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Daily Report of Proprietary Anchors
Project: POLYGON AT ROSHAK RIDGE-LOT 241 CTI Job#: T18o4799•CB
Address: 16944 SW ROCKHAMPTON LN TIGARD OR Jurisdiction: TIGARD
CTI representative: Ken Jordison was on this site on date: 07/16/2021 to perform
Special Inspection for Permit: MST2o2o-oo311 PO#:
SCOPE OF INSPECTION Location of proprietary anchors inspected[to include grid lines,elevations
1. Checked in with superintendent or client representative: (floors)and drawing details]:
OBSERVED INSTALLATION OF FOUR#4 REBAR VERTICAL
Name: ROB DOWELS AT GARAGE WING WALLS INSTALLATION APPEARS
Coro an TAYLOR MORRISON TO BE PER BULLETIN CT-102(6/21/21)
P Y
2. Inspection was'IBC ❑Continuous ❑X Periodic
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports? X REPORT SUMMARY
2.Reviewed evaluation report? X
1. Work inspected was: X Completed 17 In Progress
Verified following items meet manufacturer's published installation 2. Completed work inspected C was ❑was not in compliance
materials. with
Yes No N/A
3.Verified minimum embedment depth of the anchors? X 0 Approved plans and specifications ❑Shop Drawings
4.Verified installation of the anchors? X RFI ❑Design Change Submittal ❑N/A
5.Verified anchor diameter? X Doc.No(s): CT ENGINEERING Dated: 06/21/2021
6.Verified steel grade? X
7.Verified hole diameter? X 3• Noncompliance item(s)were noted this date,details on the following
8.Verified type of drill bit used? X
page(s):El Yes ❑No ❑X N/A
9.Verified hole cleaning method? X 4. Noncompliance item(s)were reinspected this date,details on
to.Verified adhesive application? X following page(s)E Yes n No C N/A
it.Verified edge distance? X ❑Conform ❑Remain in progress
12.Verified spacing? X
13.Verified installation torque? X Report(s)findings were discussed and left with
ROB
Evaluation report number and date:
ESR 4057 EXPIRES 4/22
of TAYLOR MORRISON
Name of product being installed:
SIMPSON SET 3-G
Batch Number: 1000094415
Expiration Date: 06/09/2022
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 and subcontractors.
See additional report paws) Distribute Attachnlent(s) Proprietary Anchors Version I Page I of I