Inspection Request - Mock Up Form No - SQP09-FM-004, Rev 00 230709

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The Employer: The Engineer: The Contractor:

Project: 5220871-TAG - Elysian Shallow Services

Ref. No.IRM/MC/<XXX>
Inspection Request- Mock Up Rev. No.

Originator of IR Date:

Location/Area of Insp. Insp.Date:

Authorised Sign: Insp.Time

Type of Work Architectural Structural Electrical HVAC Interior Design


Others (Specify)
Infrastructure Landscape Mechanical Survey
………………………
Mock Up to be Inspected: Contractor's comments:

Attachments: Approved Material Submittals Approved Samples Approved Shop Drawings Specification (excerpt)
MEP Clearance Photographs Others (Specify)
Part Plan in A4 (highlighted)
…………….
The Contractor hereby certifies that the works are executed in accordance with the approved drawings, specifications and local authority regulations.

Contractor's QA/QC Engineer Sign: Date:

Contractor's PM Sign: Date:

AtkinsRealis Received Sign: Ref.No <JDE No.>/R13-

Inspection of other Inspection


AtkinsRealis Engineer's comments
Disciplines Engineer:

Surveyor
Yes No N/A Inspected By:

Inspector
Yes No N/A Inspected By:
MEP
Yes No N/A Inspected By:

Others (Specify)……
Yes No N/A Inspected By:
Checking and approval by the Consultant / Subconsultant / Employer shall not relieve the Contractor of his obligation to perform the work in accordance with
the Contract Documents, Requirements of Safety, and Local Authorities regulations.

AtkinsRealis Resident Engineer's Comments:


Code A - Approved

Code C - Not Approved,


Resubmit

Code E - Incomplete,
Resubmit

AtkinsRealis RE Sign: Date:

Ref. No <JDE No.>/R12-

Contractor Received Sign: Date:

SITE OPERATIONS Form No.SQP09/FM/004, Rev 00

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