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Report Main Office Salem Office Bend Office Geotechnical Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 7185 SW Sandburg Rd Ste 110 ard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Tigard, Oregon 97223 Carlson Testing, Inc. 7� �s Pho ne (503) (503) 684 -3460 -0954 Fa Phon e (5 ( -1309 89 -1252 Pho Fax (541) ne (541)3330 -930 -915 163 Fax 5 Phone (503) 601 (503)60 1 -8250 + ing, Inc. Fax Report Of In -Place Density Tests Date: 10/02/2008 Job Number: T0807769. Permit #: BUP2008 -00246 Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS — CATHY INSLER Project: BURGERVILLE #45 (TIGARD) — NEW CONSTRUCTION Address: 12785 SW PACIFIC HIGHWAY TIGARD OR ROCKY SILTY CLAY NATIVE Material Description: Maximum Dry Density: 131 lbs. /cu. ft. Optimum Moisture: 9 5 o Required Compaction: 95 % Standard Count for Gauge Serial # Troxler 37190 Method of Test: ASTM D2922 D3017/ ASTM D1557 Source of Value Dated 09/23/2008 is project specific. Standard Counts - Density: 2669 Moisture: 683 Calibration Data: 9/4/08 cyo In -Place Density Date Of Test Code Test Density Moist. Mode Depth Elev. Field (Ibs /cu. ft.) % Test No. Location Count Count Ft. Moist. Wet Dry Comp. 2052 ' 287 DT 6" —2 19.4 126.3 105.7 09 -23 1 SF O{EAST " END`OF FOOTING 80 1 8•''- SOUTH OF��-NORTH EN ;�� 1 2788 I 270 ,. I DT I 6" I —2 18.4 I 121.3 I 102.1 RI 09 -23 2 SF 8LWESTy .OF.`EASSrENDjj 7 ON SOUTH'"END1 FOOTINGS I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Please see reverse side for additional information. 0 Distribute attachments. Job Number: T080776,9. , , s Date Of Test: 09/23/20W io In -Place Density Date Of Test Code Test Density Moist. Mode Depth Elev. Field (Ibs /cu. ft.) % Test No. Location Count Count Ft. Moist. Wet Dry Comp. 1 1 I I 1 1 1 I I 1 1 1 1 1 1 I I 1 1 1 1 1 1 I I 1 1 I 1 1 1 1 1 1 1 1 1 1 Asterisked ( *) percent compaction test results did not meet listed acceptance criteria. Remarks: TOOK 2 SHOTS ON BASE FOR FOOTINGS FOR CONCRETE. THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Typist: JAP Test By: T . EMERSON Reviewed By: James Hietpas On 10/01/2008 Test results were discussed and left with SCOTT Of LEASE CRUTCHER LEWIS Code Descriptions NC - No code (general fill areas and backfill /original ground /not fil BC - Base course (Rock Only) ET - Electrical trench SF - Structural fill (Buildings Non - Residential) RW - Retaining wall backfill GT - Gass line trench LF - Residential lot engineered fill WT - Water line trench CT - Cable, phone trenches RF - Roadway engineered fill (Soil Only) ST - Sanitary sewer trench PS - Pavement subgrade DT - Storm drain trench Our report pertains to the material tested only. 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. Carlson Testing, Inc. o' NCL, of Low Compressive Strength Tests & Compaction Tests Oct 02, 2008 T0807769. Project Name: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION Project Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Permit No: BUP2008 -00246 P.O. No: Project Manager: JAMES F. HIETPAS Compliance CTI Sign -Off Date Corrected Sample Type Proctor Date Tested Test # % Comp Req % Comp Soils 2 09/23/2008 SF 1 80 95 Location: ON EAST END OF FOOTING 8' SOUTH OF NORTH END Soils 2 09/23/2008 SF 2 78 95 Location: 8' WEST OF EAST END ON SOUTH END OF FOOTINGS THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER TO:CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG LEASE CRUTCHER LEWIS - JUSTIN RIORDAN WORKPLACE MANAGEMENT LLC - CHERYL PIN THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER Page: 1 ' Daily Report of Proprietary Ancho.., For: 09/23/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/01/2008 MCW /JAP THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Main Office iem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Carlson Testing, Inc. Tigard, Oregon 97281 503) 589-1252 Bend, Oregon 97708 Phone (503)03) 684-3460 Phone hone (503)589 -125125 2 Phone (541)330 -915-915 330-9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTIJob #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative M. WAGONER OBOA 746/OBOA 749 was on site this date Sep. 23, 2008 to perform Special Inspection for: Permit BUP2008 -00246 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. OBSERVED INSTALLATION OF (6) #5 HORIZ BARS AND Name: SCOTT (8) #6 VERT BARS AT DRIVE IN WINDOW. OBSERVED Company: LEASE CRUTCHER LEWIS INSTALLATION OF (3) #5 HORIZ BARS IN EACH 2. Inspection was "IBC" © Continuous El Periodic FOOTING AT X3 /Y1 AND X3 /Y4. #5 BARS HAD EMBED OF 8" AND #6 BARS HAD EMBED OF 10 ". ALL WORK PER DETAILS 10 /S501 & THE BAR SCHEDULE ON S002. PROPRIETARY ANCHORS NOTE: APPROVED PLANS SHOWED RE -500 AND ER Yes No N/A REPORT FOR RE- 500 -SD. ENGINEER OF RECORD GAVE VERBAL APPROVAL FOR THE USE OF RE -500. 