Report (71) • Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Eugene Office (541)345-0289
Inc. Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: P0t144'4" rvL,/ 40;t,"0,. 7.ei.4is e;p ,4e t1 1e7- lL/
Address: if~7 y 7 Sr., P46rsr. 7 Ham,//"es' .S'7? 72(-1,-4/ CTT Job#: / .
CTI representative ,C P1.+► ,•Lh► ...57 '1/97 was on site this date e--/4-il 7 to perform
-"01 Inspector Name&Cert No.)
Special Inspection for .permit El DFS#(s) /*1 S'?"..v 17 — 0 0/4 jurisdiction ore,
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. T/ i e.,,s O A S:,..e , gi sj a,/7.4' 7;7.1* 11,1,4Name: (a les' TlJ e A, c e_&-ti 1,-,elc.. c.. t...,,'y A Pr-'.,.,--,-
Company:
'-,4.
Company: p../y n ;4t% 11 CO.4d''f 74-04 4,61.1.41"eel .44 e X ae.- 4,172
2.Inspection was"IBC" 0 Continuous eriodic ?.gyp/{,(.,/e.�.�`''.l"
" .Q,, ' P44,.,—'r '14�'i'ii -5"1-7->""-{a},s
+++��••��� 7 O .+r a Ito* /d!ail 4/ t/ele/def M.sr ea"7' 4/4...g-7 S/d a G'f#�
4�.,* alierfreff.0.. .410,;61 lav / "�" r1"11,�, ,--
PROPRIETARY ANCHORS Pe ''7`. ; ,•,,q,..,% 'oR ...r.--/C.--/4,
Yes NoN/A P.,,,,.,.4-u, .P..�r,-,a.y f 4/ y fr1 .4'.)."-e
1.Reviewed previous inspection reports? 1 vt /I.r ha r :A C' "-,' "p'"7'!t e,1`y ,.;r.r rr Al p e r.. 4,4.0,d;7,
2.Reviewed evaluation report?
REPORT SUMMARY
..:-verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: Completed ❑In progress
3.Verified minimum embedment depth of the `
anchors. t,2.Completed work inspected vas El was.not
4.Verified installation of the anchors. in compliance with
❑ Approved plans and specifications ❑ Shop drawings
5.Verified anchor diameter.
RFI Designchange ubmittal N/A
6.Verified steel grade. ,/ 0 ❑ g � ❑
7.Verified hole diameter. e/ Document#(s) SpA Dated: r=/S /5.'
8.Verified type of drill bit used. t/ 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. ✓ following page(s). ❑ YesTo ❑ N/A
10.Verified adhesive application. ii
11.Verified edge distance. I 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. ✓ on following page(s). ❑ Yes ❑ No 2/N/A
13.Verified installation-torque. 1," ❑ Conform ❑ Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
..5 P e?.c-i,g e)?f 201? I ./.../a".,./.,7 p me Ta fi t
/ / of ��e0A
Name of product being installed .SST Y P riel ex y
13atch Number Dy?e 09 2 C •
Expiration Date p-13-/7
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: ..?+r /gr,f:-17
❑ See additional report page(s). ❑ Distribute attachments. Page _of _. .-
PronAnchors Ver.1 2/12/2009