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Miscellaneous Field Test & Inspection Report 2013-10-3 (2)
Bend Office . (541)330-9155 • Ceotechnical Office (503)601-8250 ' -- Eugene Office (541)345-0289 Carlson Testing, Inc. Salem Office (503)589-1252 Tigard Office (503)684-3460 ' • Daily Report of Proprietary Anchors • • Project: Zu/LLB ,4j.A i-- /0= vi . iOY. GDLea : -. Address: & ittowitzfurD/J 1<'LJ -Skti.4...'r_"n-%t(/);(Oc. CTI Job#: 6J'7)/1-56-7 • CTI representative YL��E r c# ,/y •was on site this:date 1 U�JI/2- to perform - (Inspector Name&Cert.No.) Special Inspection for ❑ permit ❑ DFS#(s) • /! ✓1 zZO/�3 — (�))I jurisdiction,'Cf'k'�L`�(�t+�Z�J • 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 o�r/client representative. .. .. ,r;r,`ge,«) r.•f-c i:6-2 n%r /r r'' 6:� =;- %i . Name: 4) %1,.- / /. 1 t i s/--1”t/i f/q Inc; Fx •.v A:.fi'.. )• Company r/" 1'//is; jr /JC ( o ii is (71.) !/JO ti.. < RI ) -P r '7,' / 4:17,1/ '—u' ) : 2.Inspection was IBC .- p Continuous 0 Periodic - , ` �. ._ kr' ; 5714 ii r'e-U , AJO;I/T, n.1< y!° per-/I_) . PROPRIETARY ANCHORS Yes NoN/A. 1.Reviewed previous inspection reports? t �/' - . . 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 . 2.•Completed work inspected Zw.as was not anchors. • V/ LI ❑ 4.Verified installation of the anchors. in compliance with -) 5.Verified anchor diameter. ✓ �Apprbved plans and specifications Shop drawings 6.Verified steel grade.. ✓ ❑ RFI ❑ Design change ❑ Submittal ❑ N/A • • 7.Verified hole.diameter. 5i<--I 5 K" ~ �./ • Document#(s) / >?' Dated: yP!�� in 8.Verified type of diill`bit used. - ✓ 3.Noncompliance item(s)were noted this date,details on 9.Verified hole cleaning method. I./ following page(s). ❑ Yes ❑ No ©'N/A - •- -10.-Verified adhesive application:- V 11.Verified edge distance. `,,i • 4.Noncompliance item(s)were reinspected this date, details 12.Verified spacing. V' on following page(s). ❑ Yes ❑ No EN/A 13. Verified installation torque.f../;J /<< , V n.Conform ❑ Remain in progress - Evaluation report number&date: / SC Report(s)findings were discussed and left with t/GS /"/ 17 - rr'i ctd-iS/T of Name of product being installed HL i/ K/' °-r A itZ 1-`414 1-- Batch Number-` 5 - • Expiration-Date---—• .1 • - Based-on-the-Code;approval is required f om the Building Official before the SPECIAL INSPECTED items noted above can be • . covered. Carlson Testing has no aut' jri ,tg',direct w rk of-cc'7o�' 'actors or subcontractors. ---- Inspector Signature: -_- - . 1 -/�' �' ��' iN_� s • - ' / I -See audiuuimi-icpolt page(,): - - • - n Dishiuuic attaciunents. rage •-- of r/ - • PropAnchors Ver.1 2/12/2009