Report (43) Bend Office
Carlson Testin (541)330-9155
Geotechnical Office (503)601-8250
g1, Inc. Eugene Office
Salem Office (541)345-0289
Tigard Office (503)689- 460
Daily Report of Proprietary Anchors (503)684-33460
Project: o/y,. . tlfL/ Q
"` 4. 0
Address:
--<`--as--�) _ a,'CYC l�
..r ,a
CTI representative --- ,. ,f„ :ICr CTI Job#: _z_6___.<-___7,s:: �I � c�
a ` was onsite this date --
"�spector Name&Cert.No.) � to perform
Special Inspection for
hermit ❑ DFS#(s) ---t11. -7.-20 r? --o oa q
A. jurisdiction +T'ra s-c�
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
1.Checked in with superintendent or client representative. lines,elevations(floors)and drawing details]:
Name: r To ...
c. -iv �y,
,�, e,
Company: .,/ : �� r
2.Inspection was"IBC"
❑ Continuous �r,...,„„,„,,,,,,,.4,,,,/,, ,47.,-
�eriodic , •'c:�, / d.,,•..., 7 s
PROPRIETARY ANCHORS " `-CF-7= e /--."
CY r O Cap G.�«.
-M,Reviewed previous inspection reports? Yes NoN/A /��cr�
DJ ra.e7.ti
IIIIIIM
- ,;,::Reviewed evaluation report?.
Verified ��®
following items meet manufacturer's REPORT SUMMARY
published installation instructions.
3. Verified minimum embedment depth of the 1. Work inspected was:
Verified
111111 Completed In progress
an
4.Verified installation of the anchors. 2. Completed •work inspected
�'■■ in co .fiance with ❑'was ❑ was not
5. Verified anchor diameter.
6.Verified steel am
�n. �` • °•roved plans and specifications
grade. �t. El
drawings
7.Verified hole diameter. RFI ❑ Design change uDatedl 0 N/A
8. Verified type of drill bit used.
Document#(s) _ ��
9. Verified hole cleaning method. `�—d Dated: ,1 _rT_
��= 3.Noncompliance item(s)were noted this date,details on
10. Verified adhesive application. followingn�
11. Verified edge distance. �i■ page(s). Yes Lam'lvo ❑ N/A
12.Verified spacing. Amin 4.Noncompliance item(s)were reinspected this date,details
13. Verified installation torque. [',r on following page(s). ❑ Yes ❑ �-. ��
No I.� "'q
IIIIIIM ❑ Conform ❑ Remain in progress
Evaluation report number&date:
o g Report(s)findings were discussed and left with
Name of product being installed ,� °f r17
Batch Number
kpiration Date ____�, s
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: ^
0 See additional report page(s).
❑ Distribute attachments.
Page-- —of ______
PropAnchors Ver.1 2/12/2009
Term
os
Client recognizes that construction observation and/or tent orvices provided
dediby CTIa aftertechniquesu
which may reduce the risk of construction defects,deficti. any during ortype. Even con-
with
struction. Services performed by CTI do esr r'onstitC_uTt r corastru warranty
defects,guarantee or deficiencies, or omissions
diligent construction monitori�, and. g by
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 e adheringaly to plans
la ssubcontractor,
and
ecifica-
dons. CTI's work or failure to perform same shall not y Y
or supplier from performance of its work in accordance with the contract documents.
nar
ily
CTI will provide its professional services to Client with that degree f are adsskillie odiootheriexercised
warran-
under similar circumstances by members of its profession.Thiss
ty or representation, either expressed or implied. It is also understood
d and afire 1 eeed thatstated tots mcon-
ade
in CTI reports are observations based on technical judgments,
rts come to
c;usive representations of fact. If conditions different
recommended that Clirent contact CTI idicated in the mmediately to
Client's attention after receipt of the rep
orts,it authorize further appropriate evaluation.
C";I's work shall nor include determining,supervising or implementing r
ng he e tial;or means,methods,odstechniques,job
sequences or procedures of construction.CTI shall not be responsible
s related to health,safety or welfare.