Report �{ Main Offur Seder', Office Bend Office
Carlson ■ esting, Inc. BaO Sir
(03) 5 000 Hudson SL,A'E 630?SOB ell
1 Inc. Tigard, OR 97 ??3 Salem OR 97301 Brnd, OR 9770?
Phone: (503) 6b'J -3460 Phone (503) 589 -1 ?5? Phone. (541) 330-9155
Fax /5031684 -0954 Fax S5031589-1309 Fos (5411 330 -9163
Construction Materials Testing & Inspection
Special Inspection
FINAL SUMMARY LETTER
September 13, 2010
T0901159
City of Tigard
13125 SW Hall Blvd
Tigard, OR 97223 -8199
Attn: Building Department
Re: National Safety Co — New Office Building
7059 SW Gonzaga Street — Tigard, OR
Permit No.: BUP2009 -00077
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
Installation of Cast in Place Anchors
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 TESTING INC.
q ,(„ L i
Neil S. Shannon
Project Manager
NSS /rb
cc: National Safety Co Inc — John Skourtes Fax: 503 620 -5338
City of Tigard Building Division
James G Pierson Inc — Peder Golberg
Dibenedetto / Thomson / Livingstone — Michael Madias
Carlson Testing, Inc.
Incompleted Items List (NCL)
Sep 10, 2010
T0901159.
Project Name: NATIONAL SAFETY CO - NEW OFFICE BUILDING
Project Address: 7059 SW GONZAGA STREET TIGARD OR
Permit No: BUP2009 -00077
P.O. No: Project Manager: NEIL S. SHANNON
Item # Insp. Date Item Description Compliance CTI Sign -Off Date
Corrected
1 YV 09/18/2009 CONCRETE MIX DESIGN 30500ZW WAS NOT APPROVED BY APPROVED AS BUILT BY NEIL S. SHANNON 09/10/2010
EOR. PHONE CONVERSATION WITH
EOR PEDER GOLBERG.
9/22/09: PER INSPECTION THIS DATE, NCL IS STILL
OUTSTANDING.
CC:NATIONAL SAFETY CO INC - JOHN SKOURTES
CITY OF TIGARD BUILDING DIVISION
JAMES G PIERSON INC - PEDER GOLBERG
DIBENEDETTO /THOMSON /LIVINGSTONE - MICHAEL MADIAS
NATIONAL SAFETY CO INC - JOHN SKOURTES
Page: 1
SEP -13 -2010 MON 12:48 PM CARLSON TESTING INC. FAX NO. 5036840954 P. 02/03
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Carlson Testing, 1 1J//SII'/lur, 7221 allpP lHnlrrvi l7., NE 60:501
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Construct.Ion Materials Testing & Inspection fn "''`u, +lfaa -r01 Prv: /50313Hil -)31W r >n nau. {.(n.u
Special Inspection
FINAL SUMMARY LETTER
September 13, 2010
T0901159
City of Tigard
13125 SW Hall Blvd
Tigard, OR 97223 -8199
Attn: Building Department
Re: National Safety Co — New Office Building
7059 SW Gonzaga Street — Tigard, OR
Permit No.: BUP2009 -00077
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
Installation of Cast in Place Anchors
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 TESTING INC.
Cg . (1 . 4 41tAAA_4.4
Neil S. Shannon
Project Manager
NSS /rb
CC; National Safety Co Inc — John Skourtes r-ax: 503 6ZO -5338
City of Tigard Building Division
James G Pierson Inc — Peder Golberg
Dibenedetto / Thomson / Livingstone — Michael Medias
Carlson Testing, Inc.
Incompleted Items List (NCL) m
Sep 10,2010 -
TO901159.
ry
Project Name: NATIONAL SAFETY CO - NEW OFFICE BUILDING
Project Address: 7059 SW GONEAGA STREET TIGAaRD OR
Permit No: BIJP2009 -00077 30
P.O. No: Project Manager: NEIL S. SHANNON
Item # Insp. Date Item Description Date °'
P Compliance CTI Sign-Off Corrected `d
1 YV 09/18/2009 CONCRETE MIX DESIGN 30500Zw WAS NOT APPROVED BY APPROVED AS BUILT BY NEIL S. SHANNON 05/10/2010
ERR. PHONE CONVERSATION WITH a>
a0
FOR PEDER GOLBERG.
9/22/09: PER INSPECTION THIS DATE, NCL IS STILL
OUTSTANDING.
