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Report Main Office alem Office Bend Office ' P.O. Box 23814 4060 Hudson Ave., NE P.O. Box 7918 ss�� 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: BNK CONSTRUCTION INC - RON NIELSEN Project: PACIFIC PARK PLAZA CTI Job #: T0601322.A Address: 9975 SW FREWING STREET TIGARD OR Jurisdiction: TIGARD CTI representative K. THRALL OBOA 347 was on site this date Sep. 20, 2007 to perform Special Inspection for: Permit BUP2004 -00297 DFS #(s) PO Number: SCOPE OF INSPECTION CONCRETE 1. Checked in with superintendent or client representative. 1. Mix Design approved? © Yes D No ❑ N/A Name: JAY Com an BNK 2. Monitored loads arriving at job site for correct: P y Mix #: 305002W 2. Type of work: © Concrete © Reinforcing 4 % /o Slump Air 1.4 3. Work included: © Sampling © Inspection 3. Type of samples made? 4 X 8 CONCRETE CYLINDERS 4. Inspection was 'IBC' © Continuous Periodic Number of sets 1 Samples per set 3 5. Work performed: ® In the field At precast shop 4. Inspected placing and consolidation of approx. 2 0 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' 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. REPORT SUMMARY 7. Verified support & anchorage of reinforcing steel in the forms. X 1. Work inspected was: ® Completed fl 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. 9. Verified structrual embedments in the forms © Approved plans and specifications Shop drawings with regard to weld inspection, quantity, and X El RFI 1=1 Design change 1=I 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). El Yes El No © N/A ALL TYPE D AND E FOOTINGS. ALL COLUMNS GROUTED 4. Noncompliance item(s) were reinspected this date, details AT BASE. on following page(s). El Yes No © N/A El Conform Remain in progress Report(s) findings were discussed and left with JAY of BNK 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). El Distribute attachments. Page 1 of 1 , . 4 Daily Report of Reinforced Concrc,_ For: 09/20/2007 CTI Job #: T0601322.A Project: PACIFIC PARK PLAZA • 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: Steven W Leach Review Date: 09/26/2007 KRT /CK BNK CONSTRUCTION INC - RON NIELSEN TO: CITY OF TIGARD BUILDING DIVISION T M RIPPEY CONSULTING ENGINEERS - TIM RIPPEY