1. Reviewed previous inspection reports? x 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 in compliance with 5. Verified anchor diameter. © Approved plans and specifications El Shop drawings 6. Verified steel grade. RFI ❑ Design change n Submittal El N/A 7. Verified hole diameter. X Document #(s) Dated: 8. Verified type of drill bit used. 9. Verified hole cleaning method. 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. x following page(s). Yes ® No N/A 11. Verified edge distance. x 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. on following page(s). ❑ Yes ❑ No © N/A 13. Verified installation torque. x El Conform Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR -1682, DATED 12/01/2004 SCOTT of LEASE CRUTCHER LEWIS Name of product being installed HILTI RE -500 Batch Number 0608081115 L3 Expiration Date 08/2009 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). ID Distribute attachments. Page 1 of 1 • . 'onstruction In & Related Tests Carlson Testing, Inc. Geotechnical Consulting Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Phone(503)684 -3460 Phone(503)589 -1252 Phone(541)330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 REPORT OF 4 X 8 CONCRETE TEST SPECIMENS Test Methods: ASTM C31 /C172/C192/C617/C1064/C231/C143 Date Molded: 10/07/2008 Job Number: T0807769. Permit #: BUP2008 -00246 Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS — CATHY INSLER Project: BURGERVILLE #45 (TIGARD) — NEW CONSTRUCTION Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD Contractor: LEASE CRUTCHER LEWIS — JUSTIN RIORDAN Subcontractor: Cast By: A. LEWIS Concrete Supplier: KNIFE RIVER (METRO OPERATIONS) — QUALITY CONTROL Truck #: 2157 Load #: 1 Ticket#: 3121219 Weather: CLEAR Test Time: 12 : 05 PM Air Temp. at Sampling Time: 69 Cylinders were cast for the following locations: SLAB —ON —GRADE AT FRONT OF BUILDING PER 10 /S501 Total Concrete Placement Location: SAME AS ABOVE Strength Requirement: 3000 psi f c@ 28 Days Slump: 4.000" % Air: 3.00% Mix Number: 1412 4 5 HN 15 0 0 0 * Conc. Temp: 69 Cement Type: I /II Max Agg: 3/4 Admix/Amt: Cubic Yards: 4.5 TOTAL Register Number: 0087244 Lab Location: TIGARD Set Test @ Date Test Total Area Unit Type Of Tested No. Days Rec'd Date Load PSI Fracture By I 7 10/08/2008 10/14/2008 47733 12.56 3800 2 RH2 28 10/08/2008 11/04/2008 28 10/08/2008 11/04/2008 28 10/08/2008 11/04/2008 ❑ Distribute attachments. Average f @ 28 days Please see reverse side for additional information. Job Number: T 0807769 - Register Number: 0087244 Date Molded: 10/07/2008 11 Project: BURGERVILLE #45 (TIGARD) — NEW CONSTRUCTION < 1 in. [25 mm] )\\ II I 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 f / 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 :nd of cylinder is pointed ends; tap with hammer to with unbonded caps) distinguish from Type 1 Asterisked ( *) average unit PSI test results did not meet listed acceptance criteria. Remarks: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Project Manager: JAMES F. HIETPAS Reviewed By: Ty Toller On 10/15/2008 Our report pertains to the material tested only. 