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CC: NATIONAL. SAFETY CO INC - JOHN SKOUR T ES
CITY OF TIGARD BUILDING DIVISION -o
JAMES G PIERSON INC - PEDER GOLBERG
DIBEiEDETTO /TDONSON /LIVINGSTONE - MICHAEL MADIAS o
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NATIOPJAL SAFETY CO INC - JOHN SKOURTES �
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Page: 1
Bend Office (541) 330 -9155
Geotechnical Office (503) 601 -8250
Carlson Testing, Inc. Salem Office (50)589 -1252
�6. 1 Salem Office (5033) 589 -1252
Tigard Office (503) 684-3460
Report of In -Place Asphaltic Concrete Density Tests
Date: 08/12/2010 Job Number: T0901159.
Permit #: BUP2009 -00077
Client: NATIONAL SAFETY CO INC - JOHN SKOURTES
Project: NATIONAL SAFETY CO - NEW OFFICE BUILDING
Address: 7059 SW GONZAGA STREET TIGARD OR
Description: HMAC 1/2" MIX C KNIFE RIVER
Rice Value: 151.9 Marshall Value: % Required: 92.0 Method of Test: ASTM D2950
Source of Value Dated 08/05/2010 was supplied by Knife River.
Standard Count for Gauge Serial #: Trox . 39510 Density: 2748 Calibration Date: _CIE 10
Date of Test Density Lift Thick- In Place
Test No. Test Location Mode Count No. mess Density Comp.
6'S OF CURB LINE END OF PLACEMENT AT CAST 1
08 -05 1 BS 1092 2" 140.9 92.8
100'W OF TEST 1 AT DRIVE APPROACH 1
08 -05 2 BS 1078 2" 141.9 93.4
Please see reverse side for additional information.
El Distribute attachments.
Job Number: T0901159. Date of Test: 08/05/2010
Date of Test Density Lift Thick- In Place %
Test No. Test Location Mode Count No. ness Density Comp.
Asterisked ( *) percent compaction test results did not meet listed acceptance criteria.
Remarks:
NATIONAL SAFETY CO INC - JOHN SKOURTES FAX /503- 620 -5338
TO: CITY OF TIGARD BUILDING DIVISION
JAMES G PIERSON INC - PEDER GOLBERG
DIBENEDETTO /THOMSON /LIVINGSTONE - MICHAEL MADIAS
NATIONAL SAFETY CO INC - JOHN SKOURTES
Typist: KA Test By: H . TIMZEN
Reviewed By: Neil Shannon On 08/11/2010
Test results were discussed and left withKIETH
Of KNL INDUSTRIES
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.
Bend Office (541) 330 -9155
Geotechnical Office (503) 601 -8250
Eugene Office (541) 345-0289
Carlson Testing, Inc. Salem Office
Tigard Office (503) 589 -1252
(503) 684-3460
Report Of In -Place Density Tests
Date: 08/10/2010 Job Number: T0901159.
Permit #: BUP2009 -00077
Client: NATIONAL SAFETY CO INC - JOHN SKOURTES
Project: NATIONAL SAFETY CO - NEW OFFICE BUILDING
Address: 7059 SW GONZAGA STREET TIGARD OR
REJECT KNIFE RIVER - COFFEE LAKE
Material Description:
Maximum Dry Density: 124.3 lbs. /cu. ft. Optimum Moisture: 13 % Required Compaction: 92
Standard Count for Gauge Serial # Troxler 39510
Method of Test: ASTM D2 92 2 , D3 017 / ASTM D698
Source of Value Dated 08/03/2010 is project specific.
Standard Counts - Density: 2727 Moisture: 640 Calibration Data: 06/2010
cyo In -Place Density
Date Of Test Test Density Moist. Ele. Field (lbs/cu. ft.) %
Code v
Mode Depth ( )
Test No. Location Count Count Ft. Moist. Wet Dry Comp.
1459 91 DT 2" TSG 5.5 120.1 113.8
08 -03 1 BC 200' PATCH NORTH SIDE GONZAGA 10'W OF DRIVEWAY CL 92
1 1484 1 86 I DT 1 2" I TSG 15.2 1 119 1 113.1
08 -03 2 BC 200' PATCH NORTH SIDE GONZAGA 50'E OF DRIVEWAY CL 91*
1 3549 1 115 1 DT 1 2" 1 TSG 1 7 1 125.6 I 117.4
08 -03 3 BC CENTER OF DRIVEWAY CL 94
I I I I
I I I 1 I
Please see reverse side for additional information.
