Report Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Office (541)345-0289
Carlson Testing, Inc. Eugene O Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: t'IA t y 6 t V1 ti\ 0 Sh P.td
Address: l q el C hi I A + T ij f i d,u[` CTI Job#: 114O')99 PT
CTI representative A v i _ "11, -14 §T 6 213 4 was on site this date St.i/ 1.QL to perform
(Inspector Name&Cert.No.)
Special Inspection for E3„permit ❑ DFS#(s) jurisdiction 7 ''1 .4'r,i .
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. i t I rv. .A v, ` i,4't ti;i1N
Name: t
1 , lei \iiioo, 'I e `'ANA( v+,j ‘ it LAI Ei'N'IA �
Company: 1 i" i E if , t: ,n 1 Di- I 7 /i-' ''' 0 4 .w N) f ti 1/4.4. t_ah
Periodic � ��` "�`iL ""4° S`{ `"'r'' r`"5'+ j ,4 t+�
2.Inspection was"IBC" n Continuous
t; lipa +fdtt,yi IPk.r w,$‘, S Vi ,At4 hs;..'r
PROPRIETARY ANCHORS oir,o,j i A,,,II.., k 4„�, ,1 A t i.,1 J O vh. 1 O.ti r[rs1 �-
YesNoN/A ti'� �1h
�.r.i 1,, l• (,f f!- Pt), �,A4,
1.Reviewed previous inspection reports? ,-", 1 1 I 1
2.Reviewed evaluation report? '' REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was:
p --0 Completed El In progress
3.Verified minimum embedment depth of the anchors. sA 2. Completed work inspected was was not
4.Verified installation of the anchors. ,,.. in compliance with
_.
5.Verified anchor diameter. `.Approved plans and specifications ElShop drawings
,,,-
6.Verified steel grade. El RFI El Design change El Submittal 0 N/A
7.Verified hole diameter. s.<,. Document#(s) ¢' Dated: ) 1 //I I
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 El 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 Ei No - -N/A
13.Verified installation torque. Conform ❑ Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
of
Name of product being installed t1 f ...''1
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 contractors or subcontractors.
Inspector Signature: `' . _ ,
0 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 warranty or guarantee of any type. Even with
diligent construction monitoring and/or testing by CTI, construction defects, deficiencies, or omissions
in the Contractor's work may exist. 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.
CTI will 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-
ty or representation, either expressed or implied. It is also understood and agreed that statements made
in CTI reports are observations based on technical judgements, and should not be construed to be con-
clusive representations of fact. If conditions different from what are indicated in the reports come to
Client's attention after receipt of the reports, it is recommended that Client contact CTI 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.CTI shall not be responsible for evaluating or reporting job con-
ditions related to health, safety or welfare.