Report os7 ex)/4,
Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, ffice (541) 345-0289
Inc. Eugene O Salem Office (503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: L S PANAS & ASSOCIATES (LAKE OSWEGO) - DON MULLER
Project: BARTON ADDITION CTI Job#:. T2104278.
Address: 14845 SW 100TH AVE TIGARD OR Jurisdiction: TIGARD
CTI representative G. PALMQUIST WABO SI 02197
was on site this date Sep. 22, 2021 to perform Special Inspection for:
Permit MST2021-00107
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: DON CTI MET WITH DON WITH LS PANAS. OBSERVED DON
Company: LS PANAS INSTALL (2) 5/8" THREADED ROD ANCHORS VERTICALLY
INTO CONCRETE FOUNDATION WITH 8" MINIMUM
2. Inspection was "IBC" x Continuous Periodic EMBEDMENT USING SET-XP ADHESIVE TO ANCHOR HDU2
HOLDOWNS PER 5/52.2 BRACKET AND ANCHOR
PROPRIETARY ANCHORS INSTALLATION (E) FOUNDATION HOLDOWN 02/11/21 IN
YesNoN/A NORTH WALL OF KITCHEN.
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: x Completed I j 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. I I RFI n Design change I I Submittal n N/A
X
8. Verified type of drill bit used. x Document #(s) PLANS Dated: 02-7J202_1
9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. following page(s). Yes x I 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 x I N/A
13. Verified installation torque. x
II Conform I I Remain in progress
Evaluation report number & date:
ESR-2508. 07/2017 Report(s) findings were discussed and left with
DON
of LS PANAS
Name of product being installed SET-XP ADHESIVE
Batch Number 1000154363
Expiration Date 2023-04-01
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: 09/22/2021
CTI Job #: T2104278.
Project: BARTON ADDITION
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:09/22/2021
GP/GP
CC. L S PANAS & ASSOCIATES (LAKE OSWEGO) - DON MULLER DON@LS PANAS.COM
VISTA STRUCTURAL ENGINEERING - DENNIS HEIER DENNIS@VISTASTRUCTURAL.cOM
KEITH R ABEL RESIDENTIAL DESIGN LLC - KEITH ABEL KEITH.ABEL@COMCAST.NET
X
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
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