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Report Main Office Salem Office Bend office Carlson T e ('11 4 Inc. 30.5'VV' lln,riker 41160 Hudson 5'r -. NE Bend. oR Riley Rd �! l 1 / \J ■6e I i■ 8430.5 OR ')7113 Salem, OR 97301 Bend, OR 97707 Phone: (503) M4 -3460 Phone: (503) 589 -1152 Phone: (541) 330 -9/55 Far_ 6071 - 09 , 51 Far (50) 5,49 -17{19 Fns 6411 570 -9163 Construction Materials Testing & Inspection &.PP e z � . cz C Special Inspection 00 FINAL SUMMARY LETTER April 8, 2009 CTI Job #T0908942 City of Tigard Building Division 13125 SW Hall Blvd Tigard, OR 97223 -8199 Attn: Building Department Re: Dutch Brothers Coffee — New Construction 11746 SW Pacific Highway — Tigard, OR Permit No.: BUP2009 -0007 Dear Sir or Madam: This is to certify that in accordance with Section 1704.1.2 of the International Building Code, we have performed special inspection of the following item(s) per our inspection reports only: Reinforced Concrete Structural Welding All inspections and tests were performed and reported according to the requirements of Project Documents and, to the best of our knowledge, the work was in conformance with the approved plans and specifications, approved change orders and applicable workmanship provisions of the State Building Code and Standards, as well as the structural engineer's design changes, approvals and verbal instructions. 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 TESTI . , INC Neil S. Shan on Project Manager NSS/lh cc: Dalke Construction Co. Inc. — Scott Dalke V City of Tigard Building Division Multi Tech Engineering Services Inc. — Jeff Bolton Ryan Hawkins Bend Office (541) 330 -9155 ��11 Testing eotechnical Office (503) 601 -8250 ����� ®ia Inc. � Eugene Office (541) 345-0289 Salem Office (503) 589 -1252 Tigard Office (503) 684 -3460 Daily Report of Reinforced Concrete Revised 04/09/2009 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? © Yes 0 No ❑ 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' ® Continuous fl Periodic Number of sets 1 Samples per set 3 5. Work performed: ® In the field ❑ 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. 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 After samples are tested, results will follow on break report. of contact laps, and min. diameter of bends. X 7. Verified support & anchorage of reinforcing REPORT SUMMARY steel in the forms. X 1. Work inspected was: ® Completed ❑ 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. 9. Verified structrual embedments in the forms ® Approved plans and specifications ❑ Shop drawings with regard to weld inspection, quantity, and X RFI ❑ Design change ❑ Submittal 0 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). ❑ Yes ® No ❑ 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 N/A SIDE OF THE BUILDING. Conform 0 Remain in progress NOTE: CONTRACTOR INSTALLED A 20' #5 BAR AS LIFER 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. ❑ See additional report page(s). 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: REVISED FOR CORRECTION OF NOTE IN REINFORCING SECTION 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 fi 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. Reviewed By: Neil Shannon Review Date: 04/09/2009 SF /LNH 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