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Report Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 Carlson Testing Inc. Eugene Office (541) 345 -0289 (503) 589 -1252 ing Ic Salem Office Tigard Office (503) 684 -3460 Daily Report of Proprietary Anchors Client: BC CUSTOM HOMES CORP - DOUG WEEKS Project: LIEBREICH RESIDENCE - NEW CONSTRUCTION CTI Job #: T1104118. Address: 12760 SW GLACIER LILY CIRCLE TIGARD OR Jurisdiction: TIGARD CTI representative C. STASCH WABO 3011 /OBOA 331 /WABO SI 01132 was on site this date Apr. 07, 2 011 to perform Special Inspection for: Permit MST2010 -00154 DFS #(s) PO Number: JOB NO. 396 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. (3) 5/8" THREADED RODS, 7-1/2" MINIMUM EMBEDMENT Name: RYAN IN FOUNDATION AT LIVING AREA AND LAUNDRY AREA Company: DUAL FORCE CONSTRUCTION FOR (3) HDU4 HOLD-DOWNS. 2. Inspection was "IBC" © Continuous 1=1 Periodic NCL ITEM #1 WAS ADDED (SEE ATTACHED LIST FOR MORE INFORMATION). PROPRIETARY ANCHORS Yes No N/A 1. Reviewed previous inspection reports? 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: IN Completed L In progress anchors. x 2. Completed work inspected was not in compliance with 4.Verified installation of the anchors. x 5. Verified anchor diameter. ® Approved plans and specifications 0 Shop drawings x 6. Verified steel grade. x 0 RFI 0 Design change 0 Submittal 0 N/A 7. Verified hole diameter. x Document #(s) Dated: 8. Verified type of drill bit used. x 9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. x following page(s). E Yes ❑ No ❑ N/A 11. Verified edge distance. x 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. x on following page(s). ❑ Yes 0 No ® N/A 13. Verified installation torque. x fl Conform ❑ Remain in progress Evaluation report number & date: Report(s) fmdings were discussed and left with ESR -2322 (JULY 2010 - REV.) RYAN of DUAL FORCE CONSTRUCTION Name of product being installed HILTI RE 500 SD Batch Number 1311L3 Expiration Date 10/2011 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. fl See additional report page(s). 0 Distribute attachments. Page 1 of 1 Daily Report of Proprietary Anchors For: 04/07/2011 CTI Job #: T1104118 . Project: LIEBREICH RESIDENCE - 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 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: Neil Shannon Review Date: 04/13/2011 CDS /EAH BC CUSTOM HOMES CORP - DOUG WEEKS TO: CITY OF TIGARD BUILDING DIVISION PACIFIC NORTHWEST ENGINEERING INC - MARK ELLINGSEN MARK STEWART HOME DESIGN - MARK STEWART Carlson Testing, Inc. Incompleted Items List (NCL) Apr 14, 2011 T1104118. Project Name: LIEBREICH RESIDENCE - NEW CONSTRUCTION Project Address: 12760 SW GLACIER LILY CIRCLE TIGARD OR Permit No: MST2010 -00154 P.O. No: JOB NO. 396 Project Manager: NEIL S. SHANNON Item # Ins Date Item Description Compliance CTI Sign -Off Date Insp. P Corrected 1 CDS 04/07/2011 (3) 5/8" THREADED RODS WERE EPDXIED 7 -1/2" INTO FOUNDATION FOR (3) MISSING HDU4 HOLD - DOWNS. NO DRAWINGS ON JOBSITE TO SHOW WHAT EPDXY OR EMBEDMENT TO USE, NEED OKAY FROM ENGINEER. BC CUSTOM HOMES CORP - DOUG WEEKS TO :CITY OF TIGARD BUILDING DIVISION PACIFIC NORTHWEST ENGINEERING INC - MARK ELLINGSEN MARK STEWART HOME DESIGN - MARK STEWART Page: 1