Report (37) r
end Office (541)330-9155
I� •otechnical Office (503)601-8250
Carlson Testing, Inc.
„ugene Office olein Office (541)345-0289
(503)589-1252
I,igard Office (503)684-3460
Daily Report of Proprietary Ancho
Project: p o r t f t:s. g_,...s c.
J
Address: 3 5 Si......) i -4tk}s� -1-,..,::,,q f2 4 2, Cu• , #: T"t 3
CTI representative `� '` was on site IIII's date ' 3 o to perform
(Inspector Name&Cert.No.)
Special Inspection for ® permit ❑ DFS#(s) 11 5 7-2..c'cl " c:,, 6 1 Gs 1 jurisdiction _r '"' `z-›
In some cases more than one box may be checked for a given ite
SCOPE OF INSPECTION Location of proprietary anch t l's inspected[to include grid
lines,elevations(floors)and , wing details]:
I.Checked in with superintendent or client representative. (..->47,5,:,-,_\.4,1,_
.: r=:.loci r,tt•,./11C+` '/-. R ca 1-0-42..4 x 4 x?
Name: D Cu C1
Company: i<AC•._'^ii 0. 1 M e 9.1 s^i s, ! til 0.04 t t(� t2 Zd+� .. ..
i...5 5,7d4> A�..L_-T ',“.A, t"s, ":: '-'.111' .-*.>
"IBC" -t"-.... F a+..; i...}4 .. P, 14. i� S-3..• . K ,h'....?LD Sf,5` ''
2.Inspection was ❑ Continuous ® Periodic
t..�- 4. ..
<-#0.. ....:>‹,3,....-)..--1 S G..-i s_i�a 11 c r14,2„...< a , C - I ,0
PROPRIETARY ANCHORS
Yes No N/A I`
1.Reviewed previous inspection reports? `')C"
2.Reviewed evaluation report? \-"
Verified following items meet manufacturer's REPO' SUMMARY
published installation instructions. 1.Work inspected was: IG
Pa Completed 0 In progress
3.Verified minimum embedment depth of the
anchors. " 2.Completed work inspecte.1,ID was ❑ was not
4.Verified installation of the anchors. in compliance with i�,
5.Verified anchor diameter. E} Approved plans and s.p1J! ifications ❑ Shop drawings
6.Verified steelgrade. Ili
'�. � RFI � Design ch• lice_e � Submittal � N/A
7.Verified hole diameter. �'` til' Dated: f `
Document#(s) � 1 o
8.Verified type of drill bit used. <.- III!
9.Verified hole cleaning method. ')‹„ 3.Noncompliance item(s)w i noted this date,details on
10.Verified adhesive application. following page(s). I'Yes ® No N/A
11.Verified edge distance. 4.Noncompliance item(s)w 11:I'- reinspected this date,details
12.Verified spacing. X" ' on following page(s). Ell Yes ❑ No EJ N/A
13.Verified installation torque. MI•
q x ❑ Conform ❑ Re .;..min progress
Evaluation report number&date:
Report(s)findings were disc I1 ed and left with
E5f2 -25C18
of 1,.ta- 3ri0 1
Name of product being installed ,r t 5 =+-X
Batch Number 1 G 4;60 2•7943
Expiration Date c:` ?`'
Based on the Code,approval is required from the Building Official before the SPECIAL INSPE$IIli D items noted above can be
covered.Carlson Testing has no autho_LiV to direct work of contractors or subcontractors.
Ins ector Si '- "_'
p gnature:
See additional report page(s). ❑ Distribute attachments. 1 j Page 1 of !
1 PropAnchors Ver.I 2/12/2009
Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Eugene Office (541) 345-0289
Carlson Testing, Inc. Salem Office (503) 589-1252
Tigard Office (503) 684-3460
REPORT OF 4 X 8 CONCRETE CYLINDRICAL TEST SPECIMENS
Test Methods: ASTM C39/C172/C1064/C31/C143/C1231
Date Molded: 05/03/2019 Date Received: 05/04/2019 Job Number: T1906731.
