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Report (648) Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 Carls ®n Testing, Inc. Salem Office (5 ) 345 -0289 Salem Office (503) 589 -1252 Tigard Office (503) 684-3460 Daily Report of Reinforced Concrete Client: DALKE CONSTRUCTION CO INC - SCOTT DALKE Project: DUTCH BROTHERS COFFEE - NEW CONSTRUCTION CTI Job #: T0908942. Address: 11746 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative S. FOX OBOA 177 was on site this date Feb. 18, 2009 to perform Special Inspection for: Permit BUP2009 -0007 DFS #(s) PO Number: SCOPE OF INSPECTION CONCRETE 1. Checked in with superintendent or client representative. 1. Mix Design approved? E Yes fl No 0 N/A Name: PHIL y Com an DALKE CONST 2. Monitored loads arriving at job site for correct: Company: Mix #: 225 GLACIER 2. Type of work: © Concrete © Reinforcing Slump 4 +- 1 % Air N/A 3. Work included: © Sampling © Inspection 3. Type of samples made? 4 X 8 CONCRETE CYLINDERS 4. Inspection was 'IBC' IN Continuous Periodic Number of sets 1 Samples per set 3 5. Work performed: ® In the field 0 At precast shop 4. Inspected placing and consolidation of approx. 20 cubic yards of concrete. REINFORCING Yes No N/A Location of concrete placement [to include grid lines, elevations (floors) and drawing details]: 1. Reviewed previous inspection reports? X 2. Forms clear of debris? SAME AS REINFORCING X 3. Type, grade, size, quantity, spacing and X condition conform? 4. Verified forms will nominally result in hardened concrete of the required X cross - sectional dimensions. 5. Verified location of reinforcing steel, pipes, conduits and sleeves with respect to X minimum concrete cover. 6. Verified type and location of splices, length X After samples are tested, results will follow on break report. of contact laps, and min. diameter of bends. 7. Verified support & anchorage of reinforcing REPORT SUMMARY steel in the forms. X 1. Work inspected was: © Completed 0 In progress 8. Verified structural embedments in the forms x 2. Completed work inspected was in compliance with with regard to fabrication, quality and type. Approved plans and specifications E Shop drawings 9. Verified structrual embedments in the forms with regard to weld inspection, quantity, and x RFI Design change 0 Submittal El N/A permits issued. 10. Verified cast in place anchors. X Document #(s) Dated: Description of structure inspected [to include grid lines, 3. Noncompliance item(s) were noted this date, details on elevations (floors) and drawing details]: following page(s). 0 Yes © No 0 N/A BUILDING SLAB ON GRADE WITH THICKENED EDGE 4. Noncompliance item(s) were reinspected this date, details FOOTINGS AND FOOTINGS FOR CANOPY BASE AT EACH on following page(s). 0 Yes © No El N/A SIDE OF THE BUILDING. Conform D Remain in progress NOTE: CONTRACTOR INSTALLED A 20' #5 BAR AS FOR Report(s) findings were discussed and left with GROUND IN WEST FOOTING. PHIL of DALKE CONST 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. El See additional report page(s). 0 Distribute attachments. Page 1 of 1 Daily Report of Reinforced Concrete For: 02/18/2009 CTI Job #: T0908942. Project: DUTCH BROTHERS COFFEE - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: Neil Shannon Review Date: 02/23/2009 SF /ARR DALKE CONSTRUCTION CO INC - SCOTT DALKE TO: CITY OF TIGARD BUILDING DIVISION MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON DALKE CONSTRUCTION CO INC - SCOTT DALKE RYAN HAWKINS Bend Office (541) 330 -9155 o Geotechnical Office (503) 601 -8250 ss�� I nc. Eugene Office (541) 345 -0289 6a�°�3 ®� Testing, �C Salem Office (503) 589 -1252 Tigard Office (503) 684 -3460 Daily Report of Structural Steel Client: DALKE CONSTRUCTION CO INC — SCOTT DALKE Project: DUTCH BROTHERS COFFEE — NEW CONSTRUCTION CTI Job #: T0908942. Address: 11746 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative A. ACKERMANN OBOA 790 was on site this date Feb. 12, 2009 to perform Special Inspection for: Permit BUP2009 -0007 DFS #(s) PO Number: SCOPE OF INSPECTION Location of steel inspection [to include grid lines, elevations (floors) and drawing details]: 1. Checked in with superintendent, client or shop rep. Name: ROBERT STRUCTURAL CONNECTIONS MADE BY WELDING 1 FCAW Company: ON SITE MOBILE WITH E71T -1 ON COLUMN COMPONENTS. VISUAL INSPECTION WAS PERFORMED PER APPLICABLE 2. Inspection was "IBC" 0 Continuous © Periodic DRAWING DETAILS AND AWS D1.1 CODE REQUIREMENTS. 3. Work performed: 0 In the field © At fab shop (4) COMPLETED COLUMN MEMBERS WERE CHECKED DURING ON SITE MOBILE THIS DATED INSPECTION. 4. If shop inspection do they have fabrication and QC procedures? © Yes El No 0 N/A INSPECTION Yes NoN /A • 1. Reviewed previous inspection reports? X 2. Verified steel materials are in compliance by reviewing random samples of the mill test reports, steel ID X markings or other documentation. 