6570 Bid Material Testing Services

Statement of Special Inspections
Project: Hillcrest Middle School
Location: 530 Daniels Farm Road, Trumbull, CT 06611
Owner: Town of Trumbull
Structural Engineer of Record: Michael Horton Associates, Inc.
This Statement of Special Inspections is submitted as a condition for permit issuance in accordance with the
Special Inspection and Structural Testing requirements of the Building Code. It includes a schedule of
Special Inspection services applicable to this project as well as the name of the Special Inspection
Coordinator and the identity of other approved agencies to be retained for conducting these inspections and
tests. This Statement of Special Inspections encompass the following disciplines:
Structural Mechanical/Electrical/Plumbing
Architectural Other:
The Special Inspection Coordinator shall keep records of all inspections and shall furnish inspection reports to
the Building Official and the Structural Engineer of Record. Discovered discrepancies shall be brought to the
immediate attention of the Contractor for correction. If such discrepancies are not corrected, the
discrepancies shall be brought to the attention of the Building Official and the Structural Engineer of Record.
The Special Inspection program does not relieve the Contractor of his or her responsibilities.
Interim reports shall be submitted to the Building Official and the Structural Engineer of Record.
A Final Report of Special Inspections documenting completion of all required Special Inspections, testing and
correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of
Use and Occupancy.
Job site safety and means and methods of construction are solely the responsibility of the Contractor.
Interim Report Frequency: Monthly or per attached schedule.
Prepared by: Design Professional Seal
Paul J. Sheehan, P.E.
(type or print name)
4-1-2026
Signature Date
Owner's Authorization: Building Official's Acceptance:
Signature Date Signature Date
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Page 2 of 10
Schedule of Inspection and Testing Agencies
This Statement of Special Inspections / Quality Assurance Plan includes the following building systems:
Soils and Foundations Spray Fire Resistant Material
Cast-in-Place Concrete Wood Construction
Precast Concrete Exterior Insulation and Finish System
Masonry Mechanical & Electrical Systems
Structural Steel Architectural Systems
Cold-Formed Steel Framing Special Cases
Special Inspection Agencies Firm Address, Telephone, e-mail
1. Special Inspection TBD
Coordinator
2. Inspector Langan Alfred Jones
ajones@langan.com
617-824-9122
555 Long Wharf Drive
New Haven, CT 06511
3. Inspector
4. Testing Agency TBD
5. Testing Agency
6. Other
Note: The inspectors and testing agencies shall be engaged by the Owner or the Owner's Agent, and not by
the Contractor or Subcontractor whose work is to be inspected or tested. Any conflict of interest must be
disclosed to the Building Official, prior to commencing work.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Page 3 of 10
Quality Assurance Plan
Quality Assurance for Seismic Resistance
Seismic Design Category B
Quality Assurance Plan Required (Y/N) N
Description of seismic force resisting system and designated seismic systems:
STEEL SYSTEMS NOT SPECIFICALLY DETAILED FOR SEISMIC RESISTANCE
Quality Assurance for Wind Requirements
Basic Wind Speed (3 second gust) 130 (Vult) 101(Vasd)
Wind Exposure Category C
Quality Assurance Plan Required (Y/N) N
Description of wind force resisting system and designated wind resisting components:
STEEL SYSTEMS NOT SPECIFICALLY DETAILED FOR SEISMIC RESISTANCE
Statement of Responsibility
Each contractor responsible for the construction or fabrication of a system or component designated above
must submit a Statement of Responsibility.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Page 4 of 10
Qualifications of Inspectors and Testing Technicians
The qualifications of all personnel performing Special Inspection and testing activities are subject to the
approval of the Building Official. The credentials of all Inspectors and testing technicians shall be provided if
requested.
Key for Minimum Qualifications of Inspection Agents:
When the Registered Design Professional in Responsible Charge deems it appropriate that the individual
performing a stipulated test or inspection have a specific certification or license as indicated below, such
designation shall appear below the Agency Number on the Schedule.
PE/SE Structural Engineer - a licensed SE or PE specializing in the design of building structures
PE/GE Geotechnical Engineer - a licensed PE specializing in soil mechanics and foundations
EIT Engineer-In-Training - a graduate engineer who has passed the Fundamentals of
Engineering examination
American Concrete Institute (ACI) Certification
ACI-CFTT Concrete Field Testing Technician - Grade 1
ACI-CCI Concrete Construction Inspector
ACI-LTT Laboratory Testing Technician - Grade 1&2
ACI-STT Strength Testing Technician
American Welding Society (AWS) Certification
AWS-CWI Certified Welding Inspector
AWS/AISC-SSI Certified Structural Steel Inspector
American Society of Non-Destructive Testing (ASNT) Certification
ASNT Non-Destructive Testing Technician - Level II or III.
