Report (138) ms-r- g-0060.ss
Bead Office (541)330-9155
11 gorl-c_51,4.1 6,111-6ttirV: Geotechnical Office (503)601-8250
(541)345-0289
Carlson Testing, Inc.
Eugene Office
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: (.. ") ,
Address: tes .
CTI Job#: • -; _•• - '
CTI representative - v •• ' t ( was on site this date •; ; to perforrn
(Inspector Name&Cert.No.)
Special Inspection for 1;3 permit El DFS#(s) 2 jurisdiction
In some cases more than one box may be checked for a given item.
SCOPE OF INSPECTION Location of proprietary anchors ins to include grid
Peere"
lines,elevations(floors)and drawing de :
1.Checked in with superintendent or client representative.
Name:
Company: ,
t
2.Inspection was"IBC" Ej Continuous Periodic
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports?
2.Reviewed evaluation report?
REPORTAIMMARY
Verified following items meet manufacturer's
published installation instructions.
I.Work inspected was: [-j Completed [3mi progress
3.Verified minimum embedment depth of the
2.Completed work inspected 9 was was not
anchors.
4.Verified installation of the anchors. in compliance with
Approved plans and specifications El Shop drawings
5.Verified anchor diameter.
RFI Design change Submittal El N/A
6.Verified steel grade.
7.Verified hole diameter. Document#(s) r, Dated: i 27 -
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). El Yes ID No D N/A
10.Verified adhesive application.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. on following page(s). Yes No ID N/A
13.Verified installation torque. El Conform D 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 • subcontractors.
' —
Inspector Signature:
See additional report page(s). El Distribute attachments. Page ) of )
PropAnchors Ver.1 2/12/2009
Terms:
Client recognizes that construction observation and:or testing services provided by CTI are techniques
which may reduce the risk of construction defects, deficiencies. or omissions arising during or after con-
struction. Services performed by CTI do not constitute a \v arranty or guarantee of any type. Even with
diligent construction monitoring and/`or testing by C'1 I, construction defects, deficiencies, or omissions
in the Contractor's work may dist, In all cases. Client and/or the Contractor shall assign the Contractor
the responsibility for the quality and completeness of the work and for adhering to plans and specifica-
tions. CTI's work or failure to perform same shall no in any way excuse any contractor_ subcontractor,
or supplier from performance of its work in accordance with the contract documents.
CII yvitl provide its professional services to Client with that degree of care and skill ordinarily exercised
under similar circumstances by members of its profession. This representation is in lieu of other warran-
tv or representation, either expressed or implied. It is also understood and agreed that statements made
in CII reports are observations based on technical judgements, and should not be construed to be con-
clusive representations or fact. If conditions different from \.\hat are indicated in the reports come to
Client's attention after receipt of the reports, it is recommended that Client contact CTT immediately to
authorize further appropriate evaluation.
CTI's work shall not include determining. supervising or implementing the means. methods, techniques,
sequences. or procedures of construction. CII shall not be responsible for evaluating or reporting job con-
ditions related to health. saint! or wcllarc.