Report (29) in.. o 17 — 0 6) O C Bend ulnce (541)JiU-9155
r Geotechnical Office (503)601-8250
Carlson Testing, Inc.• f�` � S Ic5pe'�n�, Gtr
Eugene Office
Salem Office (541)345-0289
(503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Client:
Project: Polygon east river terrace lot 60 CTI Job No.: T1702247bb I'
Job Address: Jurisdiction: t!�
CTI Representative Rick Virts Onsite date 2-13-18 to pert's; Inspection for:
Permit Mst2017-00269 Proprietary r4,wections
SCOPE OF INSPECTION Location of proprietary anchors inspectedto incl' grid lines,elevation(floors)
1. Checked in with superintendent,client or shop rep. and drawing details]:
Name: Ken ,,At ; sine hold Own anchor rod
�" °-,N, i � atemwall north wall.
Company: Polygon P Y Yg Per f-II polygon
2. Inspection was"IBC" Continuous X Periodic x esr report embedment chart
PROPRIETARY ANCHORS
5/8"threaded rod with 6"embed.
Completed
Yes No N/A
1. Reviewed previous inspection reports? X ',-,,
ef
2. Reviewed evaluation report? X
Verified following items meet manufacturer's published installation instructions" s REPORT SUMMARY
3. Verified minimum embedment depth of the anchors. X " I. Work`"pected was: X Completed 0 In progress
4. Verified installation of the anchors. Xopleted work inspected X was was not
5. Verified anchor diameter. X rn compliance with
6. Verified steel grade. Approved plans and specifications 0 Shop drawings
Vod
RFI Design 0 Submittal X N/A
7. Verified hole diameter. change
8. Verified type of drill bit used. X ''' Document#(s) Er 263 Dated: 11-17
9. Verified hole cleaning method. X 3. Noncompliance item(s)were noted this date,details on
10.Verified adhesive application. ;,
„ V b Aw following page(s). Yes 0 No X N/A
11.Verified edge distance. X 4. Noncompliance items(s)were re-inspected this date,details
12.Verified spacing. AA on following page(s). 0 Yes 0 No X N/A
13.Verified installation torque X 0 Conform 0 Remain in Progress
Evaluation report number c date,""" b;;" Report(s)findings were discussed and left with
Er 263 Jose
19-17 of Polygon
Name of product being installe. a " Set at/xp
Bat ber Ati44364f
Expiration lie 10-18 `�\`.
Based on the Code" roval 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 orrsubcontractors.
R,u' Vick
❑See additional report page(s). 0 Distribute attachments. Page of
\\Ct-home\public\Proiects\Field Report Forms\Blank Inspector Word Forms\Daily Report Of Prodnetary Anc ors doc
Page 1
10/1/00129
lfena Urnce (541)SSU-9155
Geotechnical Office (503)601-8250
Carlson Testing, ugene Office (541)345-0289
Inc.nc• Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors For:
CTI Job#:
Project:
Notes:
u
re
•
,,,.
In some cases more than one box may be checked for a given ite7i0e front page.
Our reports pertain to material tes _, e• only.InformatAtbontained herein is not to be reproduced,except in full,without prior authorization from this office.Under all
circumstances,the information untamed i is report is provided subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared.No
party other than those to whotTI has di ',t is report shall be entitled to use or rely upon the information contained in this document.
If there are any further(potions regas`dtpg this matt,please do not hesitate to contact this office.
Respectfully sub ed 04
CARLSON,TES G,INC.
CC: