

2. Document that Inspections were performed in accordance with the Schedule of Special Inspections

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

DSS Component XX

DSS Component XX

Final Walk Down Inspection and Report

(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

Final Walk Down Report, Prepared by the Registered Design Professional in Responsible Charge, Must Include:

If additional space is required, append an additional sheet listing the remaining DSS

OTHER Designated Seismic Systems (DSS) Requiring a Certificate of Compliance

DSS Building egress stair systems

DSS Building fire sprinkler systems

DSS Component XX

DSS Component XX

DSS Gas lines and associated fittings, anchorage, & flexible Connections

DSS Component XX

LATERAL FORCE RESISTING SYSTEM IDENTIFICATION

USER NOTES (Not intended to print)

< Edit Blue text/cells only

SPECIAL INSPECTOR OF RECORD (SIOR) DETERMINATION

< 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.

< For DB contracts insert the SIOR contact information. For DBB contracts enter, "Contractor to provide prior to construction start".

< 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.

DESIGNATED SEISMIC SYSTEMS (DSS)

This 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.

Example entries are provided, replace/delete as necessary

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.

2. 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).

3. 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).

4. 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).

FINAL WALK DOWN INSPECTION AND REPORT FOR NON-STRUCTURAL DSS

< A non-structural DSS final walk down inspection applies to this project

< …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

< Designated Seismic Systems DO NOT APPLY to this project, nothing further is required as part of this Statement of

DSS 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. 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).