Report (44) Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Inc.
Eugene Office (541)345-0289
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
/ i „
Project: Z. ,./e', Te v v ..,f C_ t\,, LA) / 01 '''" 1
•
C, 17
Address: i 7 3 61 6 7.;',1,,,,/ ::.; f ,4 -- , ,...,,,,,,i CTI Job#: ! / - ' - ' -• 1 t---)
CTI representative i)ie'iv ,,,,-,-1,,:,-, r f vtev, was on site this date •3 i' i ....) to perform
(Inspector Name&Cert.No.) /
Special Inspection for [ permit 0 DFS#(s) / 1 -1 2 016: 7— 44x
junsdiction , ---1 •(-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 details]:
...,' • - •-, (----.
1.Checked in with superintendent or client representative. / ; ' -1* (-7' ' 1*(- le -
7 , ,.
Name: 6--\ •
vIN. ... '- 1 '
Company
2.Inspection was"IBC" Er Continuous El Periodic
PROPRIETARY ANCHORS
Yes NoN/A
1.Reviewed previous inspection reports? tr"
• 2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: atnmpieted El In progress
3.Verified minimum embedment depth of the ,
I/ 2.Completed work inspected la-was 0 was not
anchors.
4.Verified installation of the anchors. ,.,"r in compliance with
5.Verified anchor diameter.
[3-Approved plans and specifications El Shop drawings
6.Verified steel grade. V
/ El RFI E1 Design change E:1 Submittal 0 NiA
• 7.Verified hole diameter. Li/ Document#(8) ILO -)4 I t4 d.,„ I.( Dated:
8.Verified type of drill bit used. ,z' 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. ti- following page(s). ID Yes [ 'No 0 N/A
10.Verified adhesive application. 1/
11.Verified edge distance. Y ' 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. / on following page(s). 0 Yes [ -No I=1 N/A
13.Verified installation torque. ' 1,./ 0 Conform 1:1 Remain in progress
Evaluation report number&date: Report(s)findings were discussed anh6ft with
r 1622,- '31 tti.)16 --r-
1 f
--- (2 of
A -
Name of product being installed ri t - $
Batch Number 4.--- •- '--*-''e •
Expiration Date i 1' --•;
Based on the Code,approval is required from the Building Official fore the SPECIAL INSPECTED items noted above can be
covered.Carlson Testing has no authority to direct work tors or subcontractors.
Inspector Signature_ -- ,..-.-
,...-‘......--- _
0 See additional report page(s). 0 Distribute attachments. Page i of '
, /2,..,•...
PropAnchors Ver.I 2/12/2009