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Report � . Main Office Sal Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Carlson Testing, Inc. 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 Project: Po t.LoCtt R. ri-S + 17r1. - l�rLM o � h: � .. . _ Address: 12 Ti 4 Sw M t Lc..V I Q...w CT. MI G A tZD , OR. CTI Job #: 7 2,..7 Z ' CTI representative G 2.E.G (+L.Fyt-1 I N 6 Of3oq # 81 4 was on site this date 10/t-3 /0e. to perform (Inspector Name & Cert. No.) Grr' . Special Inspection for ISrpennit DFS #(s) M STZ008 - Oo 1.-t 5 jurisdiction T t G A 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 drawing detai sj 1. Checked in with superintendent or client representative. 0 6S r.-2.V C P V . * t� . Ac + r1 d F (-6 • 5/8 •' 4 Name: „ST'EVC AC.L- TH2eA►7 10 CI-Ct i.t� 'Tb (ti-) cofJC.- Company: S LS Gv5 MOMtyS STE.r tr..aq L.L. F02. HT1 Z Z 51 C..-1 (i-t.•) ALL.. ` 2. Inspection was "IBC" 'Continuous 0 Periodic 1- lot.Dow,v s Lo r > e SM! 1 -1%) t N • a 2ri . 4 _ APPrLovii_D O(-' ti1GS a . SPIZC- t - THi. usr.. OF AT' F_ P0 . PROPRIETARY ANCHORS HAVG- VM215A1` APP20VAL- 1:12.0e1 EO2 Mn' YesNoN /A TATC2A2 T'o USC SST 22. ,t 1. Reviewed previous inspection reports? . 2. Reviewed evaluation report? x % . REPORT SUMMARY Verified following items meet manufacturer's published installation instructions. 1. Work inspected was: jg Completed El In progress anchors. �C ed minimum embedment depth of the - !r Wa 2. Completed work inspected s 0 was not ancho 4.Verified installation of the anchors. in compliance with 5. Verified anchor diameter. .2 Approved plans and specifications 0 Shop drawings 6. Verified steel grade. ❑ RFI 0 Design change D Submittal ❑ N/A 7. Verified hole diameter. x Document #(s) Dated: 8. Verified type of drill bit used. X 3. Noncompliance item(s) were noted this date, details on 9. Verified hole cleaning method. following page(s). El Yes ❑ No E N/A 10. Verified adhesive application. x 4. Noncompliance item(s) were reinspected this date, details 11. Verified edge distance. x r 12. Verified spacing. x 0 on following page(s). Yes ❑ No 51'N /A • 13. Verified installation torque. x ❑ Conform ❑ Remain in progress Evaluation report number & date: ' t . Report(s) findings were discussed and left with CSR - 177 L : ST� vE. 1/1 /2 007 of SLS CUSTDP1 HOtIE.S , Name of product being installed S I II P`' S e ` Z2 Batch Number 3793 379 73 0 L.L. . ' Expiration Date I 1 /06 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 authorityto_direct work of contractors or subcontractors. Inspector Signature: -- C -# See additional report page(s). 0 Distribute attachments. Page , of 1 PropAnch 'b6 /16/08 ,.. r °.. !‘r, 'M► eft , • . n r Terms Client recognizes that construction observation and/or testing services provided by CTI are techniques which may reduce the risk of construction defects, deficiencies, or omissions arising during or after con- struction. Services performed by CTI do not constitute a warranty or guarantee of any type. Even with diligent construction monitoring and /or testing by CTI, construction defects, deficiencies, or omissions in the Contractor's work may exist. In all cases, Client and /or the Contractor shall assign the Contractor the responsibility for the quality and completeness of the work and for adhering to plans and specifica- tions. CTI's work or failure to perform same shall not in any way excuse any contractor, subcontractor, or supplier from performance of its work in accordance with the contract documents. CTI will provide its professional services to Client with that degree of care and skill ordinarily exercised under similar circumstances by members of its profession. This representation is in lieu of other warran- ty or representation, either expressed or implied. It is also understood and agreed that statements made in CTI reports are observations based on technical judgments, and should not be construed to be con - clusive representations of fact. If conditions different from what are indicated in the reports come to Client's attention after receipt of the reports, it is recommended that Client contact C TI immediately to authorize further appropriate evaluation. CTI's work shall not include determining, supervising or implementing the means, methods, techniques, sequences or procedures of construction. CTI shall not be responsible for evaluating or reporting job con- ditions related to health, safety or welfare. • Main Office .lem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Carlson Testing, Inc. Tigard, (503) Oregon 684 97281 Salem, (503) 589-1252 97301 Bend, Phond, (541) 330-9155 97708 Phone -915 hone (503) -60 Phone (503) 5125one (541) 3-9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client SLS CUSTOM HOMES INC - KIMIE CAMPBELL Project: POLLOCK RESIDENCE - REMODEL CTI Job #: T0808272 . Address: 12394 SW MILLVIEW COURT TIGARD OR Jurisdiction: TIGARD CTI representative G. FLEMING OBOA 814 was on site this date Oct. 08, 2008 to perform Special Inspection for: Permit MST2008 -00145 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. OBSERVED PLACEMENT OF (4) 5/8" DIA ALL - THREAD Name: STEVE 10" EMBED TO (3) CONC. STEM WALL FOR HTT22 Company: SLS CUSTOM HOMES SHEARWALL HOLDDOWNS LOCATED AT SW LIVING ROOM 2. Inspection was "IBC" © Continuous fl Periodic WALL. APPROVED DRAWINGS SPECIFY THE USE OF "AT" EPDXY. HAVE VERBAL APPROVAL FROM FOR MO TAJDAR PROPRIETARY ANCHORS TO USE SET 22. Yes NoN /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 ® Approved plans and specifications 0 Shop drawings 5. Verified anchor diameter. X 6. Verified steel grade. El RFI 0 Design change El 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. 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. X following page(s). 0 Yes 0 No N/A 11. Verified edge distance. 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. on following page(s). 0 Yes El No ® N/A 13. Verified installation torque. X 0 Conform 0 Remain in progress Evaluation report number &date: Report(s) findings were discussed and left with ESR -1772 (01/01/07) STEVE of SLS CUSTOM HOMES Name of product being installed SIMPSON SET 22 Batch Number 379730LL Expiration Date 11/2008 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. El See additional report page(s). 0 Distribute attachments. Page 1 of 1 Daily Report of Proprietary Ancbu. For: 10/08/2008 CTI Job #: T0808272. Project: POLLOCK RESIDENCE - REMODEL 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 further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: Keith Gauvin Review Date: 10/10/2008 GF /CK SLS CUSTOM HOMES INC - KIMIE CAMPBELL FAX /503 692 - 7983 TO: CITY OF TIGARD BUILDING DIVISION KOVAC DANIELS DESIGNS - DAN KOVAC FAX /503 628 - 2313 SLS CUSTOM HOMES INC - KIMIE CAMPBELL