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Minnesota Department of Labor and Industry <br /> Construction Codes and Licensing Division <br /> Building Codes and Standards <br /> 443 Lafayette Road N.,St.Paul,MN 55155-4341 <br /> Phone: (651)284-5068 Fax: (651}284-5749 <br /> www.doli.state.mn.us TTY: (651)297-419B <br /> Special Structural Testing and Inspection Program Summary Schedule <br /> Project Name Hannaford Residence Project No. <br /> Location 1220 Bracketts Point Road, Orono, MN 55391 Permit No. 2016-00133 ��� <br /> Technical 2 Type of Specific Report Assigned <br /> Section Table Descri tion 3 Ins ector 4 Frequenc (5 Firm(6) <br /> IBC 1704.8 1704.8 Pile Foundaiions-Helical SIS Per Visit <br /> IBC 1704.7 1704.7 Soils SIT Per isit <br /> IBC 1 04.4 1704.4 Cancrete Construction SIT Per Vfsit <br /> IBC 1704.3 1704.3 Steel Construction SIS Per Visit <br /> Note: This schedule shall be filled out and Included tn a Speciaf Structural Testing and inspectlon P�ogram. <br /> (if not otherwise speciffed,assumed program will be"Guidelines for Special Inspection 8�Testing"as contained in the <br /> State Building Code and as modified by the state adopted IBC.) <br /> *A complete specification-ready program can be downloaded directly by visiting CASE/MN at www.cecm.org* <br /> (1) Permit No.to be pravided by the Building Official <br /> (2) Referenced to the specific technical scope section in the program. <br /> (3) Use descriptions per IBC Chapter 17, as adopted by Minnesota State Building Code. <br /> (4) Special Inspactor-Technical(SIT); Special Inspector-Skructural (SIS) <br /> (5) Weekly, monthly, per tesUinspection, per floor,etc. <br /> (6) Name of Firm contracted to perform services. <br /> ��"� ACKNOWLEDGEMENTS <br /> ' (Each appropriate representative shall sign below) <br /> ��-'t� .', _�'_ <br /> Owner Be y& Jule Hannaford � Firm: Date: � '�� - �j`' <br /> `�Contractor: �7r��i-}��,v�vrr;���,�� Firm: Welch Forsman Date: S -S �((;j <br /> Archite t;� '��'��----- f Firm: Snow Kreilich Architects Date: 5- 3-1!o <br /> SE �" �r �:�c..,�.� Firm: Ericksen Roed&Associates Date: 4-7-2016 <br /> SI-S: Firm; �� Date: S-`�� �6 <br /> TA: Firm: �-�T Date: �=`�`�(o <br /> F: Firm: Date: <br /> If requested by engineer/architect of record or building official, the individual names of all prospective special <br /> inspectors and the work they intend to observe shall be identified as an attachment. <br /> Legend: SER =Structural Engineer of Record SI-T=Special Inspector-Technical TA=Testing Agency <br /> SI-S =Special Inspector-Structural F= Fabricato� <br /> � � <br /> Accepted for the Building Department By �'� /, — � Date � � <br /> OS/07 PR598 <br />