Report (42) inTfitga - no4°-.7
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Inc. Eugene Office (541)345-0289
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Al f Y l'f '�. f f-t`'...-e. ' " d""f e4 r(-SA i2€ 1, , ,,- ° ' (1,9-,e , .,.
Project: — — _ //-�._ � '
Address: / -7°,C LI y!.4r 0,14-7- i�r�'a'f !�"te. - CTI Job#: r / ' 1 ' 14
si.
CTI representative r {' �'----- was on site this date ______`—__- " 'to perform
(Inspector Name&Cert.No.)
ill Special Inspection for El permit fl DFS#(s) 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. ` Af /4/1 ,r , ,r--,e, ii`
Name: {� ri { , t1' .: .., r rFr• f' .
' 2 A -,-
�`
Company: _ r°- 4, sem., 1. ....-.2,-...,_„,# ' y
2.Inspection was"IBC" 0 Continuous 0 Periodic /
PROPRIETARY ANCHORS J'rr-
Yes No N/A "r/7CT (i\ c>�r - Y'c�. '°+' `
1.Reviewed previous inspection reports? --10-
2.Reviewed evaluation report? `mac_
REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: [ Completed El In progress
3.Verified minimum embedment depth of the X 2.Completed work inspected IS was El was not
anchors.
in compliance with
4.Verified installation of the anchors. '
u Approved plans and specifications 0 Shop drawings
5.Verified anchor diameter. Y
6.Verified steel grade. "1- 0 RFI 0 Design change El Sub l n N/A
7.Verified hole diameter. Document#(s) C '�° 1< '" " Dated:` ` / g'�"
C
8.Verified type of drill bit used. s 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. following page(s). El Yes El No Dl N/A
10.Verified adhesive application. Yi
11.Verified edge distance. V 4.Noncompliance items)were reinspected this date,details
12.Verified spacing. on following page(s). 0 Yes 0 No PCI N/A
13.Verified installation torque. X 0 Conform 0 Remain in progress
Evaluation report number&date: y! t om ;- Report(s)findings were discussed and left with
of pf 1.,
Name of product being installed )---; l
Batch Number - / 6 ?. s b
Expiration Date 1 c.� °
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 rk6/./...e..4-tr.
off contractors or subcontractors.
Inspector Signature: 1' ��`'' ..4 4y
n See additional report page(s). ' n Distribute attachments. Page of 1
PropAnchors Ver.i 2/12/2009