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9 ,����� ����n } <br /> ' Brldg�water Bank-Z446 Shadywaad Road Sqeclaf Teating and lnspectlon Schaduie <br /> Otono,Minnssota Section Ot 43 33 <br /> Momanium Dssign Group PaQe 7 of 2 ; <br /> ,.j�� <br /> ACKIVOWLEDGE�IFNTS � <br /> Each appropr�ate representative must sign below: # <br /> E <br /> i <br /> € <br /> Owner; firm: Bridgewater Bank Oate: t <br /> � A' 1 <br /> ca�t���o�: ,_,..�--`�= �HF r,�q�ti�y G�J�P u��: !I G F <br /> Architect. , � Firrn: Momentum Deslgn Group,LI.0 Date: <br /> �.. -s'f` 70 <br /> s��� •�' � . Firm: Vofgt&Associates, Inc. Oata: �� .�g ' <br /> � <br /> S!•S: i�rn: �!�����'�t � Date: � �� , <br /> TA: �o � ` <br /> � . /J✓��.� /..�+^� Data: ,7 <br /> t <br /> SI-'i: Firm: Date: <br /> T� Firm: Date: <br /> SI-T: Ff rm: Date: <br /> F: Firm: Qatet : <br /> F: Ftrm: Date: <br /> 'The individuaf names of ail pro5pecttve speciaE inspectars and the worktF�ey intend to abserve shall be <br /> identified on the reverse side of this form If necessary. <br /> LEGEND: SER� Structural Engfneer of RecBrd SI-T• Special fnspector-Technical <br /> TA= Test€ng Agent S!-5= Specisl Inspector• <br /> Structural <br /> E� Fabrlcator <br /> Accepted For the Building Department: <br /> i <br /> BY �'% Date �7 <br /> END QF SPECIAL STRUCTURAL TESTfPfG AND <br /> INSPECT�QN SCHERUIE S�Ci'iqN <br /> JH <br />