Special inspection report.pdfj3LD 20 ti % 39� OTTO ROSENAU & ASSOCIATES, INC.
PROPRIETARY ANCHOR ADHESIVE INSPECTION REPORT 365387
Job Number:
Permit Number:
Project:
Client:
Address: •, -;
Contractor:
Inspector:
Date:
DESCRIPTION/LOCATION
Intended Use: 17—
Building Code &Year:
❑ Reinforcing Steel
D All Thread
Bar/Dowel Size & Quantity:
Anchor Size & Quantity:
Rebar Manufacturer:
Type of Steel (ASTM): ❑ A-36 ❑ F-1554 ❑ A-307
Grade: ❑ 36 ❑ 50 ❑ 75 ❑ Other:
Rebar Grade: ❑ 40 ❑ 60 ❑ Other:
Type of Bar: ❑ A-615 ❑ A-706
❑ A-775 ❑ Other:
Special Ductile Quality (SDQ):
❑ Yes ❑ No
Anchor Length:
Hole Depth:
Required Embedment:
Hole Diameter:
Concrete Thickness:
Concrete Strength:,
Hole Orientation: ❑Vertical Down
❑ Vertical Up ❑ Horizontal
Base Material: ❑ Normal Weight Concrete ❑ Light Weight Concrete ❑ CMU ❑ Brick ❑ Composite Deck
Hole Cleaning: ❑ Compressed Air
❑ Hand Pump ❑ Other:
Compressed Air PSI:
Brushed: ❑.Yes ❑ No
Hole Condition: ❑ Dry ❑ Damp ❑ Water Saturated ❑ Submerged
Drill Bit (ANSI 13212.15): ❑ Yes
❑ No
Approved Diamond Cored Hole: ❑`Yes ❑ No
Adhesive Manufacturer/Type: '-
Expiration Date:
ICC ESR #:
Weather.
Ambient Temperature:
Substrate Temperature: ; j
Comments
Reference Standard(s) Used:
Conforms
Does Not Conform
Is this a re -inspection? ❑ No
Inspected by:
Start Time:
❑ Yes - Original inspection date:
Finish Time:
Reviewed by:
This report applies only to the items tested or reported and is the exclusive property of Otto Rosenau & Associates, Inc. Reproduction of this report,
except in full, without written permission from our firm is strictly prohibited.
Page _ of
6747 M.L. King Way S., Seattle, Washington 98118 - Phone (206) 725-4600 or 1-888-OTTO-4-US - Fax (206) 723-2221
Form No.: INSP-86-02 (Rev 05113)