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. Main Office Salem Office Bend Office Geotechnical Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 7185 SW Sandburg Rd Ste 110 a Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Tigard, Oregon 97223 Carls hone(503)684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Phone (503) 601 -8250 ����Il�� Inc. � Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Fax (503) 601 -8254 Report Of In -Place Density Tests Date: 10/13/2008 Job Number: T0807769. Permit #: BUP2008 -00246 Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS — CATHY INSLER Project: BURGERVILLE #45 (TIGARD) NEW CONSTRUCTION Address: 12785 SW PACIFIC HIGHWAY TIGARD OR 3/4" — 0 FROM KNIFE RIVER Material Description: 132.0 11.0 95 Maximum Dry Density- lbs. /cu. ft. Optimum Moisture: % Required Compaction: Standard Count for Gauge Serial # Troxler 37192 Method of Test: ASTM D2922, D3017/ ASTM D1557 Source of Value Dated 10/03/2008 Standard Counts - Density: 2550 Moisture: 679 Calibration Data: 9/2009 In -Place Density Date Of Test Code Test Density Moist. Mode Depth Elev. Field (Ibs /cu. ft.) Test No. Location Count Count Ft. Moist. Wet Dry Comp. 976 152 DT 8" FRG 7.7 146.1 135.6 10 -06 3 SF SE CORNER OF BUILDING 1FT OF SLAB 100+ 1 982 1 178 I DT 1 8" 1 FRG 1 9.4 1 145.8 1 133.3 10 -06 4 SF 6' WEST OF SE CORNER OF BUILDING SLAB AT EDGE OF 100+ EXTENSION SLAB 1 985 1 152 1 DT 1 8" 1 FRG 17.8 1 145.8 1 135.3 10 -06 5 SF SW CORNER OF BUILDING, 1' WEST OF SLAB 100+ 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Please see reverse side for additional information. E Distribute attachments. Job Number: T0807769. Date Of Test: 10/06/2008 /o In -Place Density -----. Date Of Test Code Test Density Moist. Mode Depth Elev. Field (lbs/cu. ft.) % Test No. Location Count Count Ft. Moist. Wet Dry Comp. I 1 I 1 1 1 I I 1 1 I 1 I 1 1 1 I I 1 1 1 1 I I 1 1 1 1 1 1 1 1 Asterisked ( *) percent compaction test results did not meet listed acceptance criteria. Remarks: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Typist: ARR Test By: M. RINNE Reviewed By: James Hietpas On 10/10/2008 Test results were discussed and left with of Code Descriptions NC - No code (general fill areas and backfill /original ground /not fil BC - Base course (Rock Only) ET - Electrical trench SF - Structural fill (Buildings Non - Residential) RW - Retaining wall backfill GT - Gass line trench LF - Residential lot engineered fill WT - Water line trench CT - Cable, phone trenches RF - Roadway engineered fill (Soil Only) ST - Sanitary sewer trench PS - Pavement subgrade DT - Storm drain trench Our report pertains to the material tested only. 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. Main Office Salem Office Bend Office P.O. Box 23814 s0 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 C a 9+�Q ®� Testin In�o Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 1 ►7 9 FAX (503) 684 0954 FAX (503) 589 1309 FAX (541) 330 -9163 October 14, 2008 T0807769 Permit No. BUP2008 -00246 FIELD INSPECTION REPORT DATES COVERED: October 1, 2008 PROJECT: Burgerville #45 (Tigard) — New Construction ADDRESS: 12785 SW Pacific Highway — Tigard, OR INSPECTOR: G. Gillman, COP #813, ACI #01073484, OBOA #751 10 -01 -08 - Rebar / Concrete As requested, CTI representative was on site for rebar and concrete inspection as follows: . 1. Performed periodic inspection of reinforcing and continuous inspection of concrete placement for footing at X2.5/Y4 — reference S101, 8/S501, 2/S504, 4/S504, S001. 2. Performed continuous inspection of concrete placement for footings at X4 line from Y1 to Y4 and connected wings from X3 to X4 at Y1 and Y4. Reinforcing was inspected by CTI on 09/24/08. Approximately 6.5 Yds of 4000 -psi, 5 '/2 -sack concrete, Knife River mix design SHN15000, were placed at above locations. One set of (4) 4X8 test cylinders was cast. Inspected work was completed and done in conformance to approved construction documents and the special inspection requirements of IBC 2006, table 1704.4, verification and inspection items 1, 4, 6, 11. "** CHECK ONE BOX ONLY*** YES NO 1. This is a preliminary inspection only. — OR — ❑ 2. The work inspected conforms to acceptance criteria listed above. If "No," the portions of the work that are non - conforming items are clearly stated above and will be added to the NCL. ® ID Remaining portions of the work, which are not preliminary in nature, are to be considered as conforming. 