Report (61) pis- a o i 6 - 00L-0-/5--
Bend
® t'/-/S Bend Office (541)330-9155
•
Geotechnical Office (503)601-8250
Carlson Testing, Inc. Eugene Office (54})345-0289
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: 1o 1 0.1 W e 5/ 4"i! Te r t .[.e - Aret,, iL - + 9'4/
Address: 1.7 .1'/2,. -SW ,�1.+t c 1,4 iT T y AF- U rI
s CTI Job#: Trk059?_2... ".!S'r'i
CTI representative 740a 5 014 ?t , - ,er fife►
was on site this date /-/9 t! to perform
(Ins , . rt.
Special Inspection for
p P � permit�'�-BF,.�.�(sl.- /�Sid It�('�J 51115- jurisdiction r.a r +Pyf" 7":71/1.
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. 'p t Cr 4d/ it%id 144,f,r,79 fit; e.�' ]�n,o!S()el Aida
Name: ,5_0(w� p
Company: (til{ . G.� !� ; �`/1 Or +Z ) S� ip/ Y ��0,, t op/ fa/pis
2.Inspection was"IBC" Continuous El Periodic S11.S�1�j. /t jt�/�..1 t/ 're 6/1-,1/ 0! �+„ eVe
PROPRIETARY ANCHORS d'`t e-74,,,/ ,� ;•, 1 e,./ 6,711-17 er Sri "
hie eAse/erl �r ,ed rS,4 0{
Yes NoN/A Presfo !OAte J kJ AS )41t f.sSit,ie
1.Reviewed previous inspection reports? „1/
2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected ected was: • progress
P �„1 Completed In ro ess
3.Verifieanchor s minimum embedment depth of the 2.Completed work inspected1S4 was 0 was not
in compliance with
4.Verified installation of the anchors. mP
S.Verified anchor diameter. 154Approved plans and specifications E Shop drawings
6.Verified steel grade. X [ RFI [] Design change [ Submittal fl N/A
7.Verified hole diameter. Document#(s) rx `1`� Dated: 11-
8.Verified type of drill bit used.
9. vcrrired hole cleaning:use o following page(s). 0 Yes I No 0 N/A
10.Verified adhesive application.
11.Verified edge distance. X 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. � on following page(s). Yes No n N/A
13.Verified installation torque. v0 Conform 0 Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
r h
of _o ----
Name of product being installed
Batch Number 4-1 j(g,T'}
Expiration Date )1--2.. -0
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: jit'4 j >f
n See additional report page(s). n Distribute attachments. Page 1 of f
PropAnchors Ver.1 2/12/2009
Aler#
tictififfurd
it herd recognizes that construction observation andior casting seri ices provided b k i acif
hieh
clay reduce the risk of construction defects,deficiencies,or onitsSior ;an dtUrint,... or atter con-
struction. Services performed bit ( I do not nonstnittnn nn,trinan's nutnno-nnt:.tn ;An
dii Tent construction rnomithiantif and.or testicle ince L construtmod &mend deceit:ins-ins, or omeorricis
10 the•Contractors work rusty exist. In all cases,rk lent and/or the(Contract;em:than assign tint,Conai seiter
the responsibility MI the quality and completeness oldie work and for adhering en plans and voceilicas
dons, Ma Fs work or hal lure to perliirm idinfie shall no in arc, ettousii anit• taintrifeita. ride iCtOl..
suriplitsc or as iistirliordidaftd,oh iso work insi.1,,,„',Ordaro....„2 with the contract oniatiments,
C will provide its pliiiitisciasintil services,dm Cheat with that degree of care and
ander si.m.iiar circuniraancicsi by members of us prdlession, his repreSentation in in lieu of other vitamin-
ty or representatiom either expressed or implied it is also understood and agreed that iikaterneuls made
CT I reports are observations based on technical badacninarks„and should not he construed to lac eon-
elusive representations ttrfact. If conditions different from \vitat are indicated in the r,p0,1,,conic to
Client's.attention drier receipt of the reports,•it is recommended that Client contact ha H ininnevittitelv, to
tiothiirixe Itirdner appropriate evaluation,
tis donk shalt not include determining, sane nvising or thiplemerninif the meanie met:nods.,tetamitices,
sequences..or birorcduresoreonskruction,(11 oot rnntnnntnnt. the cvaboatin wmn rnimrlin fon Linn-
halons relaied to health,:tardy or vveillem,