Report (25) Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Inc.
sE au!emn e0Of fif fic:e (541)345-0289
(503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
,...
Project: s—
,,,,-4,,
::7 I
Address: / -;',91 ,s-ii, ••••.-_," CTI Job#:
, --I
CTI representative ' - "'-li--./ ((%,-,--e---' -<---/ e".2/,'.7. was on site this date 3---•,S,-1---/A` to perform
spector Name&Cert.No.)
Special Inspection for 12'permit 1:1 DFS#(s) A'47.2ev ----->4' jurisdiction7/r^et 1--Si
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]:
• ei e
1.Checked in with superintendent or client representative. L-- 7/ i„,,,,,,,,, ,.....4,,, .z--,,..,.,% ..,.. ( _ ....„/ie,,.,„, , . -
Name: ( .-, .
Company: ,2:h,:,,,,.,,,,,,,,
/..-1 •-_ (s; ; '5,,.,„-,•,,,,„,,-,- •..„.
2.Inspection was"IBC" Continuous aPeriodic / 'C, 7 'i•.-,-••.----•,—•eft,cl,l../., ,4k
gr
7", .--,,*..-if,e...."IA s- i.-1 :
ro.7 7,;".0.„.., <-,, --,
-+. f
PROPRIETARY ANCHORS , / - -
Yes No N/A
1.Reviewed previous inspection reports? I I
2.Reviewed evaluation report?
REPORT SUMMARY
Verified following items meet manufacturer's
-...:- published installation instructions.
1.Work inspected was: aCompleted 0 In progress
3.Verified minimum embedment depth of the
2.Completed work inspected I2-was 0 was not
anchors.
/...,
4.VerifiedNistallation of the anchors, in compliance with
5.Verified anchor diameter. El-Approved plans and specifications 0 Shop drawings
6.Verified steel grade. k•-• El RFI El Design change 0 Submittal 0 N/A
17
7.Verified hole diameter.
,-
Document#(s) ?/..,„-i_5. Dated: i _,/e- -ii•I`
8.Verified type of drill bit used. .,." 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. .,/
1.." following page(s). D Yes ID.-No El N/A
10.Verified adhesive application.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. 7on following page(s). ID Yes El No
13.Verified installation torque. 7 n Conform El Remain in progress
Evaluation report number&date: Report(s)findings were discussed and left with
:' -7,,,,c;! 0;,//)eyS
01, ,1
i
Name of product being installed ,c;1:-/- KP ,--,,,
Batch Number
Expiration Date
Date
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: .,...-:-- , i--,/-- ,c,--
0 See additional report page(s). ID Distribute attachments. Page / of i
PropAnchors Ver.] 2/12/2009
Tern-is:
Client recogni/es that construction observation and/or testing, services provided by CT! arc techniques
which may reduce the risk of construction defects. deficiencies. or ()missions arising during or after con-
struction. Set'Vices performed by CFI do not constitute a warranty or guarantee of any type, hven with
diligent construction monitoring and/or testing by CFI.; construction defects,'deficiencies, or omissions
in the Contractor's work may exist. In all cases. Client and:or the Contractor shalt assign the Contractor
the responsibility for the quality and completeness of the work and for adhering 10 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.
CTI will prow',de its professional ser\-ices to Client with that degree of care and skill ordinarilv exercised
under similar circumstances 1w members of its profession, [his representation is in lieu of other warran-
ty or representation, either expressed or iitylied. It is also understood and agreed that statements made
in CH reports are observations based on technical judgements, and should not be construed to be con-
clusive representations of fact. It-conditions different from what are indicated in the reports come to
Client's attention other receipt of the reports, it is recommended that Client contact CT! immediately to
authorize further appropriate evaluation.
C.:TVs work shall not include determining, supervising or implementing the means, methods, techniques,
sequences.or procedures of construction. CTI shall not be responsible for evaluating or reporting job con-
ditions related to health. safety or weltlire,