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. ' Respectfu, submitted, CARLS• TESTING, INC. Ja ids F. Hietpas P eject Manager f. G /ck cc: The Holland Inc /Burgerville Restaurants — Cathy Insler cathyi @burgerville.com City of Tigard Building Division Catena Consulting Engineers — Jason Holland Jason @catenaengineers.com Litmus Design & Architecture LLC — Alan Armstrong alan @litmus.com Lease Crutcher Lewis — Justin Riordan Justin.riordan @lewisbuilds.com Workplace Management LLC — Cheryl Pin wrkplacemgt @comcast.net The Holland Inc /Burgerville Restaurants — Dana Gardner danag @thehollandinc.com 10- 01- 08fr.doc • Main Office Salem Office Bend Office P.O. Box 23814 -60 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 c a *v � C Testitn Y ®� ���♦ Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 1 ►7 9 FAX (503) 684 0954 FAX (503) 589 1309 FAX (541) 330 -9163 Moisture - Density Relationship Client: The Holland Inc / Burgerville Restaurants - Cathy Insler 10/8/2008 Project: Burgerville #45 (Tigard) - New Construction Job Number: T0807769 Material Type: 3/4" - 0 Sampled from: Onsite Stockpile Source: Knife River Test Method: ASTM D -1557 C, C -136, D -2216 Date Sampled: 10/03/08 Sample Method: ASTM D -75 Date Tested: 10/03/08 Preparation Method: Moist Oversized Material: Removed Compacting Method: Mechanical Hammer Type: Pie Wedge 134 - 133 132 c 7\ a 131 '6 C p 130 G 129 128 127 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Moisture Content ( %) Optimum Moisture: 11.0% Max. Dry Density:) 132.0 Ibs /ft Percent Passing 3/4" Sieve: 99.0% CC: The Holland Inc / Burgerville Restaurants - Cathy Insler cathyi©burgerville.com City of Tigard Building Division Catena Consulting Engineers - Jason Holland • on©catenaengineers.com Litmus Design & Architecture LLC - Alan Armstrong alan @litmus.com Lease Crutcher Lewis - Justin Riordan justin.riordan @lewisbuilds.com Workplace Management LLC - Cheryl Pin wrkplacemgt @comcast.net The Holland Inc / Burgerville Restaurants - Dana Gardner danag • thehgllandinc.com cn Reviewed By: _—,...A i James F... -•tpas Test results pertain to the specific material tested /inspected only and may not be re : entative of other locations or elevations. Information contained herein is not to be reproduced, except in full, without prior authorization ■ Carlson Testing, Inc. The remaining sample material will be discarded two weeks after e date the test was completed. • Main Office ,alem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 ss�� pp ¢a 9 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Carlson Testing, Inc. Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Reinforced Concrete Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTI Job #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative A. LEWIS OBOA 750 /WABO SI 01737 was on site this date Oct. 07, 2008 to perform Special Inspection for: Permit BUP2008 -00246 DFS #(s) PO Number: SCOPE OF INSPECTION CONCRETE 1. Checked in with superintendent or client representative. 1. Mix Design approved? © Yes No 1=1 N/A Name: SCOTT Company: LEASE CRUTCHER LEWIS 2. Monitored loads arriving at job site for correct: Mix #: 141245HN15000 2. Type of work: © Concrete © Reinforcing % Slump 4 Air 3 3. Work included: © Sampling ©Inspection 3. Type of samples made? 4 X 8 CONCRETE CYLINDERS 4. Inspection was 'IBC' © Continuous 1=I Periodic Number of sets 1 Samples per set 4 5. Work performed: ® In the field 1=I At precast shop 4. Inspected placing and consolidation of approx. 4 - 5 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? SAME AS REINFORCING. 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: ® 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. 9. Verified structrual embedments in the forms © Approved plans and specifications Shop drawings with regard to weld inspection, quantity, and x 0 RFI El Design change Submittal El N/A permits issued. Document #(s) SEE NARRATIVE Dated: 10. Verified cast in place anchors. X 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). n Yes I x l No N/A SLAB -ON -GRADE AT GRIDS X3- X4 /Y1, X4 /Y1 -Y4, AND 4. Noncompliance item(s) were reinspected this date, details X3 -X4 /Y4 PER DETAIL 10/S501. CAST IN PLACE on following page(s). El Yes © No Ei N/A J -BOLTS ALSO VERIFIED. Conform n Remain in progress Report(s) findings were discussed and left with SCOTT of LEASE CRUTCHER LEWIS 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 1 Daily Report of Reinforced Concrt.. _ For: 