Report (11) [ ;LF2-Y 54,, ✓
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Eugene Office (541)345-0289
Carlson Testing, Inc. Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: -
Address: _—___—_ _.___ CTI Job#:
CTI representative (Inspector Name&Cert.No.) was on site this date to perform
Special Inspection for ❑ permit ❑ DFS#(s) _— _ jurisdiction _
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.
Name:
Company: --
2.Inspection was"IBC" F1 Continuous Periodic -
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports?
2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: E] Completed F-1 In progress
3. Verified minimum embedment depth of the 2. Completed work inspected ❑was was not
anchors.
4.Verified installation of the anchors. in compliance with
5. Verified anchor diameter. Approved plans and specifications E] Shop drawings
6.Verified steel grade. RFI E] Design change D Submittal N/A
7.Verified hole diameter. 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). F� Yes E] No E] N/A
10. Verified adhesive;application.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected:his date,details
12.Verified spacing. on following page(s). Yes i`To N/A
13.Verified installation torque. Conform Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
- of
Name of product being installed _
Batch Number
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 authority to direct work of contractors or subcontractors.
Inspector Signature:
See additional report page(s). Distribute attachments. Page of
PropAnchors Ver.1 2/12/2009
,�_ A,:
Clic°rlt reco xrris t}r,rt i;�ah�ir cuti��r}obsen atioll arld`trr prm ided 1)% CI I arc techrriqu-,y
tn-brch €1ti11 E'E'.CIErce 1,7e rt d, t)( ;:i)i1St2'k[C 3:i[M d iCcLs, del cielleics_or tar kl ions arising dlrrrn�z or after Coll-
struction> Services perrtiir,rircd'D� (-11 do nol Corlst.itrrtc,a tiaarr,miv c+r gU lraw.te-ol`auv type.I'ier ,viLh
diliwrent Corl.?ructiorr fflolaitonll� arildlor te,tin-b; („l t,corrll uc-tisrrl cleiects.detic.ic:rrcic,,or ornisiion5
ill iltc' v ork€na� (rt X11 cases,cli,rw and'o lhy.C'ollu"Ictor Shall as-,iLm lira C ontr;zcloti
the respolisiNlil� iter°Cite qualk'N and cofll pleteness oCtlle work and I'Or adhering to playas and spe=iii ra-
tions. C TI's \Nork or lailurc to pearl'r>rm sarare shall no in.arra v'm excuse aril Colltractut•.suhcorrtraclor,
or supplier-From pc rigrinarlce of its%wrk in ac COPCIarlcea %milli the Colltl-ICL docualerlts.
E.T1 will pr(m Me its poii ssiomlll serf icv"s to C'liemt with that 'c—loc and skill ordiraaril� c-crciscd
crrlclel ,irnrla: rncrnbcr s of its profi siirrr.'t f,r,rehrc5crrt.ttic�rr is itl ticcr oi`c>thcl ttarrtrrl-
t� Or Nil-.sc.rltauorl,either e-,qpressCd or implied.It is A o under-stood and agreed Lh it sta€ternerlt's mad%
ill C reports are obscrr�atiorrs based oil tcc�hnical,j�cldetllent,,arld should.1101,be constrErcd t«tie cc+n-
elusivC rc pl-csc ntatiolls of fact. It'Conditions diilcrCrrt 1,will o�hat are indicated in the reports corm:to
Clic€lt's att<rltiolt artier rccc ipt ofthe reports,it is rccommcndcd tfwt Client cerltact d`H illiawdialck to
aw or3Zc iurt Cr appropriate ck Juati{)n,
C 11's stork shall riot include C1Ctermillitlg,surra,rsirlg or irnpiCC7wfaing the nicalls,rrletllods_1CcI1rljques,
st`tltre.rWcs,or proccdcrres ofccnistructiun,t'"H-stlaill noC tic mpr;rsiblct fir cvalu rtira or reporting job con,
ditions'deli,to Il{ r!lfl.sa ta,ty oi.v Clillre.