Report (5) a
c•w ," •. .,.......,...... . ....__. ..,,.:, +�h ,<. - r<' „,..,,,,,,,,,, ,,-,,..,..,,.,!,.:.1/4.,, ,,,,,,,..,:i.:.,,,.,:: �'�Y9,:6 {+ •25.0`
r t • e LS' (Cr—t�t2_.j E ri ' re ( 1)34 -82Sf}
a ice 45i) �t c3Z3
. � Inc. (-Z'^l .S`*i 174-1 �'�° t>c (5 )SS -t?52
Daily Report of Proprietary Anchors 1 t� .- �
f'.3'(,.‘"3 L s w „_ �)-'
Project: I .,W__ R.'4`r'tv i _.. .. r:,
address: 1 s d . a` CT!Jit tt P.
CTI representative _a,,.t „_ ye_ �1 vVe.et, "�, ) ( 64' was on site this date _L _. top fo
(inspector Name&Cert.PIo.) Ga'r` 3 'i{ ' . ,, Le+
Special Inspection for pent i DFS s) `' I ; t' .5 f 1 1 I jurisdiction _,...
In some cases more than one box may be checked for a gi en item.
r SCOPE OF INSPECTION Location of proprietary anchors a :” inelttde d
lixtesa elevations fltxars)and.dra
I.Checked i Zvi superintendent or client representative: tS,' t' .. >�'c '
7\4atne- � ...
�..., G_ '.,�7 ....., ,.. r 1,,.t gyp- �,� 3°,� ....
� �"�' ' � ---
Company:
Company: __........... an.... ci „._. - f L6 �«� '; `t r',: o4 'a► .. .<
L.Inspection was"TBC" ontinuous Periodic �` r *'c i 3,• / `
e `ss••. ♦X . f I'''''' tr (I , a
PROPRIETARY ANCHORS „44.,..,,,,,,„,./114.! T -1.-4— , $ .. a — .
4,4 i.=.1.Reviewed previous inspection reports? , , a l-
Reviewed evaluation report? t"
REPORT SUMMARY
Verified following items meet rnanufactzuer's
published installation instructions. 1.Work'
inspected was: otrrpTeted 0 In groess
Ver'lied aninimuzn embedment depth of the
„anchors. 2.Completed work inspected vvas Q was not
erified installation of the anchors. t,� m .•ra.ltaoce with
I Approved plans and specifications drawings
terified anchor diameter. V Shop
ffi a ed steel grade
'A .' I ' 0 RFI 0 Design ange Li Submittal NIA
... d bole diameter. Document#(s) ,5 Dated: /3 I'4'
«t. ed type of drill bit used. t/f,,,..."' 3.Noncompliance items)were noted this date,details on
tif1ed hole cleani g method. �`
/ following pages). Yes �vc$ N/A
4.,. • adhesive application_ "fir
a edge distaiasae. ^ ,,,/- 4.Noncompliance itetre(s)were reinspected this date,details
on followingpage(s). Yes No [J N/A
',' led Iris €Ila tion'torque. ir?' 0 Confoim I_.:1 Remain in progress
r !ia «i;re ort number&date:
p Report(s)findings were discussed and left with
- of . _ ) tan,
, Pro- .ct bein installed -e, T- - ,
hex b d 1 '-
a m e Code.,approval is requirr ..om the B 'mg ` s $ ore the SPECIAL INSPECTED items noted above canhe
rl � arlson Teton' has s e rt is y to di ` t s tractors or
a RrSiguatsu _
• to additional rt page(s), [] Distribute attachments, Page a
.:
tea t rAa�chtpt5 'r" tt
;mac. �:
-
s �