10/07/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/13/2008 AFL /CK THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Carlson ������� Inc. Construction In & Related Tests Geotechnical Consulting Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 REPORT OF 4 X 8 CONCRETE TEST SPECIMENS Test Methods: ASTM C31 /C172/C192/C617/C1064/C231/C143 Date Molded: 10/01/2008 Job Number: T0807769. Permit #: BUP2008 -00246 Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD Contractor: LEASE CRUTCHER LEWIS - JUSTIN RIORDAN Subcontractor: Cast By: G. GILLMAN Concrete Supplier: KNIFE RIVER (METRO OPERATIONS) - QUALITY CONTROL Truck #: 3192 Load #: 1 Ticket#: 3121070 Weather: CLEAR 1 -3 MPH Test Time: 8:10 Air Temp. at Sampling Time: 57 Cylinders were cast for the following locations: SAME AS BELOW Total Concrete Placement Location: FOOTINGS AT X2.5 AT Y4; X4 /Y1 -Y4 ( -6.5 CU/ YDS) Strength Requirement: 4000 psi Pc @ 28 Days Slump: 3.250" % Air: 1.50% Mix Number: 5 HN 15 0 0 0 Conc. Temp: 75 Cement Type: 1/ 1 I Max Agg: 3/ 4 Admix/Amt: WRDA64 = 100 OZ Cubic Yards: 6.5 OF 6.5 Register Number: 0087140 Lab Location: TIGARD Set Test @ Date Test Total Area Unit Type Of Tested No. Days Rec'd Date Load PSI Fracture By I 7 10/02/2008 10/08/2008 51359 12.56 4090 4 RH2 28 10/02/2008 10/29/2008 28 10/02/2008 10/29/2008 28 10/02/2008 10/29/2008 ❑ Distribute attachments. Average fc @ 28 days Please see reverse side for additional information. Job Number: T0807769. Register Number: 0087140 Date Molded: 10/01/2008 Project: BURGERVILLE #45 (TIGARD) — NEW CONSTRUCTION <1 in. [25 mm] )\ g I . 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 f \ . f / 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 .tnd of cylinder is pointed ends; tap with hammer to with unbonded caps) distinguish from Type 1 Asterisked ( *) average unit PSI test results did not meet listed acceptance criteria. Remarks: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM Project Manager: JAMES F. HIETPAS Reviewed By: Ty Toller On 10/09/2008 Our report pertains to the material tested only. 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. Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 Tigard. Oregon 97281 Salem. Oregon 97301 Bend, Oregon 97708 hone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 6{1�'IS�� ����1�� Inc. � Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Masonry Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTI Job #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative M. WAGONER OBOA 746/OBOA 749 was on site this date Oct. 03, 2008 to perform Special Inspection for: Permit BUP2008 -00246 DFS #(s) PO Number: SCOPE OF INSPECTION SAMPLING 1. Checked in with superintendent or client representative. 1. Grout mix design approved? © Yes fl No 0 N/A Name: SCOTT Mix # SEE BELOW Company: LEASE CRUTCHER LEWIS 2. Type of grout samples made? N/A 2. Type of work: rout X Mortar © Grout M Number of sets Samples per set ii Prism a. Reinforcing M Solid Grout Partial Grout 3. Mortar mix design approved? © Yes 0 No D N/A — Mortar Type s 3. Work included: ® Sampling © Inspection 4. Type of mortar samples made? N/A 4. Inspection was "IBC" ® Level 1 0 Level II ❑ N/A Number of sets Samples per set 5. Work performed: © In the field 0 At precast shop 5. Type of prism samples made? SEE NOTES INSPECTION Yes No N/A Number of sets 1 Samples per set 3 1. Reviewed previous inspection reports? X Location of material placement [to include grid lines, elevations 2. Verified material stored properly, appropriately, (floors) and drawing details]: and meet the requirements of the project? X 3. Verified placement of masonry units and x SAME AS NOTED UNDER INSPECTION SECTION. construction of mortar joints. 4. Verified size & location of structural elements. x 5. Verified cleanouts provided. x ITEM 1 ABOVE: DESIGN MIX COARSE GROUT 6. Verified welding of resteel was inspected. (SITE- MIXED) . Confirmed by: X ITEM 5 ABOVE: 8" CMU PRISM SAMPLES MADE. 7. Verified protection of masonry during cold x (below 40F) or hot (above 90F) weather. REPORT SUMMARY 8. Resteel size, grade, spacing, splices, and x clearances conform? 