Report (31) ilA ST2D17— boaca-
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Inc. Eugene Office
Salem Office (541)345-0289
(503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: 7c. .',a re'/,..s,, ,r,r .e
Address: it')>5 _;% 5 74/ Ale , 7'11 72 1 r'7, y CTI Job#• 77Ze) a>
CTI representative - „ .r�"f ^ 'tl.-�/� 1 e)•";4/9 7 was on site this date rg'-•2 /,� to perform
(tFrspector Name&Cert.No.)
❑ #(s) ') jurisdiction _f%( .
Special Inspection for ermit DFS �`' �"� � �"• *.� .
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.
L-
,
Name: t s.� !/I c C, •. ,4s x r 14.--i 6, Al r, ‹).4...,�el'',
Company: '_:,,.;. r. xF, x : 7,''to/ it . £ ..1 ,r,<-,,,,,,, /- y,r'^`,.1 - ✓�-
.,1,,,',orF4OP, f.,r'C „t74a.:0.',,rx-+c,! rr,ei P, .r 'r:.'Y+ l [ ,.c.....i
2.Inspection was"IBC” ❑ Continuous A 'eriodic '� --- "P" ^x'/' / ` ' �-> ' f,-;4 y.'4,.r-,..0., j
,:,<�,^> 1:::•".e..,•.,:,tea'7 s'C,s•f Ci 7" //n,.`..n � ,s:'" dr47 -n
PROPRIETARY ANCHORS /A' -r.P /�-0,, .1..>
. ; At .,, ,. ,...•'
.V.-' 4 t9''e---a. Com, A..t,d-
Yes NoN/A G:e,,, ^ra..n ex• P,,- S&r,i:,,,I -"H:•,.,r--,,,-1,,
1.Reviewed previous inspection reports? ir,Aio,,,-r Com.,,, ( ,.7;e,,,, h4h4rawfwy 134.44/p./ 0,I
2.Reviewed evaluation report? ' ✓ r,r>T X / 2)(/, /3 "f /,ar - cVs"V 4-t y-/7
REPORT SUMMARY ,.;
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was: ompleted u In progress
3.Verified minimum embedment depth of the 2.Completed work inspected Lavas ❑ was not
anchors.
4.Verified installation of the anchors. L, in compliance with
5.Verified anchor diameter. " pproved plans and specifications ❑ Shop drawings
6.Verified steel grade. t ❑ RFI ❑Design change ❑ Submittal ❑ N/A
7.Verified hole diameter. t/' Document#(s) P414.3 j Dated: 4---7,-,-../7
8.Verified type of drill bit used. V 3.Noncompliance item(s)were noted this date details on
9.Verified hole cleaning method. r/ following page(s). ElYestfc�`""1"' ❑ N/A }
10.Verified adhesive application.
11.Verified edge distance. 4.Noncompliance itei (s)were reinspected this date,details
L.12.Verified spacing. Von following page(s). ❑ Yes ElNo
13.Verified installation torque. tr'' ❑ Conform ❑ Remain in progress
Evaluation reporti number&date:f r
Report(s)findings were discussed and left with
<.
of ''''':\'''')'
° :� -r.�-_
Name of product being installed )/. '�-jr-'.." _, , 9,,2.
Batch Number 3)`9Z, gO .. /
Expiration Date tom'-'.4 :•`y'2
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: ,Le).....- tom.:/-i, a,A,'. '7
❑ See additional report page(s). Distribute attachments.
❑ Page_i____of
PropAnchors Ver.i 2/12/2009
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