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Report Main Office Clem Office Bend Office P.O. Box 23814 400„ Hudson Ave., NE P.O. Box 7918 Carlson Testing, Inc. Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 i A'''' Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330-9163 Daily Report of Proprietary Anchors Project:,rLL,q V/.57 - n ' 5Z/60 /1/ /.SIQA/ _ - /9 - , f -- - -- - - -- /� 7ZJ .57.0 J� V /NC/ L-9^/1--- _ CTI Job #: f A72 ? 0 7 Address: - -- - - - -- - -- ` CTI representative /1lG/�/ /rte — was on site this date__ 7 to perform (Inspector Name & Cert. No.) J�� Special Inspection for i permit DFS #(s) /V`5 iwae 5- --,61171/Z jurisdicti r!'' l / � / 2 �� S P p �I P ❑ In some cases more than one box may be checked for a given item. SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid lines, elevations (floors) and dravOng details]: 1. Checked ' with superintendent or client representative. l}� Q�e0 /NS -- 7 - A1119 "T7J� of Name: ,QJVI LD + ! 7 // - 2 - R %eAO / /, 0/1.$ Company /y r ! 'tIQ E D 6 4 t :' - ) ` .1 ' 2. Inspection was "IBC" ❑ Continuous ❑ Periodic 3. Work performed: ❑ In the field ❑ At precast shop -- - Shop name: ` - 4. If shop inspection do they have fabrication and QC __ procedures? ❑ Yes ❑ No ❑ N/A _ (. PROPRIETORY ANCHORS REPORT SUMMARY Yes No N/A 1. Reviewed previous inspection reports? X 1. Work inspected was: M Completed ❑ In progress 2. Reviewed evaluation report? Y 3. Verified manufacturer's anchor use conforms 2. Completed work inspected f'was ❑ was not to acceptance criteria in report summary. in compliance with ® Approved plans and specifications ❑ Shop drawings Verified following items meet manufacturer's RFI ❑Design change El Submittal 1:1 N/A published installation instructions. 4. Verified minimum embedment depth of the Document #(s) _ _ __ Dated: l 2 y - b S anchors. 3. Noncompliance item(s) were noted this date, details on 5.Verified installation of the anchors. X following page(s). LI Yes ❑ No rg N/A 6. Verified anchor diameter. K 7. Verified steel grade. ' Y. 4. Noncompliance item(s) were reinspected this date, details 8. Verified hole diameter. . e on following page(s). ❑ Yes El No a N /A 9. Verified type of drill bit used. 'Y ❑ Conform ❑ Remain in progress 10. Verified cleanliness of hole and anchor. Y �r Report(s) findings were discussed and left with 11. Verified adhesive application. 412A /0 L 0 43 /Z . 17 - 7 � f ir "" =BS :� A/6 imp /— ,ni 71 �a� _ /o Evaluation report number __ — — _ o f _s Name of product being installed _/" 7 -5coi _ 6 / 7 Z. Batch Number / 7..j2O 8z- - _ _ - -- -- — — -- - — - B xpiration Date /o o __ — - - - -- - - - -- ased on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above can be covered. Carlson Testing hasp() authority to diregt of contractors or subcontractors. Inspector Signature: / - /�J - - - - - -/ ! Q ee adrMthlona repor page(S}. ll D��Cr�bli1 511d�lllil�lltc. NO ._.10 11—._.. .... j .. j 1t ❑ , t (I PropAnch 05/02/06 Main Office ,alem Office Bend Office • P.O. Box 23814 406(1 Hudson Ave., NE P.O. Box 7918 r • n Inc. Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Carlson Testing, In Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client: REESE GENERAL CONTRACTORS INC - ARNOLD REESE Project: BELLA VISTA SUBDIVISION - LOT 19 CTI Job #: T0601169. F Address: 12703 SW DA VINCI LANE TIGARD OR Jurisdiction: TIGARD CTI representative A. NUNLEY was on site this date Mar. 01, 2007 to perform Special Inspection for: Permit MST2005 -00412 DFS #(s) PO Number: • SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid 1. Checked in with superintendent or client representative. lines, elevations (floors) and drawing details]: Name: ARNOLD Company: REESE GENERAL CONTRACTOR • OBSERVED THE INSTALLATION OF (1) 7/8" ALL - THREAD 2. Inspection was "IBC" [—xi I Continuous n Periodic 1-1/8" DIAMETER 14" EMBEDMENT 6" 0.C. PER DETAIL 3. Work performed: © In the field n At precast shop s 1 4. If shop inspection do they have fabrication and QC procedures? n Yes n No [] N/A PROPRIETARY ANCHORS REPORT SUMMARY Yes No N/A 1. Reviewed previous inspection reports? x 1. Work inspected was: I I Completed El In progress 2. Reviewed evaluation report? x 3. Verified manufacturer's anchor use conforms x 2. Completed work inspected was in compliance with to acceptance criteria in report summary. x Approved plans and specifications n Shop drawings Verified following items meet manufacturer's El RFI ❑ Design change 0 Submittal I I N/A published installation instructions. • 4. Verified minimum embedment depth of the Document #(s) _ Dated: 12 - 08 - 05 anchors. X 3. Noncompliance item(s) were noted this date, details on 5.Verified installation of the anchors. x following page(s). (s). Yes No x N/A 6. Verified anchor diameter. x 7. Verified steel grade. x 4. Noncompliance item(s) were reinspected this date, details 8. Verified hole diameter. on following page(s). n Yes n No I x l N/A X 9. Verified type of drill bit used. x [] Conform I I Remain in progress 10. Verified cleanliness of hole and anchor. x 11. Verified adhesive application. x Report(s) findings were discussed and left with ARNOLD Evaluation report number ESR- 1772 o f REESE GENERAL CONTRACTOR Name of product being installed SIMPSON SET22 Batch Number 175208LL Expiration Date 10/08 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. 7 See additional report page(s). ril Distribute attachments. Page 1 of 1 Daily Report of Proprietary Ancho,_ For: 03/01/2007 CTI Job #: T0601169 . F Project: BELLA VISTA SUBDIVISION - LOT 19 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 full, without prior authorization from this office. If there are any urther questions regarding this matter, please do not hesitate to contact this office. Respectfully .ubmitted, .. _, CARLSO T[STI ', NC. • James ,- i-tpas Ope - tions Manager /JWA CC :REESE GENERAL CONTRACTORS INC - ARNOLD REESE CITY OF TIGARD BUILDING DIVISION CSA CONSULTING ENGINEERS MCNAUGHTON ASSOCIATES INC