HomeMy WebLinkAboutPermit Field Test & Inspection Report 2004-12-3
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1040-A Shelley Street
Spnngfleld, Oregon
Hours
Hours 0 T
Miles
XNew Inspection
- Re-lnspectlon
Standby Time
ZOl
L( 2-Y"l d S+
CLIENT
DATE \?-- O".;l-Ot..f
WEATHER FOfJ/
I (I)(),
_ 1./"
~ Performed continuous inspection dUring the installatIon of "--' "'I ( r r _
o #4 0 #5 0 other epoxied rebar dowels In the following locations -1
o 1/2" 0 5/8" 0 3/4" jEt other5' II all thread epocy anchored bolts In the
/8, followIng Ipcatlons
SPECIFIC PLACEMENT LOCATION(S)
EPOXY ANCHOR INSPECTION~S~VICES
( " 1'\'
PROJE~J._:el:(i6~;+O Mm\30~
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REPORT NO 722- Lt 0 '3 '=?> 0 --~
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'J!J Pnor to installation the prednlled holes were cleaned uSing a
18 nylon brush c( compressed air
o other
o vacuum
\(!i Venfled minimum embeddment depth of \ri.. Inches
.~ The above listed epoxy anchors were Installed uSing S'~<lll'l So-\o1PtJ/\ '"1 \~ E.,....1.~epoxy with ICBO#
J@ Contractor stated the nuts would be tightened after the ~pbxy ~as cured
''gj The epoxy anchors were Installed In accordance WItt; ~ 1.- S - .
o approved Job-site plans ~ specifications ~.... 0 latest revIsions dated
00 manufacturer's directions 0 other
o Additional Comments
01, Contractor was asked to notify our office when additional services are needed
~ To the best of our knowledge, the work Inspected above was In accordance with the bUllg!ng department approved deSign
draWings, specifications and applicable workmansl1lp provIsions of the Uniform BUilding Code except as noted
, Non-Compliance
'llspector (print)
\(0\0 UL.Aw+;~
Inspector Signature /J'tt- ~LJ
I v
o ReqUires Engineers Acceptance (RF/)
ICBO#
<a8 3J. 3 L..l-~ I
Jobslte Representative Signature
o ReJnspectlon ReqUired
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