Report P4; sW Caddy ,I tis'Irp30-00770
Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, Inc. Eugene Office (541) 345-0289
Salem Office (503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: ROGUE REMODEL - DAVIS STONE
Project: KELLY CORLL RESIDENCE CTI Job#: T2103076.
Address: 13303 SW CADDY PLACE TIGARD OR Jurisdiction: TIGARD
CTI representative J. VIALPANDO WABO SI 02254/ACI 01538462
was on site this date Jan. 15, 2021 to perform Special Inspection for:
Permit MST2020-00270
DFS #(s) PO Number: KELLY
SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid
lines, elevations (floors) and drawing details]:
1. Checked in with superintendent or client representative.
Name: DAVIS STONE WITNESSED THE INSTALLATION OF 4 5/8 THREADED ROD
Com an ROGUE REMODEL 3 WITH 9" EMBED 1 WITH 13" EMBED AND 6 1/2 TITEN
p y HD ON THE NORTH AND SOUTH WALLS OF NEW BEDROOM
2. Inspection was "IBC" Continuous x Periodic AS PER 1/P-2 GARAGE LEVEL PLAN
PROPRIETARY ANCHORS
YesNoN/A
1. Reviewed previous inspection reports? x
2. Reviewed evaluation report? x
Verified following items meet manufacturer's
published installation instructions. REPORT SUMMARY
3. Verified minimum embedment depth of the
anchors. x 1. Work inspected was: Completed x In progress
4.Verified installation of the anchors. X 2. Work inspected in progress was in compliance with
5. Verified anchor diameter. X R Approved plans and specifications n Shop drawings
6. Verified steel grade. x
7. Verified hole diameter. ❑ RFI Design change Submittal N/A
X
8. Verified type of drill bit used. x Document #(s) SITE PLANS Dated: 12-04-2020
9. Verified hole cleaning method. X 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. X following page(s). n Yes ❑ No El N/A
11. Verified edge distance. x
12. Verified spacing. 4. Noncompliance item(s) were reinspected this date, details
p g. X on following page(s). Yes I I No I x I N/A
13. Verified installation torque.
PI Conform E. Remain in progress
Evaluation report number & date:
ESR 2508 7/20 - 7/21 Report(s) findings were discussed and left with
ESR 2713 1/21 - 9/21 DAVIS STONE
of ROGUE REMODEL
Name of product being installed SIMPSON SET XP & TITEN HD
Batch Number 1000113866
Expiration Date 2022-11-22
Based on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above can
be covered. Carlson Testing has no authority to direct work of contractors or subcontractors.
See additional report page(s). n Distribute attachments. Page 1 of 2
Daily Report of Proprietary Anchors For: 01/15/2021
CTI Job#: T2103076.
Project: KELLY CORLL RESIDENCE
Notes:
In some cases more than one box may be checked for a given item on the front page.
Our reports pertain to the material tested/inspected only.Information contained herein is not to be reproduced,except in full,
without prior authorization from this office.Under all circumstances,the information contained in this report is provided
subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared.No party other
than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this
document.
If there are any further questions regarding this matter,please do not hesitate to contact this office.
Respectfully submitted,
CARLSON TESTING,INC.
Johnny Johnson Reviewed By:Project Manager
Project Manager Review Date:01/15/2021
JV/JV
CC: ROGUE REMODEL - DAVIS STONE ROGUEREMODEL@OUTLOOK.COM
• CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT FINAL/NCL ONLY
DELTA STUDIOS ARCHITECTURE AND PLANNING LLC OREGONARCHITECT@HOTMAIL.COM
PROPERTY DAMAGE SOLUTIONS LLC (PDS) - CHRIS NESTLERODE CHRIS@PDSLLCNW.COM
ROGUE REMODEL - DAVIS STONE ROGUEREMODEL@OUTLOOK.COM
KELLY CORLL KCORLL@COMCAST.NET
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
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