Bureau of Building Code Compliance
6606 Tussing Road
PO Box 4009
Reynoldsburg, OH 43068-9009 U.S.A.
An Equal Opportunity Employer and Service Provider
614 | 644 2622
Fax 614 | 644 3145
TTY/TDD 800 | 750 0750
www.com.ohio.gov
Statement of Special Inspections
State CPA No.:
Project Name:
Project Location:
Pursuant to section 1704.3 Ohio Building Code, this statement of special inspections must be prepared by the
registered design professional in responsible charge acting as the owner’s agent. This statement (2-part
documents) should be submitted as a condition for plan approval and should include the following:
Part I: A complete list of materials and work requiring special inspections and the required frequency of
inspections by sections 1705.1 through 1705.18 Ohio Building Code.
Part II: A list of special inspectors who are qualified and are competent to the particular type of
construction or operations. These special inspectors shall be employed by the owner or by the
owner’s representative, other than the contractor. Submit proper resumes and/or certificates of the
special inspectors.
** Please mark “X” on all work items requiring special inspection and the required frequency of inspections for
this project per requirements in section 1705 OBC.
PART I: SCHEDULE OF SPECIAL INSPECTIONS
No. ITEM Req’d
Continuous
Inspection
Periodic
Inspection
1 Special Cases (1705.1 OBC)
2 Steel Construction (1705.2 OBC)
3 Concrete Construction (1705.3 OBC)
4 Masonry Construction (1705.4 OBC)
5 Wood Construction (1705.5 OBC)
6 Soil Conditions (1705.6 OBC)
7 Driven Deep Foundations (1705.7 OBC)
8 Cast-in-place Deep Foundation (1705.8 OBC)
9 Helical Pile Foundation (1705.9 OBC)
10 Fabricated Items (1705.10 OBC)
11 Wind Resistance (1705.11 OBC)
12 Seismic Resistance (1705.12 OBC)
13 Testing for Seismic Resistance (1705.13 OBC)
14 Sprayed Fire Resistant Materials (1705.14 OBC)
15 Mastic & Intumescent Coatings )1705.15 OBC)
16 EIFS Systems (1705.16 OBC)
17
Fire Resistant Penetrations & Joints (1705.17
OBC)
18 Smoke Control System (1705.18 OBC)
Submit the resume of special inspectors for all marked special inspection items in the part I table
showing the qualification and/or special training per 1704.2.1 OBC.
PART II: LIST OF SPECIAL INSPECTORS
No. ITEM Inspection Company Name of Inspector
1
Special Cases
(1705.1 OBC)
2
Steel Construction
(1705.2 OBC)
3
(1705.3 OBC)
4
Masonry Construction
(1705.4OBC)
5
Wood Construction
(1705.5 OBC)
6
Soils (1705.6OBC)
7
Driven Deep Foundation
(1705.7OBC)
8
Cast-In-Place Deep
Foundation (1705.8 OBC)
9
Helical Pile Foundation
(1705.9 OBC)
10
Fabricated Items
(1705.10 OBC)
11
(1705.11 OBC)
12
Seismic Resistance
(1705.12 OBC)
13
(1705.13 OBC)
14
Sprayed Fire-Resistant
Materials (1705.14 OBC)
15
Mastic & Intumescent Fire
Resistant Coatings
(1705.15 OBC)
16
Exterior Insulation & Finish
System (EIFS) (1705.16 OBC)
17
Fire-Resistant Penetrations &
Joints (1705.17 OBC)
18
Smoke Control System
(1705.18 OBC)
The project registered design professional acknowledges the responsibility of reviewing and approving
the special inspection reports submitted by the special inspectors at the required inspection periods.
Any discrepancies in special inspection reports shall be reported to the building official. A final
special inspection report documenting required special inspections and corrections of any
discrepancies noted in the inspections shall be submitted to the building official.
Statement certified by:
Name of Designer: Registration No.
Name of Company:
Designer Signature:
Date
Name of Owner: Company
Owner Signature:
Date
(Revised 04-23-2018)
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