3. Verified weld filler materials conform. X 4. Checked steel members to see they were fabricated and erected in accordance with the workmanship and X tolerances required. 5. Checked welded studs and structural connections were REPORT SUMMARY installed as required. X 6. Verified high strength bolts and fasteners conform. X 1. Work inspected was: ® Completed fl In progress 7. Verified the quality of welds produced by welders, 2 . Completed work inspected was in compliance with welding operators. and tackers conform. X P P P 8. Verified steel frame joint details for bracing, stiffening, 11 Approved plans and specifications Shop drawings member locations. and application of joint details at each X RFI Design change Submittal N/A connection are in compliance by random sampling. g g Document #(s) SHOP Dated: 1/22/09 WELDER INFORMATION 3. Noncompliance item(s) were noted this date, details on Welders Name: C. HOFFMAN Certification #: 7757 following page(s). ❑ Yes ❑ No © N/A 4. Noncompliance item(s) were reinspected this date, details Yes No N/A on following page(s). ❑ Yes 0 No ® N/A 1. Verified the contractor's Welding Procedure progress Co nform Remain in Specifications are in conformance with x p AWS requirements. 2. Verified the essential variables outlined in the Report(s) findings were discussed and left with Welding Procedure Specifications were X ROBERT employed during execution of the work. o f ON SITE MOBILE 3. Verified the weldability of reinforcing steel Based on the Code. approval is required from the Building Official before the other than ASTM A706. X SPECIAL INSPECTED items noted above can be covered. Carlson Testing has no authority to direct work of contractors or subcontractors. 0 See additional report page(s). El Distribute attachments. Page 1 of 1 Daily Report of Structural Steel For: 02 /12 /2009 CTI Job #: T0908942. Project: DUTCH BROTHERS COFFEE - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: Neil Shannon Review Date: 02/16/2009 AA /ARR DALKE CONSTRUCTION CO INC - SCOTT DALKE TO: CITY OF TIGARD BUILDING DIVISION MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON DALKE CONSTRUCTION CO INC - SCOTT DALKE RYAN HAWKINS Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 c e Eugene Office (541) 345 -0289 Carlson Testing Into Salem Office (503) 589 -1252 Tigard Office (503) 684 -3460 REPORT OF 4 X 8 CONCRETE TEST SPECIMENS Test Methods: ASTM C31/ C172 /C192/C39/C1064/C231/C143/C1231 Date Molded: 02/18/2009 Job Number: T0908942. Permit #: BUP2009 -0007 Client: DALKE CONSTRUCTION CO INC — SCOTT DALKE Project: DUTCH BROTHERS COFFEE — NEW CONSTRUCTION Address: 11746 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD Contractor: DALKE CONSTRUCTION CO INC — SCOTT DALKE Subcontractor: Cast By: S . FOX Concrete Supplier: GLACIER NORTHWEST Truck #: 352 Load #: 1 Ticket#: 209060 Weather: CLOUDY Test Time: 8 : 00 AM Air Temp. at Sampling Time: 35 Cylinders were cast for the following locations: SOUTH CANOPY FOOTING AND BUILDING THICKENED EDGES Total Concrete Placement Location: SLAB ON GRADE WITH THICKENED EDGE FOOTINGS AND 2 CANOPY BASE FOOTINGS Strength Requirement: 3000 psi f c@ 28 Days Slump: 5.000" % Air: 1.80% Mix Number: 225 Conc. Temp: 58 Cement Type: VI 1 Max Agg: 1 Admix/Amt: NO BATCH WEIGHTS PROVIDED 9.5/22 Cubic Yards: Register Number: 0089791 Lab Location: TIGARD Set Test @ Date Test Total Area Unit Type Of Cap Tested No. Days Rec'd Date Load PSI Fracture Type By I 7 02/19/2009 02/25/2009 37398 12.56 2980 2 PAD 60 AF 28 02/19/2009 03/18 /2009 28 02/19/2009 03/18 /2009 ❑ Distribute attachments. Average fc @ 28 days Please see reverse side for additional information. Job Number: T0908942. Register Number: .0089791 Date Molded: 02/18/2009 Project: DUTCH BROTHERS COFFEE — NEW CONSTRUCTION < 1 in. [25 mm] X g ii -.. Type 1 Type 2 Type 3 Reasonable well- formed Well- Formed cone on one Columnar vertical cracking cones on both ends, less end, vertical cracks running through both ends, no than 1 in. [25 mm] of through caps, no well- defined well - formed cones cracking through caps cone on other end Type 4 Type 5 Type 6 Diagonal fracture with Side fractures at top or Similar to Type 5 but no cracking through bottom (occur commonly :nd of cylinder is pointed ends: tap with hammer to with unbonded caps) distinguish from Type 1 Asterisked ( *) average unit PSI test results did not meet listed acceptance criteria. Remarks: DALKE CONSTRUCTION CO INC - SCOTT DALKE TO: CITY OF TIGARD BUILDING DIVISION MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON MULTI TECH ENGINEERING SERVICES INC - JEFF BOLTON DALKE CONSTRUCTION CO INC - SCOTT DALKE RYAN HAWKINS Project Manager: NEIL S. SHANNON Reviewed By: Ty Toller On 02/26/2009 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.