Report ' Main Office Salem Office Bend Office
P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 1
Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 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
December 1, 2004
. T0407022.CT - G /
Permit N • % . 2004 =00291 / i f,5o 0
FIELD INSPECTION REPORT
DATES COVERED: November 22, 2004 RECEIVED E®
PROJECT: Ghaffari Residence
tDEC. �
ADDRESS: 9490 SW Sattler - Tigard, OR CITY OF TIGARD
INSPECTOR: S. McLean, COP #785, ACI#480538, ICC #5096223 -49, oBoalateNG DIVISION .
11- 22 -04: As requested, CTI representative was on site and conducted proprietary anchor
inspection. Observed the Cnstallat'ol n of (2)_518" all :thread a -nchorr into 3 /4" drilled holes that
were cleaned with brush and compressed air and had a minimum embedment of 2
All work was done per plans and specifications as well as ICBO ER -5279. Adhesive used was
Simpson Strong -Tie Anchoring System SET -PAC with an expiration date of 12 -2005 for lot
#211438BB.
" "" CHECK ONE BOX ONLY*" Y S 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.
Remaining portions of the work, which are not preliminary in nature, are to be considered as ❑
conforming.
U
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 TESTI ; INC. ,
Jai• -- - . Hietpas
''a erations Manager
M /sab
cc: UGR - Rahim Ghaffari .
•
City of Tigard Building Dept
Nicoli Engineering Inc
CAD Northwest