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Report 4;- G5) Bend Office (541)330-9155 Carlson Testing, Inc. Geotechnical Office (503)601-8250 Eugene Office (541)345-0289 Salem Office (503)589-1252 Tigard Office (503)684-3464 Daily Report of Proprietary Anchors Client: POLYGON NORTHWEST CO - CHRIS WALTEER Project: POLYGON - NW RIVER TERRACE AREA 1 LOT 113 CTI Job #: T1605921.CO - Address: 17336 SW SHADOW TRAIL ST TIGARD OR Jur CTI representative R. MONTGOMERY OBOA 1119 WABO SI 02145,WABO 359213diC1lOII: TIGARD was on site this date Jun. 30 2017 to perform Special Inspection for: Permit MST2017-00041 DFS#(s) - PO Number: SCOPE OF INSPECTION Location of proprietary anchors inspected[to include grid 1.Checked in with superintendent or client representative. lines,elevations(floors)and drawing details]: Name: TOM PER B ETON DATED 5 15 2014 FOR THE Company: POLYGON NORTHWEST CO -__-___ W INSTALLATION OF 5 B" THREADED ROD FOR TiDU4 HOLDOWNS. RODS HAVE A 5-1 2" EMBEDMENT. HOLDOWNS 2.Inspection was"IBC" 0 Continuous 1::1Periodic PLACED ADJACENT TO FRONT DOOR INTO FOUNDATION WITH 24" SPACING. 2 ANCHORS INSTALLED TODAY. PROPRIETARY ANCHORS _____ -� _ __ Yes No N/A I.Reviewed previous inspection reports? 2.Reviewed evaluation report? ---~----- ______ _.__ x Verified following items meet manufacturer's published installation instructions. REPORT SUMMARY 3. Vera ancedhors.minimum em. ent dep ©,. anchors. a 0 ' 1.Work inspected was: Completed 4.Verified installation of the anchors. ©■■ 2.Completed work inspected in compliance with In progress 5.Verified anchor diameter. ©a. ❑ 6.Verified steel grade. Approved plans and specifications ❑ Shop drawings 7.Verified hole diameter. ©o 0 RFI ElDesignchange ❑ Submittal ❑ N/A 8.Verified type of drill bit used. Document#(s) BULLETIN 9.Verified hole cleaningDated: 1 s__/____L____5 4 method. ©u 3.Noncompliance item(s)were noted this date,details on 10.Verified adhesive application. ME following page(s). ❑ YesNo 11,Verified edge distance, ❑ El N/A 12.Verified edge di, non 4.Noncompliance item(s)were reinspected this date,details 13.Verified installation torque. 11111111 on following page(s). ❑ Yes ❑ No El N/A 111111111n 0 Conform ❑Remain in progress Evaluation report number&date: 2508 (JULY 2016 Report(s)findings were discussed and left with TOM of POLYGON NORTHWEST CO — Name of product being installed S IMPSON SET XP "-------- Batch Number 095Z146Z_ 155z 3782 Expiration Date 4L2Q1.8 5120lg Based on the Code,approval is required from the Building 'be covered.Carlson Testing has no authority to direct workof Official or subcEont SPECrs. IAL items noted above can ❑ See additional report page(s). ❑Distribute attachments. Page 1 of 2_ Daily Report of Proprietary Anchors CTI Job#: T1605921.C0 For: 06/30/2017 Project: POLYGON - NW RIVER TERRACE AREA 1 -------- - LOT 113 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, without prior authorization from this office.Under all circumstances,the information contained in this report is provided subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared.No'partyexcept infi than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this document. If there are any further questions regarding this matter,please do not hesitate to contact this office. Respectfully submitted, CAR.LSaOuNvin bSTING,INC. Project Manager Reviewed By:Project Manager /BB Review Date: 07/10/2017 CC: POLYGON NORTHWEST CO - CHRIS WALTHER CITY OF TIGARD BUILDING DIVISION - WALTER 'CHIP CNRA5.CL ONL RfOPOLYGONHOMES,COm BARNETT FINA/NCL ONLY CT ENGINEERING - TODD EATON MILBRANDT ARCHITECTS - RICK TOLLE5HAUG TEATONLCTENGINEERING.COM NORTHWEST EARTH) ,/ER5 INC (NEI) - JEFF DICKSON ,DICKILN NWEARRCH.COM 7DICKSONQNWEARTHMOyERS.COOA CITY OP TIGARD ENGINEERING DEPT - MIRE WHITE MIKEWC@7IGARp-OR.GOV 8430 SW HUNZIKER ST,TIGARD OR-PO BOX 230997,TIGARD OR 97281 Page 2 of 2