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Appendix A Blank Forms

Page 3 of 3

CATAWBA COUNTY, NORTH CAROLINA SPECIAL INSPECTIONS PROGRAM Quality Assurance Plan

Quality Assurance for Seismic Resistance

Seismic Design Category Quality Assurance Plan Required (Y/N)

Description of seismic force resisting system and designated seismic systems requiring special inspections (Review Section 1705, 1707 and 1708 of the NCSBC to prepare this section):

Quality Assurance for Wind Requirements

Basic Wind Speed (3 second gust) Wind Exposure Category Quality Assurance Plan Required (Y/N)

Description of wind force resisting system and designated wind resisting components requiring special inspections (Review Section 1706 of the NCSBC to prepare this section):

Statement of Responsibility

List each contractor responsible for the construction or fabrication of a system or component designated above. Each contractor listed must submit a Statement of Responsibility.

Name

Company

System or Component

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