Report ►td( T202.I_0012.7
11917 NE 95rr Street,Vancouver,Washington 98682 Geotechnical s Environmental . Special Inspections
Phone: lumbi weste,Fax: ringic 3-2901 Columbia West
www.columbiawestengineering.com
V ii c) n e e r I r g , Inc •
''‘gc\ 143.9PRIETARY ANCHORS INSPECTION REPORT
PROJE CLIENT PROJECT NO. REPORT DATE
11065 SW 79th Avenue TGK Construction LLC 21207 08-18-21
Tigard,OR 97223 Portland,Oregon 97211 PERMIT NO, REPORT NO.
MST-2021-00127 21207-081821-PA1
INSPECTOR INSPECTOR ID#
MDK SI-01250
CONTRACTOR(S) PROJECT REPRESENTATIVE(S) WEATHER PAGE
TGK Tom clear 1 of 1
TYPE OF INSPECTION FREQUENCY OF INSPECTION
®Adhesive Anchors ❑Mechanical Anchors ®New Inspection ❑Re-Inspection ®Continuous ❑ Periodic
LOCATION(S)/ITEM(S)
Existing foundation @ 3/C&D
REFERENCED DOCUMENTS
6/9/21—Shts.—S1.1—S2.2 detail-2
PRODUCT/ANCHOR DETAILS
MANUFACTURER/DESCRIPTION LOT NUMBER(S) ADHESIVE EXPIRATION DATE(S)
Simpson Set—XP22-N 1000158155 4/20/23
ANCHOR TYPE
❑All-Thread Rod ®Reinforcing Steel(Rebar) ❑ Expansion Anchor ❑Screw Anchor El Other:
MATERIAL/COATING GRADE(ASTM) DIAMETER(in.) LENGTH(in.)
❑Stainless Steel ❑Galvanized ❑Zinc ®Other:none A615 %z" 48"
BASE MATERIAL
TYPE STRENGTH(psi) THICKNESS(inches) TEMPERATURE(°F)
®NW Concrete ❑LW Concrete ❑Brick ❑CMU ❑Other: unknown 24" 60
APPLICATION
ORIENTATION(check all that apply) SPACING(in.) EDGE DISTANCE(in.) EMBEDMENT(in.) TORQUE(ft-Ib)—WRENCH/IMPACT
®Horizontal ❑ Inclined ❑Vertical El Overhead 12" N/A 6" N/A
Hole preparation and installation per project documents,manufacturer specifications and evaluation report? ®Yes ❑ No
NARRATIVE
Arrived on site as scheduled for proprietary anchor inspection, observed the placement of four#4A615 dowels placed in clean dry
holes and epoxied into place with Simpson Set—XP22-N epoxy system.
PARTIES NOTIFIED: ®General Contractor 0 Subcontractor 0 Architect 0 Engineer ❑Owner 0 Other: 0 Standby time:
® To the best of my knowledge,the work inspected above was in general accordance with approved project documents,specifications and applicable
workmanship provisions of the International Building Code.
El NCR Issued ❑Except As Noted ❑Requires Engineer's Acceptance ❑Re-Inspection Required ❑Unapproved Drawings/Plans/Materials
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COLUMBIA WEST ENGINEERING,INC. authorized signature
C W E-c16-r02/24/20