Report (2) Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, Inc. ugene Office (541) 345-0289
nc• Salem Office (503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: BLACK DIAMOND HOMES INC - JEFF BETTINELLI
Project: BOLEYN RESIDENCE CT1 Job#: T2002224.
Address: 14575 SW 92ND AVE TIGARD OR Jurisdiction: TIGARD
CTI representative T. DOWNER WABO SI 02441/ACI 02035709
was on site this date Auq. 05, 2020 to perform Special Inspection for:
Permit MST2020-00123
DFS #(s) PO Number:
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: ROBERT CTI OBSERVED THE INSTALLATION OF (24) SIMPSON
Company:
APEX CONSTRUCTION TITEN HD 1/2" 0 WITH 4" MINIMUM EMBED, (2) PER
SILL PLATE TOTALING (12) ; AND 3 1/2" MINIMUM
2. Inspection was "IBC" x Continuous Periodic EMBED, (2) PER STRAP WITH 8" BELOW TOP EDGE OF
CONCRETE. 10" SPACING; ALL PER DETAIL 40/S2 AT
PROPRIETARY ANCHORS LOCATIONS: NEW WALK IN CLOSET WALL, NEW ART ROOM
YesNoN/A WALL.
1. Reviewed previous inspection reports? (12) TOTAL STRAP ANCHORS.
X
2. Reviewed evaluation report?
Verified following items meet manufacturer's
published installation instructions. REPORT SUMMARY
3. Verified minimum embedment depth of the
anchors. X 1. Work inspected was: I xI Completed In progress
4.Verified installation of the anchors. x 2. Completed work inspected was in compliance with
5. Verified anchor diameter. X x Approved plans and specifications Shop drawings
6. Verified steel grade. x
7. Verified hole diameter. RFI I I Design change Submittal N/A
x
8. Verified type of drill bit used. x Document #(s) PLANS Dated: 3/17/2020
9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. X following page(s). Yes PI l No N/A
11. Verified edge distance. x
12. Verified spacing. 4. Noncompliance item(s) were reinspected this date, details
on following page(s). I I Yes No I xi N/A
13. Verified installation torque. x
Conform Remain in progress
Evaluation report number & date:
ESR 2713 9/2016 Report(s) findings were discussed and left with
ROBERT
of APEX CONSTRUCTION
Name of product being installed SIMPSON TITEN HD
Batch Number X
Expiration Date X
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). Distribute attachments.
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Daily Report of Proprietary Anchors For: 0 8/0 5/2 02 0
CT! Job #: T2002224.
Project: BOLEYN 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:08/17/2020
TD/GM
CC:• BLACK DIAMOND HOMES INC - JEFF BETTINELLI IEFF@BLACKDIAMONDHOMESINC.COM
CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIGARD-OR.GOV
NAVA CONTRACTING & ENGINEERING INC - MATT NAVA NAVAENGR4@GMAIL.COM
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
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