1. Work inspected was: © Completed 0 In progress 9. Verified test prisms contain the same masonry units, grout, and mortar as the building. x 2. Completed work inspected was in compliance with ® Approved plans and specifications El Shop drawings 10. Verified structural embedments in the forms with regard to weld inspection, quantity, and X ❑ RFI 0 Design change fl Submittal ❑ N/A permits issued. Document #(s) Dated: 1 1 . Verified type, size and location of anchors. x 12. Verified minimum dimensions of spaces 3. Noncompliance item(s) were noted this date, details on provided for placement of grout. x following page(s). 0 Yes IN No 0 N/A 13. Verified grout space clean. x 4. Noncompliance item(s) were reinspected this date, details 14. Verified consolidation by mechanical on following page(s). ❑ Yes 0 No II N/A vibration & reconsolidation after loss of X water. ❑ Conform 0 Remain in progress Description of structure inspected [to include grid lines, Report(s) findings were discussed and left with elevations (floors) and drawing details]: SCOTT INSPECTED REINFORCEMENT PER DETAILS 2/S504 & 0f LEASE CRUTCHER LEWIS 4/S504. OBSERVED PLACEMENT & CONSOLIDATION OF (5) YDS OF GROUT - SITE -MIXED (GROUT NEEDED TO Based on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above MEET STANDARD OF C -476) & HAND GROUTED FOR LIFT can be covered. Carlson Testing has no authority to direct 4-8 ' AT X2.5/Y4 . work of contractors or subcontractors. ❑ See additional report page(s). El Distribute attachments. Page 1 of 1 Daily Report of Masonry For: 10/03/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/09/2008 MCW /SB THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM • Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 Carlson Testing, Inc. Tigard. Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 � Phone one (503) 03) 684-3460 Phone (503) 589 -125125 2 Phone (5541) 1) 330-9155 5 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTIJob #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative M. WAGONER OBOA 746/OBOA 749 was on site this date oct . 03, 2008 to perform Special Inspection for: Permit BUP2008 -00246 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: SCOTT PER DETAILS 9/S501 & 10/S501, OBSERVED Company: LEASE CRUTCHER LEWIS INSTALLATION OF (39) #4 DOWELS INTO EXISTING SOG AT X4 /Y2 -Y3 WITH 6 -1/2" EMBEDMENT. 2. Inspection was "IBC" ® Continuous Periodic PROPRIETARY ANCHORS Yes No N/A 1. Reviewed previous inspection reports? 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 0 In progress anchors. x 4.Verified installation of the anchors. 2. Completed work inspected was in compliance with ® Approved plans and specifications 0 Shop drawings 5. Verified anchor diameter. X 6. Verified steel grade. X RFI 0 Design change 0 Submittal 0 N/A 7. Verified hole diameter. x Document #(s) Dated: 8. Verified type of drill bit used. x 9. Verified hole cleaning method. x 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. x following page(s). D Yes ®No 0 N/A 11. Verified edge distance. X 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. X on following page(s). 0 Yes 0 No ® N/A 13. Verified installation torque. X 0 Conform D Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR -2322 11/1/07 SCOTT of LEASE CRUTCHER LEWIS Name of product being installed HILTI RE- 500 -SD Batch Number 0608081114 L3 Expiration Date 08/2009 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. E l See additional report page(s). 0 Distribute attachments. Page 1 of 1 Daily Report of Proprietary Anchors For: 10 / 0 3/ 2 0 0 8 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/09/2008 MCW /SB THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM _ c Main Office lem Office Bend Office P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 Carlson 'Vesting, Inc. P (503) Oregon 97281 684 -3460 Phone ( 503) 589-1252 97301 Bend, 2 Phone ( 541) 3 30 0 -915 Phone (503) 684-3460 503)58125o541)3-9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Proprietary Anchors Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTI Job #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative M. WAGONER OBOA 746/OBOA 749 was on site this date Oct. 02, 2008 to perform Special Inspection for: Permit BUP2008 -00246 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. PER RFI #41, OBSERVED INSTALLATION OF (8) 5/8" Name: SCOTT ALL - THREAD AT X3 /Y4 WITH AN EMBEDMENT OF (5) Company: LEASE CRUTCHER LEWIS 5/8" & INSTALLATION OF (9) 5/8" ALL - THREAD AT X3 /Y1. PER RFI #51, OBSERVED THE INSTALLATION 2. Inspection was "IBC" © Continuous ❑ Periodic OF (5) #4 DOWELS AT X2.5 /Y4 (2' O.C.) INTO EXISTING WALL WITH EMBEDMENT OF 6 -1/2 ". PROPRIETARY ANCHORS YesNoN /A DOCUMENTS # (S) DATED = 09 -23 -08 & 09 -17 -08 1. Reviewed previous inspection reports? X 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 E In progress anchors.. X 4.Verified installation of the anchors. 