Report i1 'i " —0v 7S--- Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testi Eugene Office (541)345-0289
ng, nc• Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: ti[ ty)6 ert:i
Address: /7� -/St11 1/7. �•y Z,¢, CTI Job#: MO3 T 7 7
CTI representative eV, 4 t e5f was on site this date -1j1 19 to perform
(Inspe for Name&Cert.No.)
Special Inspection for El permit fl DFS#(s) MI-- 2..._014 ` ,1c 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. i '7') 5/S fl tQ All AYt) ! 1) 614(h
Narne: jiLA f Pe 07 rn4in t'Ak . b —.
Company: r/0LIE Gi' /�
2. Inspection was"IBC" Continuous Periodic lv o '0/f 111112.
PROPRIETARY ANCHORS
Yes No N/A
1.Reviewed previous inspection reports?
2.Reviewed evaluation report? /1
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: t Completed El In progress
3. Verified minimum embedment depth of the
anchors.
/ 2. Completed work inspected was El was not
anc
4.Verified installation of the anchors. - . in compliance with
5. Verified anchor diameter.
�/. ❑ Approved plans and specifications ❑ Shop drawings
6. Verified steel grade. f 0 RFI ErDesign change ❑ Submittal El N/A
7. Verified hole diameter. f Document#(s) re-v L Dated: /7-q-/.14
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). 0 Yes No 0 N/A
10. Verified adhesive application. / /
11. Verified edge distance. 7 4.Noncompliance item(s)were reinspected is date,details
12. Verified spacing. / on following page(s). 0 Yes No ❑ N/A
13. Verified installation torque. V U Conform 0 Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
25
- --/;1- , Th
L of � r
Name of product being installed ,f['i
Batch Number 147. 4/61--- - - -
Expiration Date V IL:
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.
....5ei____
Inspector Signature:
nSee additional report page(s). 0 Distribute attachments. Page ! of
PropAnchors V er.1 2/12/2009