Report (2) 1.4tvi---a-6 i(p —co 76?Ci3
B
Carlson Testing, ent Office (541)3330-91551
Inc• Geotechnical Office (503)601-8250
Eugene Office (541)345-0289
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of proprietary Anchors
Project: ldil ,
1111._
Address: 1 2 'i" .s(.4.) <<;ti.�'
. ".�."• -
CTI representative " - CTI Job#: ___ jai�j/,s vv
i�j'
f (I Spector Name Cert.No.) '� was on site this date �'/�� f to perform
Special Inspection for permit ® DFS#(s) - ,�ci/
��`�� jurisdiction '- _ _
In some eases more than one box may be checked for a given item.
SCOPE OF INSPECTION Location of proprietary anchors inspected[to include grid
1.Checked in with su lines,elevations(floors)and drawing details]:
perintendent or client representative.
• Name: _ ___ �P} _
Company: ����,' a. ��c' Kczt
2.Inspection was"IBC" i .
., Continuous Periodic 4" ' '� _ _ 7
•
C',a i
PROPRIETARY ANCHORS 4/l ' ,_ ___ n_�s tom• s��r�dcL r a
Yes No N/A f
1.Reviewed previous inspection reports?
2.Reviewed evaluation report? 111111111'
Verified following items meet manufacturer's REPORT SUMMARY
published installation instructions.
3.Verified minimum embedment depth of the 1•Work inspected r--, • 0 Completed ❑ In progress
anchors. 111111 2.Completed work inspected :r—�
4.Verified installation of the anchors. I_J was ® was not
in compliance with
5.Verified anchor diameter. .R Approved plans and
6.Verified steel specifications El Shop drawings
grade. :■. RFI Design change
7. Verified hole diameter. g Li Submittal � N/A
8.Verified type of drill bit used. ■:: Document#(s) .dP- . Dated: - s__ _- 2v;z
9.Verified hole cleaning method. 1111111.Noncompliance item(s)were noted this date,details on
10.Verified adhesive application. rill .. following page(s). 0 Yes El No
11.Verified edge distance. 4. 0 N/A
::: Noncompliance item(s)were reinspected this date,details
12.Verified spacing. on following page(s). 0 Yes
13.Verified installation torque. 53 No i� N/A
��� 0 Conform ED Remain i.m^gess
Evaluation report number&date:
ER
,, ; Report(s)findings were discussed,,ind left with
of
Name of product being installed ;� ,�� ---'��`'r ,,te ��lye
Batch Number
Expiration Date
R' on the Code,approval —`— ---
is from the Building Official before the SPECIAL INSPECTED items noted above can be
'.Carlson Testing has no a ority to direct work of contractors or subcontractors.
Signature: _.--7,-‘70 -,�' —A
litional report page(s). 0 Distribute attachments.
Page__i_____of
PropAnchors Ver.1 2/12/2009
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 alter 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 no in any way excuse any contractor,subcontractor,
or supplier from performance of its work in accordance with the contract documents.
co 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 wan-aa-
ty or representation,either expressed or implied.It is also understood and agreed that statements made
in CTI reports are observations based on technical judgements,and should not he construed to he con-
clusive representations of fact. if conditions different from what are indicated in the reports come to
Cheat's attention after receipt of the reports,it is recommended that Client contact CFI immediately to
authorize further appropriate evaluation.
CTI's work shall not include determining,supervising or implementing the means,methods,techniques,
sequences,lor_ eprocedures of construction.CTI shall not be responsible for evaluating or reporting job con-
to health,saity or
.