❑ Distribute attachments.
Job Number: T0901159. Date Of Test: 08/03/2010
In -Place Density �•
Date Of Test Code Test Density Moist. Mode Depth Elev. Field (lbs /cu. ft.)
Test No. Location Count Count Ft. Moist. Wet Dry Comp.
I I I I I I I I
1 I I I
I I I I I I I I
I I I I 1 I I
I 1
Asterisked ( *) percent compaction test results did not meet listed acceptance criteria.
Remarks:
NATIONAL SAFETY CO INC - JOHN SKOURTES FAX /503- 620 -5338
TO: CITY OF TIGARD BUILDING DIVISION
JAMES G PIERSON INC - PEDER GOLBERG
DIBENEDETTO /THOMSON /LIVINGSTONE - MICHAEL MADIAS
NATIONAL SAFETY CO INC - JOHN SKOURTES
Typist: CN Test By: B . SHILHANEK
Reviewed By: Neil Shannon On 08/09/2010
Test results were discussed and left with GARY
of
Code Descriptions
NC - No code (general fill areas and backfill /original ground /not fil BC - Base course (Rock Only) ET - Electrical trench
SF - Structural fill (Buildings Non- Residential) RW - Retaining wall backfill GT - Gass line trench
LF - Residential lot engineered fill WT - Water line trench CT - Cable, phone trenches
RF - Roadway engineered fill (Soil Only) ST - Sanitary sewer trench
PS - Pavement subgrade DT - Storm drain trench
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.
Carlson Testing, inc.
NCL of Low Compressive Strength Tests & Compaction Tests
Aug 10, 2010
T0901159.
Project Name: NATIONAL SAFETY CO - NEW OFFICE BUILDING
Project Address: 7059 SW GONZAGA STREET TIGARD OR
PerinitNo: BUP2009 -00077
P.O. No: Project Manager: NEIL S. SHANNON
Compliance CTI Sign -Off Date
Corrected
Sample Type Register # Date Molded Date Tested Set # Days PSI Strength Req
Concrete 92424 09/22/2009 10/20/2009 28 2860 3000
Average f'c @ 28 days 2860
Concrete 92424 09/22/2009 11/17/2009 56 3510 3000
Location: FOUNDATION WALLS & ELEVATOR FOUNDATION
Sample Type Proctor Date Tested Test # o Comp Req % Comp
Soils 2 08/03/2010 BC 2 91 92
Location: 200' PATCH NORTH SIDE GONZAGA 50'E OF DRIVEWAY CL
NATIONAL SAFETY CO INC - JOHN SKOURTES
TO :CITY OF TIGARD BUILDING DIVISION
JAMES G PIERSON INC - PEDER GOLBERG
DIBENEDETTO /THOMSON /LIVINGSTONE - MICHAEL MADIAS
NATIONAL SAFETY CO INC - JOHN SKOURTES
Page: 1
Bend Office (541) 330 -9155
Geotechnical Office (503) 601 -8250
Carls ugene Office (541) 345 -0289
tA1 �s ®n Testing, Inc. I Salem Office (503) 589 -1252
Tigard Office (503) 684 -3460
Moisture - Density Relationship OD 9- 000 7
Client: National Safety Co. Inc. - John Skourtes
8/5/2010
Project: National Safety Co. - New Office Building Job Number: T0901159
Material Type: Reject Sampled from: Grade
Source: Knife River - Coffee Lake
Test Method: ASTM D -698 C, C -136, D -2216 Date Sampled: 08/03/10
Sample Method: ASTM D -75 Date Tested: 08/03/10
Preparation Method: Moist Oversized Material: Removed
Compacting Method: Manual Hammer Type: Circular
130 -
129
128
127
126
125
124
123
122
121
120
119
118 •
117
116
•
115
114
113 6
112
111
110
8 9 10 11 12 13 14 15 16 17 18
Moisture Content ( %)
Assumed 100% Saturation Curve: 2.800
Optimum Moisture:I 13.5% Max. Dry Density:I 124.3 I lbs/ft
Percent Passing 3/4" Sieve: 96.2%
cn
CC: National Safety Co Inc. - John Skourtes - Fax: 503 -620 -5338
City of Tigard Building Division
James G. Pierson Inc. - Peder Golberg
Dibenedetto/Thomson /Livingstone - Michael Madias
a ,
Reviewed By:
Neil S. Shannon
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 CT1 has distributed this report shall be entitled to use or rely upon the information contained in this
document.