Report (74) 4/15 `
Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson TestiEugene Office (541)345-0289
ng, Inc. Salem office (so3>ss9-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: t''. ?'
/44;7-5- �' /d '_' !.'' - o :
Address: ! j. CTI Job# 4:
CTI representative +C '� `'-' `�" > >{ +' i f- ,
was on site this date ! 3-- `-? to perform
(Inspector Name&Cert.No.)
Special Inspection for Ei permit E DFS#(s)
S = _f jurisdiction i C r
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. .. f r t :- '
Name: ! 3
Company: <<.� /
#: • {
2.Inspection was"IBC" D Continuous El Periodic
PROPRIETARY ANCHORS
Yes NoN/A
1.Reviewed previous inspection reports?
2.Reviewed evaluation report? REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected wast Completed [] In progress
3.Verified minimum embedment depth of the 2.Completed work inspected ®was 0 was not
anchors.
4.Verified installation of the anchors. j r' in compliance with
5.Verified anchor diameter.
0'Approved plans and specifications ❑ Shop drawings
0 RFI Design change Submittal ID N/A
.Verified steel grade. '-;"
7.Verified hole diameter. Document#(s) + Dated: ,
8.Verified type of drill bit used. 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. a' following page(s). E Yes [] No N/A
10.Verified adhesive application. ./'
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. f,. on following page(s). El Yes M No El N/A
13.Verified installation torque. El Conform [] Remain in progress
Evaluation rePort number&date: Report(s)findings were discussed and left with
11
of c-• ct
Name of product being installed •`+ ' ' { -
70
I , I' r
Batch Number ! LExpiration Date ` ?I c.i
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,authorityto dire. work of factors or subcontractors.
Inspector Signature: [`� z",• �
Ei See additional report page(s). 1 Distribute attachments. Page 1 of 1
PropAnchors Ver.1 2/12/2009
Terms:
Client recognizes that construction observation and,or testing services provided by (-11 are techniques
which may reduce the risk of construction defects, deficiencies, or omissions arisin.j.), during or after con-
struction. Services performed by CII do not constitute a warranty or guarantee of'any type. Even with
diligent construction monitoring and/or testing by CTI, construction defects, deficiencies, or omissions
in the Contractor's work may exist. In all cases. Client and/or the Contractor shall assign the Contractor
the responsibility for the quality and completeness of the work and for adhering to plans and specifica-
tions. CTI's work or failure to perform same shall no in any way excuse any contractor, subcontractor,
or supplier from performance of its work in accordance with the contract documents,
CII will provide its professional services to Client with that degree of care and skill ordinarily exercised
under similar circumstances by members of its profession. This representation is in lieu of other warran-
t), or representation, either expressed or implied. It is also understood and agreed that statements made
in CTI reports are observations based on technical judgements. and should not he construed to he con-
clusive representations of fact. If conditions different from what are indicated in the reports come to
Client's attention alter receipt of the reports, it is recommended that Client contact CII immediately to
authorize further appropriate evaluation.
CLI's work shall not include determining, supervising or implementing the ineallS, methods, techniques.
sequences, or procedures of construction. CTI shall not be responsible for c\aluating or reportnig,job con-
ditions related to health. safety or welfare.
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