HomeMy WebLinkAboutPermit Field Test & Inspection Report 2008-5-29
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Carlson Testing,
Bend Office
POBox 7918
Bend, Oregon 97708
Phone (541) 330-9155
Fax (541) 330-9163
Salem Office
4060 Hudson Ave, NE
Salem, Oregon 97301
Phone (503) 589-1252
Fax (503) 589-1309
Daily Report of Proprietary Anchors
PrOject Que 51 t-\ \J 0{\_ 'B~~\,^Le:- ~
Address. 'If l ~ !IV\. t\. \ V\ "S t "S1>'- j Vl' r I e. l d. } 0 fZ.CTI Job #. J~ Q3DJe&&8
CTI representatIve 131'" IAlAb..,Q'v',\ Vo...V-y \'5 '^- .:tt obo l'\ T 1"-1 was on sIte thIs date.5_-:-21:-PSo perform
(Inspector Name & Cert No)
SpecIal InspectIOn for ~rmlt 0 DFS #(s) CDJV\.Q 008./ 005 4f 8 _ JunsdlctlOn Spr I Y\<S~.. el&
SCOPE OF INSPECTION
In some cases more than one box may be checked for a given Item
LocatIOn ofpropnetary anchors mspected [to mclude gnd
lmes, elevatIOns (floors) and drawmg detaIls]
~::eked wt~(~n~dent or chent representatIve (;J OJ .~ "Itt- I A ~( I.t 0 r '5 ~ U1 b.€ h~ @ ~! ~ #-'11-0
Company rb(D~lAM{) lC\..l1\J.er t'/.lyu:..Y'flG=-E koo-l1or P, l~/c 5{-JtjlA..o..s~
r lJ 26) :::;(g X '3 A ~ l /'tct/ f e Mh"'" dRd Ci? J} Yz
2 InspectIOn was "IBC" [g'Contmuous 0 Penodlc ;f/lfb ~"Ic-,.,.c::-ie 1<001 f}" (!o,eb5 hr-
3 Workperformed ~nthefield DAtprecastshop J41-e{..IA~""/~L UVlt I)' ~dt("~V1 L<4S<""I-r-r;;
Sho name -e- ,P4/ I I-It) I-t' 'j 14 rt: C le""s-? ~ f-t..e ,P"'Op?r
p fvvY9t:/C hCt5 b-.pe''? ~vf.)j, t'c1 10 A-/(
4 If shop mspectIon do they have fabncatIon and QC :14-I.A C tt.Q I" '5 *' = eJ.::J {Plk j J ~2 = .y' 0 7-( Ib j_
procedures? 0 Yes 0 No ~N/A.4/1 Wdt/<... CIlH fpYJ"/5 fz:, 5?PI<.eY5 ~ U/,,?t).--/- ,/'r--t/I.!/r.rJ4
-h> f--<-e 1.o...e5+ ().f JM-'f ~U()W/-r"t/~- (
PROPRIETORY ANCHORS 'REPORT SUMMARY
Yes NoN/A/
v 1 Work mspected was ~mpleted
2 Co~pleted work mspected ~
m comphance wIth
[9"Approved plans and specIficatIons 0 Shop drawmgs
o RFI 0 Des~ change 0 SubmIttal C,;LN/~ (_
Document #(s) b; I Dated ,.- "-' ';:'>....... (:,)
ReVIewed prevIOus mspectlOn reports?
2 ReVIewed evaluatIOn report?
3 Venfied manufacturer's anchor use conforms
to acceptance cntena m report summary
",/
v
V enfied followmg Items meet manufacturer's
pubhshed mstallatlOn mstructlOns
4 Venfied mlmmum embedment depth of the
anchors
5 Venfied mstallatlOn of the anchors
6 Venfied anchor dIameter
7 Venfied steel grade
8 Venfied hole dIameter
I 9 Venfied type of dnll bIt used
10 Venfied cleanhness of hole and anchor
II Venfied adheSIve applIcatIOn
/
.,;
"'....
,
v
v'
r'
/
I'" /
IV
I
EvaluatIOn report number E: '5 K \ g , -=t-
Name of product bemg mstalled 1,1 t t 1- i V\~bn..
Batch Number
.-b .
--er--
ExpIratIon Date
o In progress
o was not
3 Noncomphance Item(s) were noted thIS date, det~
followmg page(s) 0 Yes 0 No L.J N/A
4 Noncomphance Item(s) were remspected thIS date, d~
on followmg page(s) 0 Yes 0 No L.:.I N/A
o Conform 0 Remam m progress
--'
V Report(s) findmgs were dIscussed and left with
<5=A~
of
Based on the Code, approval IS reqUIred from the BUlldm OffiCIal before the SPECIAL INSPECTED Items noted above can be
covered Carlson TestlIl,g..b"~ 90 authotp'Yjo dIrect contractors or subcontractors
Inspector SIgnature ~ ~ _ ~- I I
o See addItIonal report page(s) " ~tnbute attachments Page _of L_
Pro pAnch 05/02/06