2. Completed work inspected was in compliance with X ❑ Approved plans and specifications ❑ Shop drawings 5. Verified anchor diameter. X 6. Verified steel grade. X © RFI El Design change Submittal N/A 7. Verified hole diameter. X * 8. Verified type of drill bit used. X Document #(s) RFI ' S 41 « 51 Dated: 9. Verified hole cleaning method. X 3. Noncompliance item(s) were noted this date, details on 10. Verified adhesive application. X following page(s). Yes No ©N /A 11. Verified edge distance. X 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. X on following page(s). ❑ Yes No ® N/A 13. Verified installation torque. X ❑ Conform 0 Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR -1967 SCOTT 12 -01 -05 of LEASE CRUTCHER LEWIS Name of product being installed HILTI HY -150 Batch Number 185525L4 Expiration Date 01 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 Daily Report of Proprietary Anchi For: 10/02/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/08/2008 MCW /JWA THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM ' 'vlaln Office - 31em Office Bend Office P.O. Box 23814 46 udson Ave.. NE P.O. Box 7918 Tigard, Oregon 97281 Salem. Oregon 97301 Bend, Oregon 97708 CarlsC a rlson Testing ' Inc. nc Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 on Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Masonry Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTI Job #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative M. WAGONER OBOA 746/OBOA 749 was on site this date Oct. 02, 2008 to perform Special Inspection for: Permit BUP2008 -00246 DFS #(s) PO Number: SCOPE OF INSPECTION SAMPLING 1. Checked in with superintendent or client representative. 1. Grout mix design approved? IN Yes E No 0 N/A Name: SCOTT * Mix Company: LEASE CRUTCHER LEWIS 2. Type of grout samples made? N/A 2. Type of work: x - Grout Mortar © Number of sets Samples per set Prism PI Reinforcing X - Solid Grout Partial Grout 3. Mortar mix design approved? © Yes ❑ No ❑ N/A Mortar Type S 3. Work included: ❑ Sampling © Inspection 4. Type of mortar samples made? N/A 4. Inspection was "IBC" ® Level I El Level II 0 N/A Number of sets Samples per set 5. Work performed: © In the field ❑ At precast shop 5. Type of prism samples made? N /A INSPECTION Yes No N/A Number of sets Samples per set 1. Reviewed previous inspection reports? X Location of material placement [to include grid lines, elevations 2. Verified material stored properly, appropriately, (floors) and drawing details]: and meet the requirements of the project? X * MIX = DESIGN MIX COARSE GROUT (SITE MIXED) 3. Verified placement of masonry units and x construction of mortar joints. SAME AS UNDER INSPECTION. 4. Verified size & location of structural elements. x 5. Verified cleanouts provided. x 6. Verified welding ofresteel was inspected. NOTE: PRISMS NEED TO BE MADE NEXT GROUT POUR. Confirmed by: X 7. Verified protection of masonry during cold x (below 40F) or hot (above 90F) weather. REPORT SUMMARY 8. Resteel size, grade, spacing, splices, and x clearances conform? 1. Work inspected was: © Completed 0 In progress 9. Verified test prisms contain the same masonry x 2. Completed work inspected was in compliance with units, grout, and mortar as the building. 