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Report I" Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 C ® Inc. Eugene Office (541) 345 -0289 arlson Testing c Salem Office (503) 589 -1252 Tigard Office (503) 684-3460 Daily Report of Proprietary Anchors Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER Project: BURGERVILLE #45 (TIGARD) - NEW COMMERCIAL BUILDING SHELL CTIJob#: T1002573. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative K. PARKIN OBOA 420 /WABO PAR 86 0560 was on site this date Jul. 14, 2010 to perform Special Inspection for: Permit BUP2010 -00106 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. PLATE ANCHOR AT GRIDS 3.1/C PER DETAIL 3/S3. Name: W ADE ONE(1) 5/8 DIAMETER ANCHOR WITH 6" EMBED USING Company: RSV BUILDING SOLUTIONS SIMPSON SET XP. 2. Inspection was "IBC" © Continuous El Periodic PROPRIETARY ANCHORS Yes No N/A 1. Reviewed previous inspection reports? X 2. Reviewed evaluation report? X Verified following items meet manufacturer's REPORT SUMMARY published installation instructions. 3. Verified minimum embedment depth of the 1. Work inspected was: © Completed ❑ In progress anchors. X 4.Verified installation of the anchors. 2. Completed work inspected was in compliance with X © Approved plans and specifications ❑ Shop drawings 5. Verified anchor diameter. X 6. Verified steel grade. [] RFI 0 Design change 0 Submittal D N/A 7. Verified hole diameter. X Document #(s) Dated: 8. Verified type of drill bit used. X 9. Verified hole cleaning method. 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. following page(s). 0 Yes No © N /A 11. Verified edge distance. 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. on following page(s). ❑ Yes No ® N/A 13. Verified installation torque. X 0 Conform ❑ Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR 2508 (9/1/09) WADE of RSV BUILDING SOLUTIONS Name of product being installed SIMPSON SET XP Batch Number 391V474V Expiration Date 6/30/11 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 Proprietary Anchors For: 07/14/2010 CTI Job #: T1002573 . Project: BURGERVILLE #45 (TIGARD) - NEW COMMERCIAL BUILDING SHELL 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 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: James Hietpas Review Date: 07/21/2010 KP /KA THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM TO: CITY OF TIGARD BUILDING DIVISION BK ENGINEERS INC - BILL BERRY ARCHITECTS ASSOCIATIVE - JEFF LIGHTHEART RSV BUILDING SOLUTIONS - JOSH LINGO RSV BUILDING SOLUTIONS - SHAWN AUBREY Send Office (541) 330 -9155 Geotechnical Office (503) 601 -3250 C 9 i o Eugene Office (541) 345 -02::9 arlson Testing I Salem Office (503) 589 -1252 Tigard Office (503) 684-3460 Daily Report of Stnictural Steel Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER Project: BURGERVILLE #45 (TIGARD) - NEW COMMERCIAL BUILDING SHELL CTI Job #: T1002573. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative R . BATY OBOA 411 was on site this date Jul. 09, 2 010 to perform Special Inspection for: Permit BUP2010 -00106 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: TOM INSPECTED SHOP WELDING OF: Company: EQUIPMENT ROUNDUP & MANUFACTURING INC (1) COLUMN PC /MK C -1 DRAWING S1. 2. Inspection was "IBC" 0 Continuous © Periodic (1) COLUMN PC /MK C -2 DRAWING S2. 3. Work performed: ❑ In the field © At fab shop (1) COLUMN PC /MK C-3 DRAWING S3. EQUIPMENT ROUNDUP & MANUFACTURING INC 4. If shop inspection do they have fabrication and QC procedures? © Yes ❑ No ❑ N/A INSPECTION Yes NoN /A 1. Reviewed previous inspection reports? 2. Verified steel materials are in compliance by reviewing random samples of the mill test reports, steel 1D X markings or other documentation. 3. Verified weld filler materials conform. 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. 1. Work inspected was: © Completed ❑ In progress 7. Verified the quality of welds produced by welders, welding operators, and tackers conform. X 2. Completed work inspected was in compliance with 8. Verified steel frame joint details for bracing, stiffening, 0 Approved plans and specifications N Shop drawings member locations, and application of joint details at each X RFI Design change E Submittal 0 N/A connection are in compliance by random sampling. Document #(s) Dated: 7-2-10 WELDER INFORMATION 3. Noncompliance item(s) were noted this date, details on Welders Name: ON FILE AT SHOP following page(s). 0 Yes 0 No © N/A Certification #: 4. Noncompliance item(s) were reinspected this date, details Yes No N/A on following page(s). 0 Yes El No © N/A 1. Verified the contractor's Welding Procedure Specifications are in conformance with X El Conform E Remain in progress AWS requirements. 2. Verified the essential variables outlined in the Report(s) findings were discussed and left with Welding Procedure Specifications were X TOM employed during execution of the work. of EQUIPMENT ROUNDUP & MANUFACTURING INC 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). 