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Report Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 ugene Office (541) 345 -0289 C arison Testing, Inc. I Salem Office (503) 589 -1252 Tigard Office (503) 684-3460 Daily Report of Proprietary Anchors Client: VERDE HOMES - SCOTT THOMPSON Project: RESIDENCE B 7158 SW ASH CREEK COURT - NEW CONSTRUCTION CTI Job #: T1104003. Address: 7158 SW ASH CREEK COURT PORTLAND OR Jurisdiction: TIGARD CTl representative H. TIMZEN OBOA 349 /WABO SI 01139 was on site this date mar. 16 , 2011 to perform Special Inspection for: Permit MST2007 -00129 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. (1) 5/8" ALL THREAD RE ENGINEERED FOR NEW DOOR Name: ANTHONY AT CRAWLSPACE FOR HOLDDOWN AT NEW DOOR PER Company: GIBSON p ROWELL ENG. DATED 03/07/2011. 2. Inspection was "IBC" el Continuous n Periodic CONCRETE APPEARED SOUND AND OF UNKNOWN STRENGTH. 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 0 In progress anchors. x 4.Verified installation of the anchors. 2. Completed work inspected was in compliance with x ❑ Approved plans and specifications El Shop drawings 5. Verified anchor diameter. x 6. Verified steel grade. x RFI © Design change fl Submittal 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 x following page(s). Yes No N/A 10. Verified adhesive application. x — 1 1 . Verified edge distance. x 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. x on following page(s). 0 Yes ❑ No E N/A 13. Verified installation torque. x fl Conform ❑ Remain in progress Evaluation report number R date: Report(s) findings were discussed and left with ESR -1772 (LEGACY) ANTHONY of GIBSON Name of product being installed SIMPSON SET Batch Number UNREADABLE Expiration Date 08/31/12 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). 0 Distribute attachments. Page 1 of 1 Daily Report of Proprietary Anchors For: 03 / 16 /2011 CTI Job #: T1104003 . Project: RESIDENCE @ 7158 SW ASH CREEK COURT - 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 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: 03/18/2011 HT /CK VERDE HOMES - SCOTT THOMPSON SCOTT @VERDE - HOMES.COM TO: CITY OF TIGARD BUILDING DIVISION