International Code Council (ICC) Certification
ICC-SMSI Structural Masonry Special Inspector
ICC-SWSI Structural Steel and Welding Special Inspector
ICC-SFSI Spray-Applied Fireproofing Special Inspector
ICC-PCSI Prestressed Concrete Special Inspector
ICC-RCSI Reinforced Concrete Special Inspector
National Institute for Certification in Engineering Technologies (NICET)
NICET-CT Concrete Technician - Levels I, II, III & IV
NICET-ST Soils Technician - Levels I, II, III & IV
NICET-GET Geotechnical Engineering Technician - Levels I, II, III & IV
Exterior Design Institute (EDI) Certification
EDI-EIFS EIFS Third Party Inspector
Other
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Soils and Foundations Page 5 of 10
Item Agency # Scope Inspection
(Qualif.) Frequency
1. Shallow Foundations 2 Review the in situ bearing strata and compacted P
PE/GE structural fill bearing strata for footings and
slabs cast on grade
Inspect soils below footings for adequate P
bearing capacity and consistency with
geotechnical report.
Inspect removal of unsuitable material and P
preparation of subgrade prior to placement of
controlled fill
2. Controlled Structural Fill 4 Perform sieve tests (ASTM D422 & D1140) and P
GE or TA modified Proctor tests (ASTM D1557) of each source
of fill material.
Inspect placement, lift thickness and compaction of
C
controlled fill for support of footings and slabs.
Test density of each lift of fill by nuclear methods
(ASTM D2922). P
Verify extent and slope of fill placement. P
3. Ground Improvement System N/A N/A
4. Deep Foundations N/A N/A
5. Other: N/A N/A
Inspection Frequency:
C: Continuous
P: Periodic Inspections. Inspection frequency shall be determined by the Geotechnical Engineer (GE.)
During ongoing soil and foundation operations, daily (minimum) inspections shall be performed.
Notes:
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Cast-in-Place Concrete Page 6 of 10
Item Agency # Scope Inspection
(Qualif.) Frequency
1. Mix Design 1,4 Review concrete batch tickets and verify P
ACI compliance with approved mix design. Verify
that water added at the site does not exceed that
allowed by the mix design.
2. Material Certification 4 Verify on site materials (reinforcing, forms, P2
accessories, embed items) are in
accordance with plans and approved
submittals.
3. Reinforcement Installation 4 Inspect size, spacing, cover, positioning and P2
ACI grade of reinforcing steel including dowels.
Verify that reinforcing bars are free of form oil
or other deleterious materials. Inspect bar laps
and mechanical splices. Verify that bars are
adequately tied and supported on chairs or
bolsters.
4. Formwork Geometry 4 Inspect formwork for shape, location and P2
ACI dimensions of the concrete member being
formed.
5. Welding of Reinforcing 4 Verify weldability of reinforcing steel other than P
AWS-CWI ASTM A706. Inspect preheating of steel when
required.
Visually inspect single-pass fillet welds, P
maximum 5/16"
Visually inspect all other welds. C
6. Anchor Rods 4 Inspect size, positioning and embedment of P 2
ACI anchor rods. Inspect concrete placement and
consolidation around anchors.
7. Concrete Placement 4 Inspect placement of concrete. Verify that C
ACI concrete conveyance and depositing avoids
segregation or contamination. Verify that
concrete is properly consolidated.
8. Sampling and Testing of 4 Test concrete compressive strength (ASTM C31 P3
Concrete ACI & C39), slump (ASTM C143), air-content
(ASTM C231 or C173) and temperature (ASTM
C1064).
9. Curing and Protection 4 Inspect curing, cold weather protection and hot P4
ACI weather protection procedures.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

10. Other: 4 Inspect that drilled and epoxied anchors are the
Drill and epoxied reinforcing ACI proper size and are installed per the
Or anchor rods manufacturer's recommendations:
Adhesive anchors installed in horizontally or C
upwardly inclined orientations to resist
sustained tension loads.
Mechanical and adhesive anchors not defined P
above.
Inspection Frequency:
C: Continuous
P: Periodic Inspections.
P1: If all requirements are met, only one inspection is required.
P2: Inspect before concrete placement.
P3: Per Section 033000 "Cast-in-Place Concrete" specification.
P4: Daily when required by weather conditions (See ACI305R, ACI 306R, ACI 306.1.)
Notes:
1. Nonstructural concrete slabs supported directly on the ground.
2. Concrete patios, driveways and sidewalks on grade.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Masonry Page 8 of 10
Required Inspection Level: A B C
Item Agency # Scope Inspection
(Qualif.) Frequency
1. Material Certification 1,4 Review masonry units, mortar and grout C
proportions, masonry ties and joint reinforcement.
2. Mixing of Mortar and Grout 4 Inspect proportioning, mixing and retempering of P
ICC-SMSI mortar and grout.
3. Installation of Masonry 4 Inspect size, layout, bonding and placement of P
ICC-SMSI masonry units.
4. Mortar Joints 4 Inspect construction of mortar joints including P
ICC-SMSI tooling and filling of head joints.
