Report (37) 5� DDVr ,
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Bend Office (541)330-9155 .
Geotechnical Office (503)601-8250
(541)345-0289
Carlson Testing, Inc. Eugene Office
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: ' v!t,--- 1-
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CTI Job
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CTI representative was on site this date _..� to perform
(Inspector Name&Cert. No.)
Special Inspection for ® permit 0 DFS#(s) ---�^ '' /1 -- -- jurisdiction r'�` `_"� "
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]:
I. Checked in with superinten, ent or client representative. t`/ 4;1 .. ,ii ' _ -'frit` -✓,..,.(11 ;,.,
Name: // 1#,-;),-,
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Company: e(e r 1-c) ,/-4 -
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2.Inspection was "IBC" E Continuous E Periodic ~ "
PROPRIETARY ANCHORS
Yes No N/A eP, �a��„/e (2:1) < " 4 r gpic) -1-
1.;Reviewed previous inspection reports? t,'
2.Reviewed evaluation report? Y
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions.
1.Work inspected was: 1E1 Completed El In progress
3.Verified minimum embedment depth of the
anchors. O2.Completed work inspected was was not
k
4.Verified installation of the anchors. in compliance with
5.Verified anchor diameter. Q Approved plans and specifications Shop drawings
•
6.Verified steel grade. El RFI ❑ Design change 0 Submittal N/A
7.Verified hole diameter. -.4. Document#(s) •1 ' r""`r Dated: t 9R,/�' =,
8.Verified type of drill bit used. X 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. 'c following page(s). El Yes E No ® N/A
10.Verified adhesive application. sir,.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. . ,‹ on following page(s). E Yes El No 0 N/A
13.Verified installation torque. ''!C 0 Conform III Remain in progress
Evaluation report number&date: Report(s)findings wereetscussed and left with
po,
Q1 .2 C)!(, of 1p�-'."' ,
Name of product being installed -S ' .8-7/5-`r'- A s .,.. P
Batch Number / 2-,,,I; :
t
Expiration Date / 73-/ -0-'' 1
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 irect or f conyactors or subcontractors.
a
Inspector Signature: -`' d
nSee additional report page(s). n Distribute attachments. Page of
PropAnchors Ver.1 2/12/2009