0 Distribute attachments. Page 1 of 1 '' 'ally Report of Structl Steel t'U0 07/09/2010 C` l job #: T7002573 . Project: BURGERVILLE #45 (TIGARD) - ; 1E W COMMERCIAL BUILDING SHELL 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 ft 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: James Hietpas Review Date: 07/16/2010 RB /KA THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM TO: CITY OF TIGARD BUILDING DIVISION BK ENGINEERS INC - BILL BERRY ARCHITECTS ASSOCIATIVE - JEFF LIGHTHEART RSV BUILDING SOLUTIONS - JOSH LINGO RSV BUILDING SOLUTIONS - SHAWN AUBREY Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 (541) 345-0289 Carlson Testing, Inc. S Euene Iem Office (503) 589 -1252 Tigard Office (503) 684 -3460 Daily Report of Wood Construction Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER Project: BURGERVILLE #45 (TIGARD) - NEW COMMERCIAL BUILDING SHELL CTI Job #: T1002573 . Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative R. GOUTHRO OBOA 646 was on site this date Jul . 15, 2010 to perform Special Inspection for: Permit BUP2010 -00106 DFS #(s) PO Number: SCOPE OF INSPECTION INSPECTION Yes No N/A 1. Checked in with superintendent, client or shop rep. 15. Verified 3" nominal framing members are provided and Name: WADE nails are staggered where shown on approved permit X documents. Company: RSV 16. Verified lag bolts, when part of the lateral force resisting 2. Inspection was "IBC" Continuous 11 Periodic system, have properly sized clearance holes for their X shanks and lead holes for their threaded portions. 3. Work performed: © In the field ❑ At fab shop 17. Confirmed bolt holes were a min. of 1/32" and a max. of 1/16" larger than the bolt diameter. X (If bolts are being installed during visit) 4. If shop inspection do they have fabrication and QC 18. Checked that shear walls of gypsum sheathing board Yes No N/A and /or gypsum wall board in combination with wood procedures? ❑ ❑ © framing conform to the applicable requirements of X the State Building Code, Ch. 23. INSPECTION Yes No N/A Location of inspection [to include grid lines, elevations 1. Reviewed previous inspection reports? x (floors) and drawing details]: 2. Verified grade, species and size of lumber, and ROOF SHEATHING ON NEW ADDITION TO BUILDING grade and thickness of wood structual panels used X in the vertical and horizontal diaphrams conform. SOUTH OF C LINE PER S2 EDGE NAILING 6" ON CENTER 3. Confirmed wood structural panels were manufactured PER S2 EDGE NAILING 6" ON CENTER AND FIELD 12" ON with exterior glue based on ID stamp. X CENTER AND CONFORMS PER DETAILS 1 AND 2 ON S4. 4. Verified nail or staple diameter and length, number of fastener lines, and spacing between fasteners in each X line and at edge margins is in compliance. 5. Verified length and location of all shear walls. X 6. Checked hold down installations at all shear walls. X REPORT SUMMARY 7. Verified diaphragm chord, drag strut, braces and related details. X 1. Work inspected was: © Completed In progress 8. Verified connection of blocking to wall top plates conforms. x 2. Completed work inspected was in compliance with 9. Confirmed pneumatic or mechanically driven fasteners are Approved laps and Sho p g roved ❑ drawings manufactured by a member of the International Staple, Nail and Tool Assoc. or in accordance with another X ❑ approved national standard. RFI ❑Design change El Submittal ❑ N/A 10. Verified when pneumatic or mechanically driven fasteners Document #(s) Dated: are substituted for common (or other specified) nails, that requirements for minimum diameter and penetration into X 3. Noncompliance item(s) were noted this date, details on the framing member are met, and notify the EOR. following page(s). ❑ Yes ❑ No ® N/A 11. Confirmed nail heads were driven flush without penetrating the surface ply of the wood structural panel. X 4. Noncompliance item(s) were reinspected this date, details 12. Verified installation of baseplate bolting was in on following page(s). ❑ Yes 0 No © N/A confromance. X 13. Verified wood to concrete contact meet EOR/Code ❑Conform 111 Remain in progress requirements (ie. treated). X Report(s) findings were discussed and left with 14. Confirmed panel edges bear on framing members and butt WADE along their center lines (with the 1/8" spacing between panel edge and end joists as recommended by the APA) of RSV that nails are placed not less than 3/8" in from the panel X edge, and that framing members or blocking are Based on the Code, approval is required from the Building Official before the provided at edges of all sheets in shear walls. 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 Wood Construction For: 07/15/2010 CTI Job #: T1002573 . Project: BURGERVILLE #45 (TIGARD) - NEW COMMERCIAL BUILDING SHELL 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 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: James Hietpas Review Date: 07/27/2010 RFG /KA THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM TO: CITY OF TIGARD BUILDING DIVISION BK ENGINEERS INC - BILL BERRY ARCHITECTS ASSOCIATIVE - JEFF LIGHTHEART RSV BUILDING SOLUTIONS - JOSH LINGO RSV BUILDING SOLUTIONS - SHAWN AUBREY