P09 01 45 35 Statement of Special Inspections Template.pdf
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- 36c25520R0100_1
About this file
This document outlines the requirements for a federal construction contract to build a warehouse addition at the Marion VA Medical Center in Virginia. Key details include constructing a 4,800 square foot pre-engineered metal building addition south of the existing warehouse building to provide additional storage space for COVID-19 emergency supplies. The addition will have a minimum interior clear height of 15 feet, connecting corridor to the existing warehouse, large roll-up door and driveway on the south side, and will include fire sprinklers and HVAC systems. The opportunity was issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15 to provide a turnkey solution for the government's need to increase storage capacity for pandemic response materials at the medical center.
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Project:
Location:
Project #:
Date:
F
II
Yes
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)
P234 ‐ Maintenance Hangar
Anytown, VA
12345678
4/10/2017
STATEMENT OF SPECIAL INSPECTIONS
Project Seismic Design Category:
Professional Registration Number: C222222
Consulting Firm Name (if any): ABC Structural Consulting
SIOR Office AND Mobile Phone Number: 1234567895 (Mobile), 123456789 (Office)
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): John Doe P.E.
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
4/10/2017
Special Force Transfer Connection See Detail X on Sheet X.XX
Statement of Special Inspections Page 1 of 2
P234 ‐ Maintenance Hangar
Anytown, VA
12345678
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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
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 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 APPLY to this project. List all Designated Seismic Systems in the blue tables below.
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).
File details come from the government source that posted it. Updated .