10. Verified structural embedments in the forms © Approved plans and specifications 0 Shop drawings with regard to weld inspection, quantity, and x 0 RFI ❑ Design change 0 Submittal 0 N/A permits issued. Document #(s) Dated: 11. Verified type, size and location of anchors. x 12. Verified minimum dimensions of spaces 3. Noncompliance item(s) were noted this date, details on provided for placement of grout. x following page(s). ❑ Yes ® No 1=1 N/A 13. Verified grout space clean. x 4. Noncompliance item(s) were reinspected this date, details 14. Verified consolidation by mechanical on following page(s). Yes El No ® N/A vibration & reconsolidation after loss of x water. ❑ Conform ❑ Remain in progress Description of structure inspected [to include grid lines, Report(s) findings were discussed and left with elevations (floors) and drawing details]: SCOTT INSPECTED REINFORCEMENT PER DETAILS 2/5504 & of LEASE CRUTCHER LEWIS 4/S504. OBSERVED PLACEMENT & CONSOLIDATION OF 5 YARDS OF GROUT -SITE MIXED (GROUT NEEDED TO MEET Based on the Code, approval is required from the Building Official before the SPECIAL INSPECTED items noted above STANDARD C -476) AND HAND GROUTED FOR LIFT 0 =4' @ can be covered. Carlson Testing has no authority to direct X2.5 / Y4 (ONE 24" SEC AT EAST & IS ONLY 16" HIGH work of contractors or subcontractors. ❑ See additional report page(s). El Distribute attachments. Page 1 of 1 A . Daily Report of Masonry For: 10/02/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 10/08/2008 MCW /JWA THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM a i Main Office aalem Office Bend Office P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 ss�� 9 Tigard, Oregon 97281 Salem, Oregon 97301 Bend, Oregon 97708 C arlson Testing Inc. Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Reinforced Concrete Client: THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION CTIJob #: T0807769. Address: 12785 SW PACIFIC HIGHWAY TIGARD OR Jurisdiction: TIGARD CTI representative G. WATSON OBOA 363 was on site this date Sep. 24, 2008 to perform Special Inspection for: Permit BUP2008 -00246 DFS #(s) PO Number: SCOPE OF INSPECTION CONCRETE 1. Checked in with superintendent or client representative. 1. Mix Design approved? 0 Yes 0 No © N/A Name: SCOTT Com an LEASE CRUTCHER LEWIS 2. Monitored loads arriving at job site for correct: P y Mix #: 2. Type of work: ❑ Concrete © Reinforcing Slump % Air 3. Work included: ❑ Sampling © Inspection 3. Type of samples made? N/A 4. Inspection was 'IBC' ❑ Continuous ® Periodic Number of sets Samples per set 5. Work performed: © In the field ❑ At precast shop 4. Inspected placing and consolidation of approx. 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? x 3. Type, grade, size, quantity, spacing and X (KEBAB ONLY) 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 7. Verified support & anchorage of reinforcing REPORT SUMMARY steel in the forms. X 1. Work inspected was: ® Completed 0 In progress 8. Verified structural embedments in the forms x 2. Completed work inspected was in compliance with with regard to fabrication. quality and type. © Approved plans and specifications D Shop drawings 9. Verified structrual embedments in the forms with regard to weld inspection, quantity, and X fl RFI El Design change fl Submittal fl N/A permits issued. 10. Verified cast in place anchors. X Document #(s) Dated: 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). 0 Yes 0 No © N/A 4. Noncompliance item(s) were reinspected this date, details NEW FOOTING BETWEEN X3 AND X4, AND NEW FOOTING on following page(s). D Yes No ® N/A AT Y4. DETAILS ON S501. El Conform 0 Remain in progress Report(s) findings were discussed and left with SCOTT of LEASE CRUTCHER LEWIS 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). Distribute attachments. Page 1 of 1 . t • Daily Report of Reinforced Concreto For: 09/24/2008 CTI Job #: T0807769. Project: BURGERVILLE #45 (TIGARD) - NEW CONSTRUCTION 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. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Reviewed By: James Hietpas Review Date: 09/29/2008 GW /SB THE HOLLAND INC /BURGERVILLE RESTAURANTS - CATHY INSLER CATHYI @BURGERVILLE.COM TO: CITY OF TIGARD BUILDING DIVISION CATENA CONSULTING ENGINEERS - JASON HOLLAND JASON @CATENAENGINEERS.COM LITMUS DESIGN & ARCHITECTURE LLC - ALAN ARMSTRONG ALAN @LITMUS.COM LEASE CRUTCHER LEWIS - JUSTIN RIORDAN JUSTIN.RIORDAN @LEWISBUILDS.COM WORKPLACE MANAGEMENT LLC - CHERYL PIN WRKPLACEMGT @COMCAST.NET THE HOLLAND INC /BURGERVILLE RESTAURANTS - DANA GARDNER DANAG @THEHOLLANDINC.COM