Section 01 45 35 Statement of SI Template.xlsx
XLSX spreadsheet 26 KB Posted
- Attached to
- Y1DA--614-22-700 EHRM Infrastructure Upgrades Construction Memphis TN Federal contract opportunity
- Solicitation number
- 36C77624B0013_1
About this file
This document is a Statement of Special Inspections template for a federal contract opportunity. It identifies the Special Inspector of Record (SIOR) and the Designated Seismic Systems (DSS) that require special inspection for a maintenance hangar project. The SIOR must be a registered professional engineer and cannot be an employee of the contractor or subcontractor. The document lists the lateral force resisting system elements that require inspection, such as braced frames, moment frames, and shear walls. It also outlines the requirements for DSS, which are non-structural components that must remain operable after a design earthquake, such as emergency power systems and hazardous material containment. The document requires the SIOR to conduct a final walk-down inspection and provide a report documenting compliance. This template is intended to be appended to the Schedule of Special Inspections and included in the project's special inspections specification.
The related federal contract opportunity is for EHRM Infrastructure Upgrades Construction at the Memphis, TN VAMC, solicited by the Department of Veterans Affairs Technology Acquisition Center in Austin. The solicitation number is 36C77624B0013_1.
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Text version
Sheet1
| Project: | P234 - Maintenance Hangar | USER 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: | E | SPECIAL 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? | No | Group H Occupancies (2015 IBC, Section 415) |
| Special Inspector of Record (SIOR) | ||
| A Special Inspector of Record (SIOR) | IS | required (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 Elements | Notes |
| Ordinary Concentric Braced Frames | North - South Direction Only, See Plan |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Special Force Transfer Connection | See Detail X on Sheet X.XX |
| Statement of Special Inspections Page 1 of 2 | ||
| Project: | P234 - Maintenance Hangar | DESIGNATED SEISMIC SYSTEMS (DSS) |
| Location: | Anytown, VA | 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. |
| 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 Compliance | 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. | DSS Emergency or Standby Power System | ||
| 2. | DSS Component XX | ||
| 3. | DSS Component XX | 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). | |
| 4. | DSS Component XX | ||
| 5. | DSS Component XX | ||
| If additional space is required, append an additional sheet listing the remaining DSS | 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). | ||
| 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 XX | 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). | |
| 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 Compliance | 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). | ||
| 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 Report | FINAL 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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