Report (22) /57 Z 2 6.736 C
I 'z J14) 6Jer ' Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, Inc. Euene s lemOfficee (541) 345-0289
503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: PARKER CONCRETE - JOHN OWEN
Project; RIVER TERRACE LOT 182 CTI Job#: T2302858.
• Address: 15425 SW EVERGLADE AVE TIGARD OR _. Jurisdiction: TIGARD
CTI representative K. WRIGHT WABO SI 02613
was on site this date Dec. 09, 2023 to perform Special Inspection for:
Permit MST2023-00360
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: ROMERO OBSERVED INSTALLATION OF (1) 5/8"0 THREADED ROD
Com an PARKER CONCRETE ANCHOR VERTICALLY DOWN INTO CONCRETE STEM WALL
P y
WITH 10" EMBEDMENT FOR ANCHORAGE OF HTT5 HOLD
2. Inspection was "IBC" n Continuous Periodic DOWN ON WEST PERIMETER WALL PER HOLD DOWN
SCHEDULE ON PAGE SIR (2/17/2021) AND EMAIL FROM
PROPRIETARY ANCHORS ENGINEER ANNE M. ANDERSON OF GREEN MOUNTAIN
YesNoN/A STRUCTURAL ENGINEERS DATED (11/27/2023)
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: [1 Completed I In progress
4.Verified installation of the anchors. x 2. Completed work inspected was in compliance with
5. Verified anchor diameter. x R Approved plans and specifications n Shop drawings
6. Verified steel grade.
7. Verified hole diameter. I xI RFI I I Design change Submittal 7 N/A
X
8. Verified type of drill bit used.
x Document #(s) PLANS Dated: 02-17-2021
9. Verified hole cleaning method. X 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. X following page(s). n Yes I I No x l N/A
11. Verified edge distance. X
12. Verified spacing. 4. Noncompliance item(s) were reinspected this date, details
x on following page(s). I(-i Yes Li No x N/A
13. Verified installation torque. X
Conform U Remain in progress
Evaluation report number & date:
ESR-2508 (07/23-07/24) Report(s) findings were discussed and left with
ROMERO
of PARKER CONCRETE
Name of product being installed SIMPSON SET-XP ADHESIVE ANCHOR
Batch Number 1000360615
Expiration Date 2025-06-12
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). I I Distribute attachments. Page 1 of 2
r
Daily Report of Proprietary Anchors For: 12/04/2023
CTI Job #: T2302858.
Project: RIVER TERRACE LOT 182
Notes:
NOTE: EMAIL FROM ENGINEER DATED 11/27/2023 SPECIFIES USE OF SIMPSON SET-XP AND 10" EMBEDMENT TO
INSTALL HOLDDOWN THAT WAS MISSED.
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.
Taylor Runckel Reviewed By: Steven W Leach
Project Manager Review Date: 12/04/2023
KW/Kw
CC: PARKER CONCRETE - JOHN OWEN JOHN@PARKERCONCRETE.COM
CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT NCL/FINAL ONLY
GREEN MOUNTAIN STRUCTURAL ENGINEERING - ANNE ANDERSON ANNE@GREENMOUNTAINSE.COM
PARKER CONCRETE - ARMANDO SAMBRANO ARMANDO@PARKERCONCRETE.COM
PACIFIC LIFESTYLE HOMES - ANDY BASFORD ANDYB@BUILDPLH.COM
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
Page 2 of 2