5. Reinforcement Installation 4 Inspect placement, positioning and lapping of C
ICC-SMSI reinforcing steel.
4
AWS Inspect welding of reinforcing steel. C
6. Prestressed Masonry None
7. Grouting Operations 4 Inspect grout space prior to grouting. C
ICC-SMSI Inspect placement and consolidation of grout.
Inspect masonry clean-outs for high-lift grouting.
8. Weather Protection 4 Inspect cold weather protection and hot weather P
ICC-SMSI protection procedures. Verify that wall cavities are
protected against precipitation.
9. Evaluation of Masonry 4 Test compressive strength of grout cube samples P
Strength ICC-SMSI (ASTM C780).
Test compressive strength of masonry prisms P
(ASTM C1314).
Observe preparation of grout specimens, mortar C
specimens, and prisms.
10. Anchors and Ties 4 Inspect size, location, spacing and embedment of C
ICC-SMSI dowels, anchors and ties.
11. Wall Bracing 4 Verify that masonry walls have been braced to the P
structure per the project details and notes.
12. Other: 4 Inspect that drilled and epoxied anchors are the
Drill and epoxied reinforcing or ACI proper size and are installed per the
anchors manufacturer's recommendations:
Adhesive anchors installed in horizontally or C
upwardly inclined orientations to resist sustained
tension loads.
Mechanical and adhesive anchors not defined P
above.
Inspection Frequency:
C: Continuous
P: Periodic Inspections.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Structural Steel Page 9 of 10
Item Agency # Scope Inspection
(Qualif.) Frequency
1. Fabricator Certification/ 4 R e v i e w shop fabrication procedures and quality P1
Quality Control Procedures control procedures.
Fabricator Exempt
2. Material Certification 1, 4 Review certified mill test reports and P2
identification markings on wide-flange shapes,
high-strength bolts, nuts and welding electrodes
3. Open Web Steel Joists 4 Inspect size, installation, field welding, and P2
AWS/AISC bridging of joists.
4. Bolting 4 Inspect installation and tightening of high- C
AWS/AISC strength bolts. Verify that splines have separated
from tension control bolts. Verify proper
tightening sequence. Continuous inspection of
bolts in slip-critical connections.
5. Welding 4 Visually inspect all welds. Inspect pre-heat, P3
AWS post-heat and surface preparation between
passes. Verify size and length of fillet welds.
Ultrasonic testing of all full-penetration welds.
6. Shear Connectors 4 Inspect size, number, positioning and welding of C
AWS shear connectors. Inspect suds for full 360
degree flash. Ring test all shear connectors with
a 3 lb hammer. Bend test all questionable studs
to 15 degrees.
7. Structural Details 1/4 Inspect steel frame for compliance with contract P2
documents, including bracing, member
configuration and connection details.
8. Metal Deck 4 Inspect size and fastening of metal floor and P2
AWS roof
9. Other: N/A N/A
Inspection Frequency:
C: Continuous
P: Periodic Inspections.
Add'l Requirements as follows:
P1: If all requirements are met, only one inspection is required.
P2: While steel erection operations are ongoing, daily inspections shall be performed, unless otherwise noted.
This inspection frequency may be increased or decreased at the Special Inspections Coordinator's discretion.
P3: Refer to Section 051000 Structural Steel
Notes:
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004

Cold-Formed Steel Framing Page 10 of 10
Item Agency # Scope Inspection
(Qualif.) Frequency
1. Member Sizes 4 Inspect size of members for conformance to the P
Contract Documents and shop drawings, for
work constructed as part of specification
Sections 05410.
2. Material Thickness 4 Review product data submission for P2
conformance with the Contract Documents and
shop drawings, for work constructed as part of
specification Sections 05410.
3. Material Properties 4 Review product data submission for P1
conformance with the Contract Documents and
shop drawings, for work constructed as part of
specification Sections 05410.
4. Mechanical Connections 4 Review installation of screw connections for P
conformance with the Contract Documents and
shop drawings, for work constructed as part of
specification Sections 05410.
5. Welding 4 Review installation of welded connections for C
AWS conformance with the Contract Documents and
shop drawings, for work constructed as part of
specification Sections 05220 and 05400.
6. Framing Details 4 Review installation of cold formed structural P2
metal framing for conformance with the
Contract Documents and shop drawings, for
work constructed as part of specification
Sections 05410.
7. Trusses N/A
8. Permanent Truss Bracing N/A
9. Other:
Inspection Frequency:
C: Continuous
P: Periodic Inspections.
Add'l Requirements as follows:
P1: If all requirements are met, only one inspection is required.
P2: While cold-form metal framing operations are ongoing, daily inspections shall be performed, unless
otherwise noted. This inspection frequency may be increased or decreased at the Special Inspections
Coordinator's discretion.
CASE Form 101 * Statement of Special Inspections * (C)CASE 2004