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Report Main Office ilem Office Bend Office P.O. Box 23814 406uiludson Ave., NE P.O. Box 7918 ss�� g� ®® 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 Client: VIAL PHAM LLC - HOA PHAM Project: BELL RESIDENCE - REMODEL CTIJob #: T0807215. Address: 11161 SW SUMMERLAKE DRIVE TIGARD OR Jurisdiction: TIGARD CTI representative R. ANDREE OBOA 789 & D. WEYRAUCE were on site this date May. 29, 2 0 0 8 to perform Special Inspection for: Permit MST2008 -00033 DFS #(s) PO Number: SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid elevations (floors)- and_draw g details]: 1. Checked in with superintendent or client representative. lines � Name: CHRIS WES T, SI =DE��OEyH OUSELr, , ..- Company: TMC CONST. NORTH AND SOUTH CORNER CONNECTIONS OF NEW p FOUNDATION 2. Inspection was "IBC" ® Continuous El Periodic REBAR INSTALLED PER PLANS 3. Work performed: © In the field El At precast shop PROPOSED FOUNDATION /1ST FLOOR FRAMING NOTE: ICC REPORT NOT ON SITE. INSPECTOR 4. If shop inspection do they have fabrication and QC REFERENCED PERSONAL COPY. procedures? Ei Yes El No © N/A PROPRIETARY ANCHORS REPORT SUMMARY Yes No N/A 1. Reviewed previous inspection reports? X 1. Work inspected was: © Completed El In progress 2. Reviewed evaluation report? X 3. Verified manufacturer's anchor use conforms 2. Completed work inspected was in compliance with to acceptance criteria in report summary. X in Approved plans and specifications D Shop drawings Verified following items meet manufacturer's RFI El Design change El Submittal ❑ N/A published installation instructions. 4. Verified minimum embedment depth of the Document #(s) Dated: anchors. X 3. Noncompliance item(s) were noted this date, details on 5.Verified installation of the anchors. X following page(s). ❑ Yes ❑ No © 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). E Yes 0 No ® N/A X 9. Verified type of drill bit used. X Conform Remain in progress 10. Verified cleanliness of hole and anchor. X 11. Verified adhesive application. X Report(s) findings were discussed and left with EMILIO Evaluation report number ICC 1772 NOT ON SITE of TMC Name of product being installed S IMPSON SET 22 Batch Number UNREADABLE Expiration Date 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). Distribute attachments. Page 1 of Daily Report of Proprietary Anchc, For: 05/29/2008 CTI Job #: T0807215. Project: BELL 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: Russell Grant Review Date: 06/06/2008 RA /CK VIAL PHAM LLC - HOA PHAM FAX /503 597 - 2428 TO: CITY OF TIGARD BUILDING DIVISION HAYDEN CONSULTING ENGINEERS Main Office .. Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE D: 4 ;it , ' .. ; Carls g. w p Tigard, Oregon 97281 Salem, Oregon 97301 •1€ ;Id, • :� ' ! ( ' on Testing, Inc. Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 3 0 -' v Fax (503) 684 -0954 Fax (503) 589 -1309 Ft 141)i1-6603 i3 -6603 Daily Report of Proprietary Anchors CITY OFTIGARD Project: k \ a , 5 BUILDING DIVISION jj Address: i � k t 6.14.). �,„.,a ,A c +AR r /(4: vi CTI CTI Job #: 1 C 1_3C r ) j 5 p , jt \.�-+.� 7 CTI representative was on site this date On to perform (Inspector Name & Cert. No.) +, / of Special Inspection for Er permit ❑ DFS #(s) '/ t 1 00 ,:. - .) -, x`06.) z 5 jurisdiction v, r (,) r ' • In some cases more than one box may be checked for given item. SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid i V lines, elevations (floors) and drawing details]: �v' ' I. Checked in with su ermtendent or client representative. ''` ' - r ` �� t =' /'+ " ���° Name: , OGI. �. i.) l {` ! ` r 4 j l lAr2 ri t.ti '.eil 1 e.r rs 4 Com an ,� . ;/res9"t�.' i i ia. t r . 2. Inspection was "IBC" Continuous ❑ Periodic f r. t } a t ( , PROPRIETARY ANCHORS Ye,NoN /A I 1. Reviewed previous inspection reports? f 2. Reviewed evaluation report? 1 REPORT SUMMARY Verified following items meet manufacturer's published installation instructions. 1. Work inspected was: I Completed ❑ In progress 3. Verified minimum embedment depth of the 2. Completed work inspected I_J was ❑ was not anchors. 4. Verified installation of the anchors. J ' in compliance with 5. Verified anchor diameter. v El Approved plans a n d specifications El Shop drawings 6. Verified steel grade. El RFI Des gn ❑ Submittal ❑ N/A 7. Verified hole diameter. V Document #(s) Dated: 8. Verified type of drill bit used. 3. Noncompliance items) were noted this d te, details on 9. Verified hole cleaning - method;;., _ ! `' • following page(s). ❑ Yes No ` ❑ N/A 10. Verified adhesive application. .` 4. Noncompliance item(s) were reinspected this date, details 11. Verified edge distance. ✓ 12. Verified spacing. ; on following page(s). 