Report MST' 490/q 00/3 Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testi Eugene Office (541)345-0289
ng, ne• Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: 614 Li hW/ —_
Address: j;4 39 sw //1//rh,i 1i( CTI Job#: #74'O /5,,/l
'
CTI representative • q41Z1tr '' was on site this date ��I r f�,r _ to perform
- (Inspector Name&Cert.No.)
/HS LON -0.06/ udc ____Special Inspection for permit #(s) jurisdiction
.
i
( 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 details]:
1. Checked in with superintendent or client representative. 1 /z� Siij 11 41/ ij t A9 jb' LM t v1 /t-vi
Name: i "\ L N fro p,. c Fill r h cn wA?/
Company: YcYPt
/� `Z) C AC-0 SI DE of 1 IZ1 A.A+ i 1✓t ra
2. Inspection was"IBC" F-' Continuous El Periodic
a 1[5 _
PROPRIETARY ANCHORS
Yes No N/A
1. Reviewed previous inspection reports? L CW WOE-GI-n-2 13eo C`Lte-k . 9i7/1/
2. Reviewed evaluation report? k-� REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions.
P 1.Work inspected was: D Completed I=1 In progress
3. Verified minimum embedment depth of the k., 2. Completed work inspected (was 0 was not
anchors.
4.Verified installation of the anchors. v- in compliance with
5. Verified anchor diameter. Approved plans and specifications El Shop drawings
6. Verified steel grade. ✓' RFI El Design change ❑ Submittal LI N/A
7. Verified hole diameter. 1.--' Document#(s) Dated:
8. Verified type of drill bit used. ✓ 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. / following page(s). El Yes IZI No 0 N/A
10. Verified adhesive application. ✓
11. Verified edge distance. v'` 4.Noncompliance item(s)were reinspected/this date,details
12. Verified spacing. ✓ on following page(s). El Yes No 1E1 N/A
13. Verified installation torque. .-' El Conform ❑ Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
1. -f5 of 22C
Name of product being installed `fi T 19
Batch Number-- -11P/522P X ;> 4
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 autltayrity to direct work of contractors or subcontractors.
Inspector Signature: - •J
LiSee additional report page(s). El Distribute attachments. Page of
PropAnchors Ver.1 2/12/2009