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Report (62) R 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 Client: JOHN GERHARD Project: GERHARD RESIDENCE - EXPAND EXISTING DORMER Address: 14275 SW 125TH AVE TIGARD OR CTI Job#: 11�n??�� CTI representative B. HARTLEY OBOA 838 WABO SI 02132 Jurisdiction: IGARD was on site this date Dec. 27 2017 to perform Special Inspection for: Permit MST2017-00282 DFS #(s) PO Number: 14275 - MASTER BED 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: MARC CORRECTIONS FOR (B) SHEAR WALLS (4) ON THE FRONT Company: GARZA OF HOUSE AND 1) FOR THE BACKSIDE. 2) %" 2. Inspection was "IBC" — DIAMETER ALL THREAD WITH SCREENS PER UREP Li Continuous Periodic CORRECTIONS. PROPRIETARY ANCHORS YesNoN/A 1. Reviewed previous inspection reports? 2. Reviewed evaluation report? X X Verified following items meet manufacturer's published installation instructions. 3. Verified minimum embedment depth of the REPORT SUMMARY anchors. Rh 1. Work inspected was: I x I Completed I I In progress 4.Verified installation of the anchors. 5. Verified anchor diameter. ©IN 2. Completed work inspected was in compliance with 6. Verified steel grade. ©.■ill L.g, Approved plans and specifications _ Shop drawings 7. Verified hole diameter. 11111111111 ■. I I RFI U Design change I I Submittal I I N/A 8. Verified type of drill bit used. ©■■ 9. Verified hole cleaning method. Document #(s) REVIsToxT 1 Dated: 12/11/2�i7 10. Verified adhesive application. ©um 3. Noncompliance item(s) were noted this date, details on 11. Verified edge distance. ©■mllill following page(s). I I Yes El No N/A 12. Verified spacing. 111111114. Noncompliance item(s) were reinspected this date, details 13. Verified installation torque. .■© on following page(s). Li Yes I x I No U N/A Evaluation report number & date: _ Conform ❑ Remain in progress ESR 3342 Report(s) findings were discussed and left with 08 2017 MARC of GARZA Name of product being installed HY-70 Batch Number L1512L1 Expiration Date Q9L2018 ---- 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. U See additional report page(s). I I Distribute attachments. Page 1 of 2 s Daily Report of Proprietary Anchors CTI Job#: T1703277, For: 12/27/2017 Project: GERHARD RESIDENCE - EXPAND EXISTING DORMER Notes: In some cases more than one box may be checked for a given item on the front page. Our reports pertain to the material tested/inspected only.Information contained herein is not to be reproduced,except in full, without prior authorization from this office.Under all circumstances,the information contained in this report is provided subject to all terms and conditions ofCTI's General Conditions in effect at the time this report is prepared.Npartyother than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this document. Ifthere are any further questions regarding this matter,please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING,INC. Doug Loftesness Reviewed By: Project Manager Project Manager Review Date:01/02/2018 BAH/KH CC: JOHN GERHARD OM CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIIGGARDORCGOV/FINAL/NCL ONLY LAUREN THOMAS CONSULTING LLC - LAUREN THOMAS LTCSTRUCTURAL@GMAIL.COM GARZA CONSTRUCTION - MARCELINO GARZA MARCELINO@GARZA-CONSTRUCTION.COM 8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281 Page 2 of 2