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Report Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 e� ® Eugene Office (541) 345 -0289 Ca Testing, 1 esti g� g, Inc. Salem Office (503) 589 -1252 Tigard Office (503) 684 -3460 Daily Report of Proprietary Anchors Client: CUSTOM BUILT INC - RANDY EGGIMAN Project: YOUNG RESIDENCE - ALTERATION CTI Job #: T1003241. Address: 13036 SW BROADMOOR PLACE TIGARD OR Jurisdiction: TIGARD CTI representative K. THRALL OBOA 347 was on site this date Oct. 11, 2010 to perform Special Inspection for: Permit MST2010 -00144 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. #5 DOWELS WITH 8" EMBEDMENT, SPACING TO MATCH Name: RANDY NEW FOOTING LAYOUT, 24" LONG Company: CUSTOM BUILT INC NE FOOTING IN BASEMENT 2. Inspection was "IBC" © Continuous 1=1 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 ❑ In progress anchors. x 4.Verified installation of the. anchors. 2. Completed work inspected was in compliance with x © Approved plans and specifications 0 Shop drawings 5. Verified anchor diameter. x 6. Verified steel grade. x RFI ❑ Design change ❑ Submittal ❑ N/A 7. Verified hole diameter. x Document #(s) APPROVED PLANS Dated: 10/8/10 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. 4. Noncompliance item(s) were reinspected this date, details 12. Verified spacing. x on following page(s). Yes No E N/A 13. Verified installation torque. x ❑ Conform Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with ESR 1772 1/2010 of Name of product being, installed SIMPSON SET Batch Number 14 9A14 6A Expiration Date 7/2012 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 1 Daily Report of Proprietary Anchors For: 10/11/2010 CTI Job #: T1003241 . Project: YOUNG RESIDENCE - ALTERATION 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 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. Reviewed By: Neil Shannon Review Date: 10/15/2010 KRT /WM CUSTOM BUILT INC - RANDY EGGIMAN TO: CITY OF TIGARD BUILDING DIVISION ROWELL ENGINEERING & DESIGN INC - TODD ROWELL CUSTOM BUILT INC - RANDY EGGIMAN TAD YOUNG ns7O/O- oo i yy Bend Office (541) 330 -9155 Geotechnical Office (503) 601 -8250 Carlson Test• Eugene Office (541) 345-0289 ing, Inc• Salem Office (503) 589 -1252 Tigard Office (503) 684-3460 Daily Report of Proprietary Anchors Project: Address: CTI Job #: CTI representative ' was on site this date to perform (Inspector Name & Cert. No.) Special Inspection for ❑ permit 0 DFS #(s) 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: Company: 2. Inspection was "IBC" El Continuous El Periodic PROPRIETARY ANCHORS Yes No N/A 1. Reviewed previous inspection reports? 2. Reviewed evaluation report? REPORT SUMMARY Verified following items meet manufacturer's published installation instructions. 1. Work inspected was: Completed El In progress 3. Verified minimum embedment depth of the 2. Completed work inspected ❑ was D was not anchors. 4.Verified installation of the anchors. in compliance with 5. Verified anchor diameter. 0 Approved plans and specifications ❑ Shop drawings 6. Verified steel grade. ❑ RFI ❑ Design change 0 Submittal ❑ N/A 7. Verified hole diameter. Document #(s) Dated: 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). ❑ Yes 0 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). Ei Yes 1=1 No N/A 13. Verified installation torque. ❑ Conform 12 Remain in progress Evaluation report number & date: Report(s) findings were discussed and left with of Name of product being installed 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: See additional report page(s). 0 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 not 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 ell reports are observations based on technical judgments, 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 Gil 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.