0 Yes 0 No DN /A 13. Verified installation torque. t, ❑ Conform 0 Remain in progress Evaluation report number & date: Report(s) fmdings were discussed and left with y 7 C 3 qi of .., r :;',`r'" %'4,," , %t i. 4. ,� , Name of product being installed ,.t ;) c „O ” ' 7 1 5°1 C i3 l Batch Number i 2 , i - Ofl Expiration Date l; I Based on the Code, approval is required fl:orti. Building Official before the SPECIAL INSPECTED items noted above can be covered. Carlson Testing has no authority tp d'irett work of contractors or subcontractors. Inspector Signature: \i`" -\,3',.iW i 0 See report page(s). ❑ Distribute attachments. Page ' of PropAnch 06/16/08 Main Office Salem Office Bend Office ss�� P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Carlson Testing, Inc. Tigard, Oregon 97281 Oregon 97301 Bend, Oregon 97708 Phone one ( (503)03) 684-3460 Phone hone (503)589 -125125 589-1252 Phone (541)330 -915-915 330-9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client: VIAL PHAM LLC - HOA PHAM Project: BELL RESIDENCE - REMODEL CTI Job #: T0807215. Address: 11161 SW SUMMERLAKE DRIVE TIGARD OR Jurisdiction: TIGARD CTI representative R. SCHULTZ was on site this date Aug. 04, 2008 to perform Special Inspection for: Permit MST2008 -00033 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. INSTALLATION PER VERBAL FROM FOR Name: HOA PHAM Com an VIAL PHAM LLC (2) 5/8" X 10" ALL - THREAD WITH SIMPSON SET, p y' 10" EMBEDMENT ON EAST WALL OF GARAGE, FOR HOLDDOWNS. 2. Inspection was "IBC" ® Continuous Periodic ICC REPORT WAS ON SITE. HOLES CLEAN, BLOWN, BRUSH, BLOWN. 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: © Completed 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. RFI © Design change Submittal El 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). 1E1 Yes ®No El 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 D No ® N/A 13. Verified installation torque. X ❑ Conform El Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR 1772 (01/01/08) HOA PHAM of VIAL PHAM LLC Name of product being installed SIMPSON SET Batch Number 173202PP Expiration Date 10/31/09 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). ❑ Distribute attachments. Page 1 of 1 Daily Report of Proprietary Anchors For: 08/04/2008 CTI Job #: T0807215. Project: BELL 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: Russell Grant Review Date: 08/13/2008 RS /CK VIAL PHAM LLC - HOA PHAM FAX /503 597 - 2428 TO: CITY OF TIGARD BUILDING DIVISION HAYDEN CONSULTING ENGINEERS .w: - - - e "".; 4+� v � .17 y ;.,. n . r :,. : ; „�.'. - ?: . , ..: a �- .rt vo s ._ i - Ti ., :. ,,� : ads a �; r _ _ Main. Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Carlson 8 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 ��°I4 ®� 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: Q Jt,k \ k (Lt5 Address: I 1 t 17 t 6. . th t•"✓t Wt. r I ix, 1,) c CTI Job #: — I c 5c 3 15 CTI representative" I. was on site this date ,7 ' 1 0 0 to perform (Inspector Name & Cert. No.) of Special Inspection for E'permit 0 DFS #(s) Alf ' t 2C) C,GIJ : / jurisdiction °,' 4 ei' O In some cases more than one box may be checked for given item. SCOPE OF INSPECTION Location of proprietary anchors inspected [to include grid I alines, elev tions (floors) and drawing details]: l 1. Checked in with superintendent or lient representative. ,;t 1 I P � eP � � ` l Lt � � a`�i ; � � f U 4 E� 4 � °� n IA A E v �� 0 Company: 0 Vial iatvl (2 3 X 1 n r t 41 �-Le/ 4( to j , .' c.6,.• c. -cF 2. Inspection was "IBC" Continuous 0 Periodic ��'`� ``� "` �' . . (L- l4 ro r 4 i(Af i+ h G� Of < < 7• le 0 ryl ` J { ( a a , , . 10 CA./ , Z y , . . 4 . t l.+ k, d r �' U' , PROPRIETARY ANCHORS YNoN /A 1. Reviewed previous inspection reports? J 2. Reviewed evaluation report? V REPORT SUMMARY Verified following items meet manufacturer's published installation instructions. 1. Work inspected was: u Completed 0 In progress 3. Verified minimum embedment depth of the 1 2. Completed work inspected was 0 was not anchors. 4.Verified installation of the anchors. J in compliance with 5. Verified anchor diameter. ✓ Q Approved plans axe specifications EI Shop drawings 9.f � 6. Verified steel grade. �" 0 RFI D esign c ti ge 0 Submittal ❑ N/A 7. Verified hole diameter. Document #(s) Dated: 8. Verified type of drill bit used. 3. Noncompliance item(s) were noted this te, details on 9. Verified hole cleaning. method:-.: - U c followg page(s). s) . 0 Yes "' No 0 N/A 10. Verified adhesive application. ` / 11. Verified edge distance. J 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. ,/ on following page(s). ❑ Yes fl No u ' /A 13. Verified installation torque. r/ 0 Conform 0 Remain in progress Ev nation report number & date: Rep rt(s) findings were discussed and left with a E5p 1 , u) 1-1-07) � {{ o f ..-tom/ "71J l/i �t l C. r . , 1 Name of product being installed . ;,,A p V A 4. 4- r Batch Number �2�� Expiration Date I (' Based on the Code, approval is required m\ • - Building Official before the SPECIAL INSPECTED items noted above can be covered. Carlson Testing has no authori ! t work of contractors or subcontractors. , � - Inspector Signature: ( 0 See additional report page(s). 0 Distribute attachments. Page of (