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Report (21) /107-02,0« or i Bend Office (541)330-9155 • Geotechnical Office (503)601-8250 Carlson Testing, Inc. SalemEugene Office ficee (503)589-1252 (503)589-1252 Tigard Office (503)684-3460 Daily Report of Proprietary Anchors Client: PARKER CONCRETE - JOHN OWEN Project: PROJECT @ 14459 SW 88TH AVE (180234) CTI Job#• T1805926. Address: 14459 SW 88TH AVE TIGARD OR Jurisdiction: TIGARD CTI representative T. RUNCKEL WABO SI 02192,WABO 3647 was on site this date Jan. 09, 2 019 to perform Special Inspection for: Permit PERMIT NOT AVAILABLE (REFERENCE NCL #1) DFS#(s) PO Number: SCOPE OF INSPECTION Location of proprietary anchors inspected[to include grid lines,elevations(floors)and drawing details]: 1.Checked in with superintendent or client representative. WITNESSED INSTALLATION OF (1) 5/8" X 16" Name: LUPE THREADED ROD VERTICALLY DOWN INTO EXISING Company: PARKER CONCRETE CONCRETE FOUNDATION WALL AT SOUTH WEST CORNER OF FOUNDATION ACHIEVING A 9 1/2" EMBED. 2.Inspection was"IBC" 0 Continuous 0 Periodic NO PLANS, DETAILS OR REFERENCES, ONLY VISUAL PROPRIETARY ANCHORS OBSERVATION. Yes No N/A *** 1.Reviewed previous inspection reports? x *** CONTINUED ON BACK 2.Reviewed evaluation report? x Verified following items meet manufacturer's REPORT SUMMARY published installation instructions. 3.Verified minimum embedment depth of the 1.Work inspected was: © Completed ❑In progress anchors. x 4.Verified installation of the anchors. 2.Completed work inspected was not in compliance with X El Approved plans and specifications 1=1 Shop drawings 5.Verified anchor diameter. x 6.Verified steel grade. [J RFI El Design change El Submittal 0 N/A 7.Verified hole diameter. x 8.Verified type of drill bit used. x Document#(s) NO DOCUMENTS Dated: 9.Verified hole cleaning method. x 3.Noncompliance item(s)were noted this date,details on 10.Verified adhesive application. following page(s). ® Yes 121 No N/A 11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details 12.Verified spacing. x on following page(s). C] Yes No ® N/A 13.Verified installation torque. x 0 Conform ID Remain in progress Evaluation report number&date: Report(s)findings were discussed and left with ESR-263 (11/30/19) LUPE of PARKER CONCRETE Name of product being installed SIMPSON AT-XP Batch Number 1000018961 Expiration Date 8/15/2019 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. 0 See additional report page(s). El Distribute attachments. Page 1 of 2 A Daily Report of Proprietary Anchors For: 01/09/2019 CTI Job#: T1805926. Project: PROJECT @ 14459 SW 88TH AVE (180234) Notes: *** CONTINUED FROM FRONT *** NCL ADDED: NCL #1: NO REFERENCE DOCUMENTS AVAILABLE AND/OR PERMIT. ENGINEER OF RECORD REVIEW. 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 fi without prior authorization from this office.Under all circumstances,the information contained in this 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 whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this document. If there 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: 01/15/2019 TR/MRM PARKER CONCRETE - JOHN OWEN JOHNO@PARKERCONCRETE.COM CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIGARD-OR.GOV ROWELL ENGINEERING & DESIGN INC - TODD ROWELL TODDR@ROWELLENG.COM TO: FOUR D CONSTRUCTION 8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281 Page 2 of 2