Report / 6 r --
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Eugene Office (541)345-0289
Salem Office (503)589-1252
Carlson Testing, Inc. Tigard Office (503)684-3460
Daily Report of Proprietary Anchors / ) .2°492"1"— °Z
Project: POLYGON AT ROSHAK RIDGE-L(7F 137 CTI Job#: T1804799•CD
Address: 16693 SW SUNSHINE COAST TIGARD Jurisdiction: TIGARD
CTI representative: Ken Jordison was on this site on date: 07/16/2021 to perform
Special Inspection for Permit: MST2o21-00072 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 ONE 5/8"DIAMETER
Name: ROB HOWSER THREADED ROD AT PATIO DOOR AND TWO REBAR
Company: TAYLORMORRISON #r-io3(7DOW1) ND#GE:NERAL(5/1514)PER BULLETIN
2. Inspection was IBC Ei Continuous 0 Periodic
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports? X
2.Reviewed evaluation report? X REPORT SUMMARY
1. Work inspected was: []Completed E In Progress
Verified following items meet manufacturer's published installation 2. Completed work inspected 0 was was not in compliance
materials. with
Yes No N/A
3.Verified minimum embedment depth of the anchors? X X Approved plans and specifications Shop Drawings
4.Verified installation of the anchors? X C RFI n Design Change Submittal n N/A
5.Verified anchor diameter? X Doc.No(s): CT ENGINEERING Dated: 07/07/2021
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? 7(
page(s):El Yes n Non N/A
9.Verified hole cleaning method? X 4. Noncompliance item(s)were reinspected this date,details on
10.Verified adhesive application? X following page(s) Yes ❑No X N/A
H.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 HOWSER
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.
0 See additional report pag(s) Distribute Attachment(s) Proprietary Anchors Version I Page I of I
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Eugene Office (541)345-0289
Salem Office (503)589-1252
Carlson Testing, Inc. Tigard Office (503)684-346o
Daily Report of Proprietary Anchors/1117-2 72/ 1'
Project: POLYGON AT ROSHAK RIDGE-LOT 136 CT I Job#: T1804799•CE
Address: 16705 SW SUNSHINE COAST TIGARD Jurisdiction: TIGARD
CTI representative: Ken Jordison was on this site on date: 07/16/2021 to perform
Special Inspection for Permit: MST2021-00054 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 ONE 5/8"THREADED ROD
Name: ROB AT PATIO DOOR INSTALLATION APPEARS TO BE PER
BULLETIN#GENERAL(5/14/14)
Company: TAYLOR MORRISON
2. Inspection was IBC n Continuous 0 Periodic
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports? X
REPORT SUMMARY
2.Reviewed evaluation report? X
1. Work inspected was: 0 Completed ❑In Progress
Verified following items meet manufacturer's published installation 2. Completed work inspected ❑X 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 n Shop Drawings
4.Verified installation of the anchors? X RFI ❑Design Change n Submittal ❑N/A
5.Verified anchor diameter? X Doc.No(s): CT ENGINEERING Dated: 05/15/2014
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
N/A
9.Verified hole cleaning method? X 4. Noncompliance item(s)were reinspected this date,details on
10.Verified adhesive application? X following page(s)❑Yes n No U N/A
11.Verified edge distance? _ X n Conform I I 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:
ESR4o57 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 paw(s) El Distribute Attachment(s) Proprietary Anchors version I Page I of I