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Report /4ST-02a9— xwc Carlson Bend Office (541)330-9155 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: STACY KOLLAR AND JOHN EVANS Project: KOLLAR EVANS RESIDENCE Address: 14810 SW 106TH AVE TIGARD OR CTI Job#: T1803852. CTI representative R. TAYLOR OBOA 874/WABO SI 02163,WABO 3610 Jurisdiction: TIGARD was on site this date Mar. 0 9, 2 018 to perform Special Inspection for: Permit MST2018-00006 DFS#(s) PO Number: KOLLAR EVANS 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: STAGY PER DETAILS ON PAGE 2 OF THE APPROVED PLASN FOR Company: HOMEOWNER THE EPDXY OF HTT5 HOLDOWNS THROUGHOUT THE HOUSE. ENGINEER LAUREN THOMAS WITH LTC CONSULTING GAVE 2.Inspection was "IBC" 0 Continuous A VERBAL APPROVAL FOR THE USE OF AT-XP IF THE ❑ Periodic EDGE DISTANCES WERE THE SAME AS SET XP FOR THE (11 HOLDOWNS. EACH HOLDOWN CONSISTS OF (1) 5 8" PROPRIETARY ANCHORS 0 THREADED ROD THAT HAS A 12" VERTICAL EMBED Yes NoN/A INTO THE TOP OF THE EXISTING STEM WALL. "» 1.Reviewed previous inspection reports? Man 2. (CONT'D ON BACK PAGE) - 2.Reviewed evaluation report? ------»»> Verified following items meet manufacturer's published installation instructions. REPORT SUMMARY 3.Verified minimum embedment depth of anchors. the 11111111.Work inspected was: © Completed In progress 4.Verified installation of the anchors. ©■■ 2. Completed work inspected was in compliance p with Approved plans and 5. Verified anchor diameter. © specifications ❑ Shop drawings 6. Verified steel grade. rill: ❑ 7.Verified hole diameter. RFI ❑ Design change 0 Submittal ElN/A 8.Verified type of drill bit used. 11111111111 ll: Document#(s) NO REVISION 9.Verified hole cleaning method. Dated: No DATES rill: 3.Noncompliance item(s)were noted this date,details on 10. Verified adhesive application. 11.0Verified adhesive distance. following page(s). ❑ Yes ® No ❑ N/A 12.Verified spacing. ©NI. 4.Noncompliance item(s)were reinspected this date,details 12.Verified installation torque. 111111111on following page(s). ❑ Yes ® No 1111111111 ❑Conform ❑ N/A Evaluation report number&date: ❑ Remain in progress ER-263 (11/2017) Report(s)findings were discussed and left with STACY Of HOMEOWNER Name of product being installed SIMPSON AT-XP® Batch Number F1141F1330 Expiration Date 1o/2e/18 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. ❑ See additional report page(s). 0 Distribute attachments. Page 1 of 2 Daily Report of Proprietary Anchors For: 03/09/2018 CTI Job#: T18038S2. Project: KOLLAR EVANS RESIDENCE Notes: ««< (CONT'D FROM FRONT PAGE) AND THEN TO REDRILL/CLEAN CTI WAS ON STANDBY WHILE CONTRACT WENT TO BUY AT-XP, A LONGER DRILL BIT, A HOLE. In some cases more than one box may be checked for a given item on the front herein is not be reproduced,except in fi the information erei is not tom r report provided her Our reports pertain to the material tested/inspected only.Information contained without prior authorization from this office.Under all circumstances, subject to all terms and conditions of CTI's General Col be entitled tonditions in euse orct at hrely uponi the pnfoirmation contained party this thbs than those to whom CTI has distributed this report shall document. If there are any further questions regarding this matter,please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING,INC. Reviewed By:Project Manager Doug Loftesness Project Manager Review Date: 04/02/2018 RT/CK MAIL/STACYKOLLAR@GMAIL.COM TO: STACY KOLLAR AND JOHN EVANS WALTER@TIGARD-OR.GOV CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT ALTER T GAD OR. OV .COM LAUREN THOMAS X TRANSFORMINGVENTURES@GMAIL.COM TRANSFORMING VENTURES INC 8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281 Page 2 of 2