Permit#: MST2019-00010
Client: HAR—BRO INC — TIM YOUNG
Project: FORD RESIDENCE
Address:12350 SW TIEDEMAN TIGARD OR Jurisdiction: TIGARD
Contractor:
Subcontractor: Cast By: C. STASCH
Concrete Supplier: JOB MIX
Truck#: N/A Load #: 1 Ticket#: N/A
Weather: SUNNY Test Time: 8:04 Air Temp.at Sampling Time: 4 5
Cylinders were cast for the following locations:
WALL REPAIR IN FRONT OF HOUSE
Total Concrete Placement Location:
WALL REPAIR IN FRONT OF HOUSE
Strength Requirement: 3000 psi f c@, 28 Days Slump: 2.00" %Air: N/T
Mix Number: 10+20 REPAIR Concrete Temp: 55
Max Agg: 3/8"
Admix/Amt: N/A
Cubic Yards: 1 OF 1
Register Number: 0 015 0 183 Lab Location: TIGARD Curing: High
Low **
Set Test @ Test Total Avg Area Unit Type Of Cap Tested
No. Days Date Load Diameter PSI Fracture Type By
7 05/10/2019 80820 4.00 12.56 6440 3 PAD 60 MBO
28 05/31/2019
28 05/31/2019
28 05/31/2019
Distribute attachments. Average Cc @ 2 8 days
Please see reverse side for additional information.
Job Number: T1906731. Register Number: 00150183 Date Molded: 05/03/2019
Project: FORD RESIDENCE
<1 in.[25 mm]
kI) ( \
\// 1 }
rr/ ti b\
1
Type 1 Type 2 Type 3
Reasonable well-formed Well-Formed cone on one Columnar vertical cracking
cones on both ends,less end,vertical cracks running through both ends,no
than 1 in.[25 mm]of through caps,no well-defined well-formed cones
cracking through caps cone on other end
\, / 7
I
Type 4 Type 5 Type 6
Diagonal fracture with Side fractures at top or Similar to Type 5 but
no cracking through bottom(occur commonly end of cylinder is pointed
ends;tap with hammer to with unbonded caps)
distinguish from Type 1
** Not measured - Departure from ASTM C31 standard
Remarks:
CC: HAR-BRO INC - TIM YOUNG TIMOTHY.YOUNG@HARBRO.COM
CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIGARD-OR.GOV
X
Project Manager: Doug Loftesness Reviewed By: Greg Leeper On 05/13/2019
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 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.
8430 SW HUNZIKER S 1,"11UARD OR-PO BOX230997,TIGARD OR 97281
Bend Office (541) 330-9155
s� Geotechnical Office (503) 601-8250
Carlson Testing, Inc. Eugene Office (541) 345-02891
1Salem Office (503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Reinforced Concrete
Client: HAR-BRO INC - TIM YOUNG
Project: FORD RESIDENCE CTI Job#: T1906731.
Address: 12350 SW TIEDEMAN TIGARD OR Jurisdiction: TIGARD
CTI representative C. STASCH OBOA 331/WABO 3011,SI 01132,WAB0 3011/ACI 00023754/ICC 8008179
was on site this date May. 03, 2 019 to perform Special Inspection for:
Permit MST2019-00010
DFS #(s) PO Number:
SCOPE OF INSPECTION CONCRETE
1. Checked in with superintendent or client representative. 1. Mix Design approved? x Yes I I No N/A
Name: TIM
Company: HAR-BRO INC 2. Monitored loads arriving at job site for correct:
Mix#: KONTEX 10 & 20 REPAIR BAG MIX
2. Type of work: Concrete I x I Reinforcing Slump N/A % Air N/A
3. Work included: x Sampling X Inspection
3. Type of samples made? 4 X 8 CONCRETE CYLINDERS
4. Inspection was 'IBC' x Continuous Periodic Number of sets 1 Samples per set 4
5. Work performed: n In the field At precast shop 4. Inspected placing and consolidation of approx. 1
cubic yards of concrete.
REINFORCING Yes No N/A Location of concrete placement [to include grid lines, elevations
(floors) and drawing details]:
1. Reviewed previous inspection reports? X
2. Forms clear of debris? WALL REPAIR IN FRONT OF HOUSE.
x
3. Type, grade, size, quantity, spacing and x
condition conform?
4. Verified forms will nominally result in
hardened concrete of the required x
cross-sectional dimensions.
