Report Mein Office Salem Office Bend Office
P.O. Box 23814 J0 Hudson Ave., NE P.O. Box 7918
C arlson Testing Inc • Phone , (5 684 -3460 Phone (503) 5897301 252 Phone (541) 330-9155
FAX (503) 684 -0954 FAX (503) 589 -1309 FAX (541) 330.9163
April 28, 2006
T0601700.CTI
Permit No. MST200500336
FIELD INSPECTION REPORT
DATES COVERED: April 19, 2006
PROJECT: Anderson Residence — Addition
ADDRESS: 10180 SW Riverwood Lane — Tigard, OR
INSPECTOR: K. Gauvin — COP#671, WABO #GAU757203, OBOA#183, ICBO #1028581 -88
04- 19 -06: CTI representative was on site and the following was noted:
Performed continuous inspection during the placement of (1) 5/8" diameter threaded rod into 3 /4"
diameter hole 9 -1/2" deep for PHD5 Simpson holddown at back of house. Simpson SET -PAC
epoxy was used for installation, batch # 495406GG with expiration date of February 2007. Hole
diameter, hole cleaning and epoxy installation conformed to ICC # 5279 and structural
calculations and sketch from Paul Kluvers, P.E.
*** 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.
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. /
Respectfully S bmitted,
CARLSO TESTING, INC.
i .
Neill. Shannon
Pr'(ect Manager
G /ja
cc: All Clean & Carpentry — Scott Smith
City of Tigard Building Dept
Cascade Design Professionals Inc — Paul Kluvers
Main Office Salem Office Bend Office
P.O. Box 23814 0 Hudson Ave., NE P.O. Box 7918
Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708
Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155
Carlson Testing, Inc • Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163
Special Inspection Page ( of /
DAILY FIELD REPORT
Project: A/A.2S0N . i il)i j t - 4M/7 Date: 4-19-6;6
Job Address: / CC/P. G Sw "44/PG .iC6 Cit; 77 64-M CTI Job No. JV u 2 l7 cJ cs
Permit No.: U0 33 (0 Type of Inspection: /qqo/ - 3 7 /7 rtV ,l
Field or Fab Shop Weather: C
Inspection Notes (include location, testing data, substitutions /deviations, materials and methods of construction, non - conforming items,
acceptance criteria, corrected non - conforming items, etc.): •
C&Ai7 /,L-'5, C7(.w 44.4 - ) 0 /4c,e1 i)u /,/A. 77/ .4// / 4A- r - c
(t ) 5 - 77/r2i) 26/) /A)fl: 3/ � hit>e £ c> %Z , .4'P Strwo_J O
Ho(6 bow," @ encie o z / c'rl_ . f C IA> 07 c,,, ufkA
/A) 41' ) kxP 2/07 46 44 5 o6c, . f /Gtr b//9 ./t; cF C(, /,L4 4 4
- -- - - - /A,41)41-t- C!4 -2&Ai .- C-f 'i#F= og,ic- r-4_.j- 723 — /CC- - -5-2 7_ . .,g4 /j
C/9 ((,(t h1/2 Air ,9J Lee roc/ 1420 P4c et U vf2s P, E ,
* ** 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. Remaining portions of the work, which ❑
are not preliminary in nature, are to be considered -as conforming. .
•
ec #67 /
Inspector: tor: �� Certification No.:
Use of the information contained in this report constitutes acceptance of all terms on the reverse of this form and Carlson Testing, Inc.'s General Conditions.
Information contained herein is not to be reproduced, except in Ml, without prior authorization from this office.
•
•
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 CTI 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 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.