Report 2-3
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, ugene Office (541)345-0289
Inc.• Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: /74,,fyso,.. e rte? 235—
Address: !� -" " ,:� 5�.��.x .Tli ST- Ti -Goti CTI Job#: 7170 2 7
CTI representative e'i--ate �""- ,�, mf's y /q7 was on site this date to perform
(Inspector Name&Cert.No.)
Special Inspection for Li permit DFS#(s) /*S 701"/ 00.1 5:2 jurisdiction
•
In some cases more than one box may be checked for a given item.
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: Se',>�. -�7 —•"7/All I--;,>%('
Company: m �.,r 7i<
p Y ` /f�,s'Oh WO a al rief r o.a�✓f�s4��ee� i-lG�cx+`'
2.Inspection was"IBC" El ContinuousPeriodic v '', f ,`n7"` ��"�`"�--, F .4044 y.1d,�^�.y
PROPRIETARY ANCHORS 7� a ` "` " S rrfo%e,o ctai; e C f s :ce
/
"n,� O®f' l/ e7'E £ 1 Ar..Ca/ 4DH 4:44<A,
Yes No N/A 4 1 = L11,/.,/4k�„
1.Reviewed previous inspection reports? / ` ,.,r /%z g//8
2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was:
P D Completed El In progress
3.Verified minimum embedment depth of the 2. Completed work inspected ID was El was not
anchors.
4.Verified installation of the anchors. in compliance with
5.Verified anchor diameter. 0 Approved plans and specifications El Shop drawings
6.Verified steel grade. ❑ RFI 0 Design change 0 Submittal [] N/A
7.Verified hole diameter. Document#(s) 1).:).k Dated: 17/7 7
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). Li Yes LI No [] 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). LI Yes LI No L N/A
13.Verified installation torque. LI Conform LI Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
/- (AO. sky off 0,229
4.4
of ,/,krer
Name of product being installed s'14-7--xP riaaxr
Batch Number ???,=r'?Ph y 9
Expiration Date -")fI/7
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.
Inspector Signature:
El See additional report page(s). El Distribute attachments. Page of
PropAnchors V er.1 2/12/2009