5. Verified location of reinforcing steel, pipes,
conduits and sleeves with respect to X
minimum concrete cover
6. Verified type and location of splices, length After samples are tested,results will follow on break report.
of contact laps, and min. diameter of bends. X
REPORT SUMMARY
7. Verified support & anchorage of reinforcing
steel in the forms. X 1. Work inspected was: x I Completed In progress
8. Verified structural embedments in the forms 2. Completed work inspected was in compliance with
with regard to fabrication, quality and type. x p p p
x Approved plans and specifications Shop drawings
9. Verified structrual embedments in the forms _with regard to weld inspection, quantity, and x ( I RFI Design change Submittal N/A
permits issued.
10. Verified cast in place anchors. x Document #(s) PLANS Dated: 12/17/18
Description of structure inspected [to include grid lines, 3. Noncompliance item(s) were noted this date, details on
elevations (floors) and drawing details]: following page(s). Yes x No I I N/A
WALL REPAIR IN FRONT OF HOUSE. 4. Noncompliance item(s) were reinspected this date, details
on following page(s). Yes x No ] N/A
Conform Remain in progress
Report(s) findings were discussed and left with
TIM
of HAR-BRO INC
Based on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above can
he covered. Carlson Testing has no authority to direct work of contractors or subcontractors.
7 See additional report page(s). — Distribute attachments. Page 1 of 2
Daily Report of Reinforced Concrete For: 05/03/2019
CTI Job #: T1906731.
Project: FORD RESIDENCE
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 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:05/09/2019
CDS/CK
CC: HAR-BRO INC - TIM YOUNG TIMOTHY.YOUNG@HARBRO.COM
• CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIGARD-OR.GOV
X
8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
Page 2 of 2
Bend Office (541) 330-9155
Geotechnical Office (503) 601-8250
Carlson Testing, ugene Office (541) 345-0289
Inc.Inc• Salem Office (503) 589-1252
Tigard Office (503) 684-3460
Daily Report of Proprietary Anchors
Client: HAR-BRO INC - TIM YOUNG
Project: FORD RESIDENCE CTI Job#: T1906731
Address: 12350 SW TIEDEMAN TIGARD OR Jurisdiction: TIGARD
CTI representative E. MORRISON OBOA 1108/WABO SI 02162,WABO 3609/ACI 01269615/ICC 8277537
was on site this date may. 02, 2019 to perform Special Inspection for:
Permit MST2019-00010
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.
Name: TIM FOUNDATION WALL REPAIR PER PLANS S3.1 DATED
Company: HAR-BRO INC 12/17/18. #4 REBAR WITH MINIMUM OF 6" EMBED, 12"
ON CENTER.
2. Inspection was "IBC" x Continuous Periodic
PROPRIETARY ANCHORS
YesNoN/A
1. Reviewed previous inspection reports?
2. Reviewed evaluation report?
Verified following items meet manufacturer's
published installation instructions. REPORT SUMMARY
3. Verified minimum embedment depth of the
anchors. X 1. Work inspected was: x Completed In progress
4.Verified installation of the anchors. x 2. Completed work inspected was in compliance with
5. Verified anchor diameter. X x Approved plans and specifications I I Shop drawings
6. Verified steel grade. x
7. Verified hole diameter. RFI I I Design change Submittal N/A
X
8. Verified type of drill bit used. X Document #(s) PLANS Dated: 12/17/18
9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on
10. Verified adhesive application. x following page(s). I I Yes fl No x N/A
11. Verified edge distance. x
12. Verified spacing. 4. Noncompliance item(s) were reinspected this date, details
X on following page(s). Yes No I x I N/A
13. Verified installation torque.
Conform I I Remain in progress
Evaluation report number & date:
ESR-2508 (07/2019) Report(s) findings were discussed and left with
TIM
of HAR-BRO INC
Name of product being installed SIMPSON SET-XP®22
Batch Number 1000028436
Expiration Date 12/18/20
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). Distribute attachments.
Page 1 of 2
Daily Report of Proprietary Anchors For: 05/02/2019
CTI Job #: T1906731.
Project: FORD RESIDENCE
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 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:05/08/2019
EM/CK
CC: HAR-BRO INC - TIM YOUNG TIMOTHY.YOUNG@HARBRO.COM
CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP' BARNETT WALTER@TIGARD-OR.GOV
X
8430 SW IIUNZIKF,R ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281
Page 2 of 2