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Bend Office (541)330-9155
Carlson Testing, 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: RESIDENCE@10025 SW JOHNSON ST CTI Job No.: T1702234
Job Address: 10025 SW Johnson St.Tigard, OR Jurisdiction: Tigard
CTI Representative Jim Wemple was on site this date 07-25-2017 to perform Special Inspection for:
Permit MST2017-00032
Location of proprietary anchors inspected[to include gridlines,elevations(floors)
SCOPE OF INSPECTION And drawing detail(s):
On site to observe,verify and inspect installation of the following epoxy anchor
1. Checked in with superintendent,client or shop rep. systems:
Name: Josh
Installation of 5/8"threaded rod to 14"minimum embedment at(2)locations,
Company: Josh Jones 20"minimum embedment at(2)locations and 11"minimum embedment at(7)
2. Inspection was"IBC" locations using Simpson SET-XP epoxy adhesive at HDU2 locations at
P X Continuous Periodic foundation level.
PROPRIETARY ANCHORS
See Dwg:2/S3.1&1/S3.2
Yes No N/A
1. Reviewed previous inspection reports? X
2. Reviewed evaluation report? X
Verified following items meet manufacturer's published installation instructions REPORT SUMMARY
3. Verified minimum embedment depth of the anchors. X 1. Work inspected was: X Completed In progress
4. Verified installation of the anchors. X 2. Completed work inspected X was was not
5. Verified anchor diameter. X in compliance with
6. Verified steel grade. X X Approved plans and specifications Shop drawings
7. Verified hole diameter. X RFI Design change Submittal N/A
8. Verified type of drill bit used. X Document 4(s) See Narrative Dated: 01-19-2017
9. Verified hole cleaning method. X 3. Noncompliance item(s)were noted this date,details on
10.Verified adhesive application. X following page(s). Yes No X N/A
11.Verified edge distance. X 4. Noncompliance item was re inspected this date,details
12.Verified spacing. X on following page(s). Yes No X N/A
13.Verified installation torque. X Conform Remain in Progress
Evaluation report number&date: Report(s)findings were discussed and E-Mailed to
ESR-2508 Josh-Not Emailed
Exp:07-2018 of Josh Jones
Name of product being installed Simpson SET-XP epoxy adhesive
Lot Number 095Z146Z 159Z412Z 239X492X
Expiration Date 04-12-2018 05-07-2018 12-09-2017
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: r WABO#5102127 OBOA#1078 CWI#09030241
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