Report (32) max .
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Bend Office (541)330-9155
Geotechnical Office (503)601-8250
Carlson Testing, Inc. Eugene Office (541)345-0289
Salem Office (503)589-1252
Tigard Office (503)684-3460
Daily Report of Proprietary Anchors
Project: 4'/
Address: 7 -C WA' - -1:x.Q / CTI Job#: 7`/70.2.2÷#7..8f`
CTI representative e.C3 9 y was on site this dateto perform
(Inspector Name&Cert.No.)
Special Inspection for El permit El DFS#(s) /7$ 7 —.04).2 cy/ .er
jurisdiction 7! _
•
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. 7, tem; e„ c'; ,0, ,41,,r tv, yh',gi yet'
Name:
Company: (/J 'g" -- �rC 7‘e- -.
2.Inspection was"IBC" Continuous Periodic "'Ode'," �1/✓r-ri cA/y rr+7o l-oaer*.7+ rf} r>aY.e�
41, 7� 4"-'fr ,yiwiwrc-at .44f.eir7' 4,4£J
PROPRIETARY ANCHORS p/aH As ra.V/.Y
Yes No N/A ,r rev,
1.Reviewed previous inspection reports?
2.Reviewed evaluation report? REPORT SUMMARY
Verified following items meet manufacturer's
published installation instructions. 1.Work inspected was:
P I=1 Completed El In progress
3.Verified minimum embedment depth of the 2.Completed work inspected E was Ei was not
anchors.
4.Verified installation of the anchors. in compliance with
5.Verified anchor diameter. Q Approved plans and specifications El Shop drawings
6.Verified steel grade. fl RFI El Design change Submittal El N/A
7.Verified hole diameter. Document#(s) Dated: 7.% J.r
8.Verified type of drill bit used. 3.Noncompliance item(s)were noted this date,details on
9.Verified hole cleaning method. following page(s). J Yes El No 0 N/A
10. Verified adhesive application.
11.Verified edge distance. 4.Noncompliance item(s)were reinspected this date,details
12.Verified spacing. on following page(s). ❑ Yes Ei No N/A
13.Verified installation torque. Conform ❑ Remain in progress
wormsompionok
Evaluation report number&date: Report(s)findings were discussed and left with
5 {� r/Vit..e)/
of ,20.47..e..�7
Name of product being installed 4' 7—X, -effe xry
Batch Number /0 ra(06 /g'/f.
Expiration Date "://)./pp
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:
ElSee additional report page(s). 0 Distribute attachments. Page of 1
PropAnchors Ver.l 2/12/2009
Terms:
Client recognizes that construction observation and/or testinyu services provided by C"Tf are techniques
which may reduce the risk of construction defects, deficiencies, or omissions arising during or after con-
struction. Services performed by CTI do not constitute a warranty or guarantee of any type. Even with
diluent construction monitoring and'or testing; by ('Ti. 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 acid for adiliering to plans and specifica-
tions. CFI's work or failure to perform sante shill no in a \vav excuse any contractor, subcontractor.
or supplier from performance of its work in accordance with the contract documents.
CTI 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-
ty
arran-ty or representation, either expressed or implied. It is also understood and agreed that statements made
in ('Ti reports are observations based on technical judgements, and should not be cotyst recd to be con-
clusive representations of fact. If conditions different from what are indicated in the reports come to
latents attention alter receipt of the reports, it is recommended that Client contact CTI immediately to -,
authorize further appropriate evaluation_
CT.I's work shall not include determining, super i ng or implementing the means, methods, techniques,
sequences, or procedures of constructio1. CTI shall not be responsible for evaluating or reporting job con-
ditions related to health, safety or weltbre.