Report Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testi Eugene Office (541)345-0289
ng IlC• Salem Office (503)589-1252
141 57-A0/11-00//q Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project:
Address: .i&it CTI Job#: /141e2
CTI representative /'?/)A.' --'2,1101 3r, was on site this date 1/-/ / to perform
(Inspector Name&Cert.No.)
0" 19X
Special Inspection for Efpermit DFS#(s) +' , 6'40, r"49//I 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]: It +r
1.Checked in with superintendent or client representative. 10,ezt,k \L f..
Name: t / t t-(13e eV
Company: O l4 D — 0 G,Yolz /e .1 Q G, ft, g- �J
161)61 i2 t-o Ek ) -r/AM-c> 1:"G)4, ii)-
2.Inspection was"IBC" E Continuous ❑ Periodic /}`ri o4 5-E W/)dip /9i L A ,`,);y
PROPRIETARY ANCHORS
Yes NON/A /L '//
1.Reviewed previous inspection reports? i
2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was:
p Ei Completed Ei In progress
3.Verified minimum embedment depth of the 2.Completed work inspected El was ❑ was not
anchors. •
4.Verified installation of the anchors. in compliance with
5.Verified anchor diameter. El-Approved plans and specifications El Shop drawings
6.Verified steel grade. ❑ RFI 0 Design change fi 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 ❑ No 0 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). El Yes No E N/A
13.Verified installation torque. El Conform El Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
of ''jE Z f3/,;7_) :7
Name of product being installed
'lilt ,U ,
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:
ElSee additional report page(s). D Distribute attachments. Page of
PropAnchors Ver.1 2/12/2009
•
I
•
•
T, i 1 •
•
1erm;:
`t- —
; 1CS ,, 1
Client recoguires that eoinutru tion.obscnatioi and/or testing services provided by CT14t�t{
which may reduce the risk ofconstnictioii defects,deficiencies,or omissions arising during or after con-
. str ictlon. Services pcsrtorrned by Cl l dew consiiiute a warranty or guarantee of any type.1 ven with
diligent Cc iructrnndncUitorin ttnd'orte3tigg b. C•TI,construction dAccts,deficiencies,or omissions
in the Contractor's.-crk 1laav c\i'0 In all cases.Client and or the C'ontrau;tor-hall assign the Contractor
the responsibilify•for the quality and completeness of tau cc ark and for;adhering to plans and specifica-
tions. C'1 l's work or failure to perform same shall no in any v,ay excuse any contractor,subcontractor,
or supplier from perlbrn.ance of its•,.ork in accordance e v itlr the contract doctunents.
, ;
( 1 I il! pro.idc its pr,f.,‘10tt;6 r• r.,Client.+ith tila<decree of ease:;11,_i skill ordinarily exercised
under similar eircun1stanees b. n!crmf ers ,f is.pn,acss rm.This repre,cntatinn m her at other.r.nr:ur
iy or representation,either exp!Cssed anapir'd. It is akii und:rsar r.I and:tercc d ilia! -'.a.ntents made 44
_ in C I I report,ate ohsenations based on technical judgements.and should not he construed to he cort-
clusi.e representations of fact if conditions different from.e hat are indicated in the: eports come to 1
Client s,anenIion alter reecipi c, :Jlc reports.it is rc coiarne ided that Chem cnntac•t C1 I immedttick to
.LtltflLi'IL• funhc:r ahproprlalc etaivation.
('Ti's.sink shall nb1 include deter supervising or impiemcnting the means,mtaethods,techniques.
sequences. ,wproc•diires ill r'unsiruction.(-II shall not be responsible fear evaluating or reporting joh con-
ditions related to lhalth,safct. iii •.1 ellare.
•
I
t `